ADHD

ADHD:   

Ritalin, Adderall, Concerta and Metadate are stimulants which help your child to ignore distractions and focus on their studies. Side effects include decreased appetite, headaches, increase TICs, agitation and insomnia.

Strattera is effective in some children and used when stimulants are ineffective or cause side effects. It, too, can cause agitation.

Clonidine and Tenex at times increase effectiveness of stimulants. Side effects include decreased blood pressure and pulse. Intunive which is the long acting form of Tenex, seems to be effective by itself, or as an addition, for some ADHD types.

Bipolar Disorders

As mentioned in the blog on diagnosis, other doctors may not agree with my recommendations, but here they are:

• I avoid stimulant medications (used for treating ADHD) and antidepressants in bipolar disorders. They usually do not work in these conditions and often agitate such patients, increasing their tantrums, aggression, and psychotic symptoms.
• In out patient setting, when the symptoms are not severe, I assess the effectiveness of medications slowly and over a period of few weeks. In the hospital though, I have to act fast, trying to calm down a highly agitated patient and to discharge them from the confine of a hospital as soon as possible.
• In the acute cases, I am more liberal in use of antipsychotics in general and zyprexa in particular. I feel urgency in improving the mood and behavior of highly agitated children, to stabilize them and discharge them to their home ad normal life quickly.

Treatment of various mood disorders are primarily with mood stabilizing medication. they are divided in 3 groups:

• Lithium Carbonate: is very effective in classic Bipolar I disorders (used to be called Manic Depressive Disorder). It however is not as effective in Bipolar II disorders and other types of mood instability.

• Anti seizure medications:

Depakote, Lamictal, Trileptal, Topamax …etc.

I have found Lamictal to be the most effective among these. It seems to be the only one with also an antidepressant effect, while it does not cause agitation as antidepressants do. It has a potentially dangerous side effect (Steven-Johnson Syndrome), which is very rare (about one in 100,000). To prevent such a side effect, it has to start at a very small dose of 25 mg and increased only 25 mg at a time every 2 weeks. It will take up to 2 months to reach a therapeutic dose of 200 mg.Abilify, Geodone, Haldol, Invega, Risperidone, Seroquel, and Zyprexa.

• Anti psychotic medications are the most effective among these 3 groups, though they also have higher risk of long-term side effects. They include:

Abilify, Geodone, Haldol, Invega, Risperidone, Seroquel, Zyprexa…

There is a general concern about one particular side effect of these medications: increase in appetite, weight and risk of developing diabetes. Only Geodone does not cause this side effect. the therapeutic effect of these medication, however, seem to be associated with this side effect! The more effective ones such as Risperidone and Zyprexa cause it the most. Geodone on the other hand is the least effective! (The effectiveness in psychotic condition however is quite different, with Geodon being as effective as others).

I however use Zyprexa often for the acute conditions that leads to hospitalization. It does not cause this side effect in some patients. It is the most effective and quite rapid. This will stabilize the Patient and the acute crisis, allowing time for the Patient, the family and the physician to assess effects, side effects and whether it should be changed to another medication. It should be stopped as soon as an increase in appetite is noted. The insatiable appetite is very hard or impossible to control.

Lithium

Lithium (Lithobid, Eskalith, Lithonate, Lithotabs)

IMPORTANT NOTE: This is a summary and does not contain all possible facts. For complete information about these product ask your health care professional. This information is also for use in children. Adult patients may have medical conditions or be taking medications that will require additional precautions.

General information

Psychiatric medications are used to treat certain brain conditions (such as mood conditions, thought disorders like schizophrenia, or ADHD). They work by helping to restore the balance of certain natural chemicals in the brain.

The dosage is based on your medical condition and response to therapy. Take these medications as directed, even if you are feeling better and thinking more clearly. Do not make any changes without consulting with your doctor.

You should familiarize yourself with the side effects but do not allow them to scare you. In most cases they are mild & temporary. The serious side effects are very rare. Remember that the benefit of treating your child’s medical condition is far greater than the risk of side effects or leaving it untreated.

Minor or moderate side effects usually go away by themselves or by reducing the dosage. You should however stop taking the medication if you notice serious side effects and report them to your doctor right away.

Lithium is used to treat mood disorders (Bipolar conditions).

WARNING:

Lithium is very safe in most people when you have the right amount of lithium in your body. Too much of it however, can be toxic & cause serious medical problems such as seizures, requiring immediate hospitalization. The difference between the correct amount of lithium and too much, is small. Therefore, it is important that your blood level be checked regularly.

Fortunately, lithium’s blood level remains stable almost always if you do not take extra dose, don’t get dehydrated, do not have a kidney problem, and are not on a low salt diet.

Also before it reaches a toxic level, it gives you warning signs such as nausea, diarrhea, shaking of the hands, slurred speech and wobbly gate. You should stop it right away and call your doctor if you have any of these symptoms.

HOW TO USE:
Take with food or milk or immediately after meals to prevent stomach upset. Drink 8-12 glasses of water or other fluid each day and maintain a regular diet while taking this medication. Do not change the amount of salt in your diet.

SIDE EFFECTS:
Mild or temporary side effects: tiredness, increased thirst, increased frequency of urination, and mild trembling of the hands.

Weight gain or severe tiredness or tremor, and skin rash may need discontinuation of the medicine.

In some patients, lithium slows down thyroid gland. Again your doctor should order thyroid studies at the start of lithium and then periodically. If hypothyroidism occurs, lithium should be discontinued. In select cases, when lithium is the only medication that is effective for your mood disorder, the doctor may decide to continue it but supplement your thyroid hormone with prescribed hormone such as Synthroid.

OVERDOSE:
If the child accidentally overdoses, go to your emergency room immediately. If he has taken only 1 or 2 extra dose, he probably will be ok, but call your doctor right away to be sure.