Question:
We are at our wits end. Does anyone out there know anything on how to
deal with a bipolar child. He's 9. The problems started when he was 3
1/2. We've been to so many doctors, psychs, counselors. He's been on
more meds than I can honestly remember. Now he's on Depakote, and
Anafranil, been on for a while. But it just doesn't seem to be doing
the trick. The doctor is taking him off of Depakote and trying
Neurontin. He says if this doesn't work, he'll try adding Tenex (a high
blood pressure pill) which is supposed to calm him down long enough to
prevent the rages from happening. Put it this way the doctor's at a
loss himself. Now he's talking about putting my 9 year old child in a
hospital for a couple of weeks to be evaluated. Now imagine putting
your child in a psych ward. SCARY!! Does anyone out there have any
kind of similar experience?
Answer:
Due to Neurontin's extremely short half life, it should be taken in equal
amounts every 6 hours. I have included a suggested dosage titration protocol for
adult outpatients. I would suggest increasing the intervals between dosage
increases for a 9 year old by a factor of 2-3. If a 100 mg capsule seems to be
too strong, you could remove the contents and dissolve them in Cool Aid. Since
gabapentin is very bitter, you could compensate for the taste with added sugar.
Neurontin exhibits antidepressant effects in approximately 25% of adults with
bipolar disorder so care should be used when titrating the dosage of Neurontin. I am aware of Neurontin being used with children as young as 4. It is not as rare as you might think. Before hospitalization I have several
other medical alternatives that you and your psychiatrist might wish to
consider. Here are a wealth of resources for support and differential diagnoses between
BP, ADD, and ADHD -- which have similar characteristics in younger children.
A good overall reference on ADD and ADHD in children:
http://www.adhdnews.com
Diagnosing Bipolar Versus ADHD in Children:
http://www.adhdnews.com/bipolar.htm
Hit Adolescent Bipolar Illness Early and Hard:
http://www.medscape.com/IMNG/ClinPsychNews/1997/v25.n12/cpn2512.19.01...
Bipolar Disorders (296) Vs. Attention Deficit Disorders (314):
http://www.addclinic.com/296.html
The American Academy of Child & Adolescent Psychiatry:
http://www.aacap.org/web/aacap
If the following site were ever to be completed, it shows promise.
The World Wide Handbook on Child and Youth Psychiatry:
http://web.inter.nl.net/hcc/T.Compernolle/contents.htm
The following site has a wealth of links dealing with mental health
issues of children:
http://members.aol.com/DrgnKpr1/BPCAT.html
Please note that you will not find universal agreement among the various
sites. For example I do NOT advocate the use of ECT until after ALL
pharmaceutical options have been exhausted. Nor will you find agreement
from one pediatric mental specialist to another. It would appear that
there are few known hard and fast rules that apply to every child. The
human brain is far too individualistic for that to occur IMO.
Although the following article does not specifically deal with issues
pertaining to juvenile BP disorder, it does give an informative overview
of the diagnosis and treatment process. IMO its most glaring deficiency
is that it does not mention the newer mood stabilizers (such as
Neurontin) that are being used so successfully with some children and
adults.
Wish I could get my sister to admit my nephew is probably BP. They're having him
evaluated, but the BP diagnosis can often be missed, and I'm wondering if anyone
will even think to check for it. I don't know who's going to "evaluate" him, but I
wish I knew if they were qualified to make a diagnosis for BP. I've offered to give her material to read, but she's completely closed off. Maybe
if we got along she might be more open, but no chance.
Is there even the remotest of possibilities that when he's being evaluated for a
ADHD disorder, that they will check him for BP also?
I am not a parent myself, but
folks like you come by from time to time so I've archived a couple of links
specifically for parents of children diagnosed with bipolar disorder. This professionally-researched website has an excellent collection of links
that will keep you busy for a while...
http://bipolar.miningco.com/msub10.htm
And here is a website with more personal stories, that a parent put together....
http://hometown.aol.com/DrgnKpr1/BPCAT.html
I am Not a doctore, but I would sure have him checked for alergies !!!!!!!!
There a so many kids out there that have horried alergies and no one checks
for that first.... check for OCD and panic disorders...... I do pray you
find answers.
