[Karen1933]

Well, I don't even know if I should be posting to this particular forum now. In Feb., my 19 yo daughter was diagnosed bipolar and given Abilify.

Long story short, yesterday, through a local mental health agency, she was given a psych evaluation. The pdoc diagnosed her MDD and GAD, with OCD tendencies, and possible panic disorder, and prescribed Lexapro, 10mg.

She had quit the Abilify two weeks after starting it cold turkey, so I'm not concerned about drug mixing. She is also being treated for hypothyroidism and is supposed to take meds for that, but according to the warnings on Lexapro, this combo could be bad. She did tell pdoc her thyroid issue.

I know I'm no expert, but I have to say that I disagree with this MDD and GAD. I have seen her manic and rapid cycle. She stresses easily, has constant thoughts of being dead, etc.

She has an appointment again in two weeks...maybe this is just a start on the path to really finding out what's going on...would appreciate your thoughts, etc., on this.

[sugahorse1]

Lexapro is an anti-depressant - if she is Bipolar, this cannot be taken without a mood stabiliser, as it is likely to push her into mania.

Not sure what MDD is, sorry I cannot help there.

She just needs to be very careful with her meds and watch her moods, and hopefully when she goes back in 2 weeks, the pdoc will have a better overview.

Did you go with her to the evaluation? Are you sure she would have mentioned the previous dx of bipolar? Would she have mentioned the mania episodes?

[mommasuesue]

hi karen sometimes it takes a while for pdocs to figure out what meds to prescribe
it is taking a while for my pdoc to get mine correctly too. i would say to keep in touch with the pdoc if you notice changes in your daughters behavior.
and if you disagree with this pdoc maybe going to a different one couldnt hurt.

[Shakti]

That second diagnosis sounds...really weird to me.

The symptoms can overlap, sure, but this just seems weird. Watch out for the Lexapro, please, very carefully. This is an SSRI. A HUGE no for bipolars. The SSRIs are especially evil in bipolar people. If she is indeed bipolar this could swing her into full mania, a psychotic mixed state, mania with psychosis,and eventually depression and anxiety and panic the likes of which there are no words to describe. At least with abilify it is "designed" for bipolar depression, but still--an anti-dep and no mood stabilizer?? Very odd choice. Just be careful. Obviously I'm not a doctor...I'm just another bipolar. With GAD and OCD. My premenstrual time (is this the MDD you spoke of? Menstrual instead of premenstrual? Maybe just different wording?) is usually a time when episodes often will occur but I do not have premenstrual dysphoric disorder.

Maybe another opinion is in order. I know. Three. Frustrating. But I think the first one got it right (but didn't do the right thing with the meds) and the second one is a mess. in my VERY VERY untrained professional opinion. Also, here's a secret--some pdocs are dumb. DUMB DUMB DUMB. They mess up meds all damn day and we pay for it while we wait out the side effects, consequences, and various et cetera.

Also, for bipolar, Abilify is not a treatment of its own usually. It's an adjunct treatment (usually) added to mood stabilizers. If there have been issues after the abilify that caused you to seek a second opinion, it may just be that the med was wrong and/or not prescribed fully and correctly. In that case, the diagnosis may have been right and the med WAY wrong.

Find a pdoc you are comfortable with and work with that person. Jumping from one to another to another every time a diagnosis or med feels wrong is counterproductive. A second opinion is never a bad idea, and a third opinion could be valid, but seems a bit much (unless you are just trying to find a doc you like and trust). Find a doc you are happy with and can trust and let the process start and stick with it. And it IS a process. It WILL take time. Maybe a lot of it. And never expect full recovery. Expect less episodes and less severity of episodes. This is a sign of proper treatment. Not being "cured."

If she's had mania and obvious rapid cycling between that and depression, the second pdoc must be wearing blinders or something. In no other disorder than bipolar does that cycle exist. It can overlap with some, but it is what it is.

Just my $.02.

[Karen1933]

Shakti and moma, thank you.

A bit of background...last Fall, she attempted suicide, I had her committed to state psych hosp...revolving door, no diagnosis, find a shelter if you have no where to go, after she signed herself out after being on suicide watch.

Feb, through family physician and me being able to get her on medicaid (she was 18 at the time), she was referred to a pdoc and diagnosed bipolar and given abilify.

Since then, she lost medicaid (due to age) and hooked up with a local mental health agency who arranged a psych eval. We had given her case manager all documentation in regard to recent treatment, etc, but this pdoc gave the major depressive disorder and generalized anxiety disorder with OCD tendencies as a diagnosis.

I am concerned that he did not pick up on rapid cycling and the mania...or maybe did not ask the questions...but I'm even more concerned about the lexapro really sending her out of her mind....

[Shakti]

I think that the local mental health agency (also a revolving door; I know--I've been spinning in and out of one for about 6 months now) just screwed up. They often don't or can't take any time at all in spitting out a diagnosis/diagnoses and take equally little time spitting out meds that may or may not be appropriate. This is not to say that local mental health places cannot be extremely helpful or even life saving. Mine was. But under NO circumstances would I allow them to diagnose me (given especially how little time they actually gave to my issues--they knew my issues and gave me meds for them...but had they wanted to change the DX I'd have walked out. I KNOW what I have).

And rapid cyclers tend to be more sensitive to anti-deps and meds in general so it's really important to take action on this and fast. And with the mania, she needs a mood stabilizer. Full stop. I'd not go back to that first pdoc if I were you, nor to the local mental health people. Start over.

The pdoc, though....I dunno enough about abilify, but it's for bipolar depression and bipolar, being bi and all, has an opposite end. Maybe it works for mania and depression? But I don't think so. I'm almost sure it's just for bipolar depression. So I'm surprised about that. Abilify and mood stabilizer I can see, but abilify alone? I might just not know enough about it. It's one I haven't taken.

She needs a good shrink and the proper meds. If she's bipolar, she needs a mood stabilizer FIRST and then move from there. All docs do it differently, and I'm not doc, so take my advice with a grain of salt, but I've seen some pdocs do some dangerous and really stupid things with meds. Sometimes you'd think they just don't give a crap. Sadly this is sometimes the case. Like I said, start over--find someone you think you can trust, get a proper diagnosis and proper meds. You will probably save her life if you help her do this.

Lexapro made me so anxious, so irritably manic, so paranoid, constantly crying and full of panic, panic attacks, mind so racing and fast and angry, and ultimately ended with my ex-husband having to literally keep me out of the kitchen and away from knives. And never in my LIFE had I considered hurting myself in ANY way ever at all ever ever ever. Please watch over her right now. This is serious stuff.

[Karen1933]

Unfortunately, the only option she has for anything right now is the mental health agency. It's a private, not for profit, not state, so I'm hopeful that makes it somewhat better.

I think the first pdoc, who diagnosed her bipolar, was somewhat of a pill pusher...he could see that she was already severely overweight, had a thyroid issue, and prescribed abilify anyway...I sat in on one session and he just talked about himself. She then lost her insurance, so he went by the wayside anyway...offered to make a deal, but I wasn't going to pay him to listen to his woes.

Abilify was totally outrageous in price, so that went bye-bye also, although she quit it first because it caused her zombie-like symptoms.

In order to get help in other areas with this agency, she has to go through their procedures and be med-compliant...She isn't living with me...and can't if she gets the help she needs...I don't have the insurance or the funds to get her what she needs, so being homeless (essentially) is the only way. Besides, it got too bad with her here...the stealing and mood swings were just too much to take.

I have tried talking to her...she won't hear me...I am hopeful that in time I will be able to talk to this pdoc...her next appt is in two weeks.

I believe she is bipolar...mania comes with nothing else...and I've seen it with her.

[maryjain lockhart]

[QUOTE=Shakti;1423759]I think that the local mental health agency (also a revolving door; I know--I've been spinning in and out of one for about 6 months now) just screwed up. They often don't or can't take any time at all in spitting out a diagnosis/diagnoses and take equally little time spitting out meds that may or may not be appropriate. This is not to say that local mental health places cannot be extremely helpful or even life saving. Mine was. But under NO circumstances would I allow them to diagnose me (given especially how little time they actually gave to my issues--they knew my issues and gave me meds for them...but had they wanted to change the DX I'd have walked out. I KNOW what I have).

And rapid cyclers tend to be more sensitive to anti-deps and meds in general so it's really important to take action on this and fast. And with the mania, she needs a mood stabilizer. Full stop. I'd not go back to that first pdoc if I were you, nor to the local mental health people. Start over.

Where I live we've gotta great place that's will evaluate u&even provides free meds&counseling. Everyone workin there is nice and the first thing they said was u r suffering&it's our goals to get ur mental health under control and provide the proper meds free of charge. I saw an actual psychiatrist&we talked for 3hrs. In the end he said I'm definitely BP1, I've got panic disorder&GAD and I'm showing symptoms of PREDICTED due to childhood abuse,neglect,and bein sodomized@4&23yrs old&the abuse I suffered in a bad relationship. Not all of those places are bad. Mine even found a state run program for people who cant get Medicaid but can't afford health insurance. I pay $40 a year&$20per MD visit during which they perform any labs, EKGs, MRIs, anything that needs to be done so u won't have to have to go to anymore appointments than necessary. This program has immensely helped me.
Come move to Tucson AZ!!!Theyve gotta lotta places to get free help. Search your area&find a place that might be able to help or just go to he er

[mommasuesue]

I agree with shataki and maryjain !!
get another opinion ! and watch her closely it can save her life !
lots of times too pharmicutical companies do help with the cost of meds , when I went the first time after getting out of the hospital i qualified for that kind of assistance
so look around more for other places to take her to and good luck !

[BlackPup]

Karen, I really hope that your daughter gets the help that she needs, the right diagnosis and the right meds.
Personally I love lithium, it is less sedating, it is antidepressant as well as antimanic, it makes you 6 x less likely to kill yourself and it is as cheap as chips!!! (except all the blood tests!)
There is a proof of concept study for the use of SSRIs in bipolar (I think it was BP2 no rapid cycles), not a large study but they were effective. SSRIs are used in Australia (not used in US coz of legal reasons) even in the absence of mood stabilisers in mild cases but this doesn't sound like a mild case- and yes you are right in saying that you have to watch out for "switching" to manias with antidepressants .

[Karen1933]

When she was first diagnosed with bipolar, the pdoc mentioned lithium. And exactly because of the blood tests involved, didn't give it to her. She is supposed to have regular blood tests anyway to make sure her thyroid medication is balancing the hormones that she's lacking, so what is the difference??? Alas...no insurance tends to weed options out pretty quick and very definitely.

She's already cycling again...out of the blue with calls wanting money...ugh.

I had to put one of my cats down last night...and in the midst of all that, she texts me wanting money for shoes she does NOT need. I simply said No...and stopped responding...I think I needed medication last night.

Of course, now I have to tell her about the cat...she is way unpredictable...gonna hold off as long as I can with that one.

I hate to say it, but I may have to throw my hands up and admit defeat here...unless she wants me involved in her care, anything I know or find out or suggest does nothing but irritate her...why do I care more than she does???

Yanno...I was watching an episode of Criminal Minds...and in it, Reed claimed that he needed to know everything about schizophrenia because his mother had it...he believed that by learning and knowing, he could fix it...I think that's me....I'm a fixer...always have been...probably always will be...

[maryjain lockhart]

If u want u can petition the state for a 72hr psychiatric watch@a hospital where they can have specialists who can help her get better and not suffer from the ups and downs anymore

[Karen1933]

That is a thought, but she is not a threat to herself or to others...she mostly just gets demanding, and money slips through her hands like water, which is why I hate giving it to her.

She needs to step up to the plate on this...she has a case manager who is really going the extra mile here for her. Is taking her next week to apply for food stamps and other assistance...this is stuff I can't do with or for her for many reasons.

I have to learn to adjust myself I think...

[Shakti]

You very well might just have to learn to adjust yourself. While mental illness is not a choice, unlike drug addiction etc., you can still be an enabler. Provided she has access to the help and resources she needs and she declines them, that is. That's kind of a big if (that she has those resources). But regardless, you can only do so much and she's an adult. It's hard to realize that there is only so much we can do. Sometimes all we have to give is love and love, while wonderful and beautiful and essential and often healing, is not a cure or a treatment. She has to take an active part in her welfare and she has to WANT to get well.

You can't fix this. Realize that now. It's a sucky and difficult thing to realize--especially in regard to our children, for whom we want the best and are sometime irrational about, but you can NOT fix this. Repeat that to yourself. Then tell her that.

The insurance thing is really awful. This nation is an embarrassment when it comes to medical care and even more so when it comes to the way we handle mental illness and the mentally ill. It's just heartbreaking. I had to leave my son behind to come to a state where I could get insurance. He'll be here in four weeks, but we've been separated for four months and that is the longest we have ever gone. We've never been apart before. Thank goodness where I came to is our home state, so that's a good thing, but the separation has been so hard. And not easy on my bipolar at all. His birthday is in a few days and he'll be 14. I've never missed a birthday before. And all because this was the only way to get some sort of treatment. It's a sick state of affairs. It disgusts me.

There must be some other resources (hoping, hoping, hoping). It's a long shot maybe, but have you looked into Easter Seals? They may have resources or be able to point you in the right direction. She needs to cooperate with her case manager because if anyone can help her find resources for treatment and meds, that's probably her best bet.

The Abilify is ridiculously priced. When I first got here and didn't have insurance yet they wanted me on it and quoted me I think about $800 a month. Yeah, right.

But you got it right: you can't fix this.

[Karen1933]

I think I've learned that some states are actually better than others when it comes to services for the disabled or the mentally ill or even the un-insured physically ill. I can tell you that here in IL, they suck.

I am thankful to God for organizations like the National Alliance for the Mentally Ill (www.nami.org). Thresholds is the organization that she has been working with and they are wonderful so far as well. But, it hasn't been an easy road to get her there and she essentially has to be destitute in order to even get help.

So, now she is. Because you have to have an address in order to get state public aid, she is now able to use the organizations address and is going to apply for whatever she can get next week. The case manager is taking her. Then they will help her with housing and employment/job training.

Provided she is compliant with meds and treatment, they will continue to help her until she is as independent as possible. But, she must do her part, and that's the way it should be.

I'm sooooooo sorry you are away from your son...it's so hard having an illness, but to be separated from your loved ones just intensifies it. I'm glad to hear he will be coming to be with you soon.

Yea...disgusting, repulsive, vile...work hard my whole adult life and some teen years as well only to have to scrape by and beg when my daughter needs help...God forbid I need it someday...

[Eurydicedear]

Hello Karen. I am not a health professional and can only speak from experience. I can relate to your frustration, but hang in there and don’t forget to take good care of yourself as well.
I have pmdd and bipolar II. Here are some things that have helped me:
· Arm yourself with as much knowledge as you can about the illness and available treatments. I borrowed books from the library and used the internet. (there’s a saying “keep your enemies’ close”. Bipolar is like that for me, the more I understand it, the better I can manage it!)
· Before going to the doctors have a list ready. A list of questions and a list of symptoms, dates, medications ect. Doctors don’t have a lot of time to get the big picture and also; when you’re depressed, anxious or just upset you tend to forget what to ask or say! (my husband encouraged me to write lists when I was feeling ok and to take them with me to the doctors)
· Keeping a mood chart or journal is very helpful getting the right diagnoses. I kept a little diary handy and scribbled short notes in it most days, charting my menstrual cycle and moods.
· If possible keep copies of any records, doctors’ letters, blood tests and such. This helps if you have to change doctors.
· I found the psych nurses in my area to be very helpful and had a lot of very practical advice.
· Talking to others with similar experiences was the greatest help and comfort for me.
· I quit drinking alcohol and caffeine, cut back on Chocolate, sugar, cola, processed foods ect. This was extremely difficult, but the trick was not to completely deny myself. I did this to help with my pms rage and mood swings but it has also helped a lot with the bipolar.
· Cognitive Behavioural Therapy has helped me enormously. If a therapist is out of the question, there are some great, easy to read books out there and a lot of free online resources.
Hope any of this helps, best wishes to you and your girl.
Eurydicedear
“I have heard there are troubles of more than one kind. Some come from ahead and some come from behind. But I’ve bought a big bat. I’m all ready you see. Now my troubles are going to have troubles with me!” Dr Seuss (my favourite doctorJ)

[BlackPup]

You can't fix this. Realize that now. It's a sucky and difficult thing to realize--especially in regard to our children, for whom we want the best and are sometime irrational about, but you can NOT fix this. Repeat that to yourself. Then tell her that.

Shakti, this is sooo true....
Karen, you are amazing in the way you care about your daughter. she is very lucky to have you on her side. Even in the way that you hold her accountable and don't say yes to her when she asks for money - in this you are respecting her as an adult even when she doesn't always act like one! I am so sorry to hear about how hard things are to get the help she needs. I hope that the case manager continues to be helpful and a solution is worked out. Please also remember that no matter how much help you, the case manager and the medical system do give her, it is up to her to get better. She has to want it.
I will be thinking of you all.

[Karen1933]

I think the most frustrating part of all of this is the fact that I can see periods where she won't accept the illness, regardless of what it is...even including the hypothyroidism.

Then there are times that she will say she knows something is really wrong.

For me, not being able to fix it or at least have some say-so in it has me just whacked. I know she's not taking the lexapro like she should...another scary thing.

I have to learn to take it as things come...I have to learn to step back and allow her the time and space to come to terms and deal with this herself. The problem is that mom is always the fall-back and the safety net...how do you change that?

[LivingMiracle]

I wish I would have saw this thread sooner. I know how you daughter feels. I am a little bit older than her, am bipolar, on Abilify, and have hypothyroidism. She needs to watch her serotonin levels (I think that's the right word) because with hypothyroidism and Abilify they both affect it. If you need to talk, we are here for ya both.

[Karen1933]

thanks Miracle. Although, now she is not considered bipolar and does not take abilify anymore...but, still I'm sure the hypothyroidism still affects her as she does not take the meds she has for that...