I thought it would be helpful for other parents to see Ava's med history. I wrote below in response to a fellow blogger but thought others may benefit from it as I always learn so much in hearing the details of other kiddos' stories and histories. I hope this leads someone else in the right direction - even if brief.
The pdoc we've been seeing for 2+ years now has just done trial and error type of prescribing for Ava. She and I really really work together as far as symptoms and theories as to what psychological issue is causing which behavior. Ava takes the following:
25 mg Zoloft, in the AM
5 mg Abilify, in the AM
27 mg Concerta, in the AM
5 mg Abilify as soon as she walks in the door from school at 4pm
Just to give you an idea of how we've figured out her latest med cocktail, here is a very brief history of Ava's meds throughout the last couple years of trial and error: Ava was first on Lamictal and we noticed slight improvements regarding her mood/depression/rages but it did not touch what seemed to be anxiety issues. We up'd the Lamictal slowly and saw no improvements. Then she began to have the rash! We stopped dosing, waited 2 weeks (to clear all out of her system) and tried Risperidol. Nada improvements or negative behavior from that - nothing. I researched and read a ton that said that Lamictal could be reintroduced with 85% rate of success without the rash. Dr. Lee agreed since we did see slight improvements so we restarted Ava on Lamictal - very, very slowly titrated up. Again, slight improvements but nothing significant. I suggested that Ava may need something for anxiety so we tried Prozac initially. This increased her rage and irritability tenfold. Stopped dosing. Waited 2 weeks. Started Zoloft and saw GREAT improvements as far as anxiety issues/sensory sensitivity issues. Her rages still continued and I felt like Lamictal wasn't really doing anything significant. We switched to Abilify as my mom is on this (BP Type II) and has had amazing results. Ava started with 5 mg in the morning. We saw improvements again but nothing super significant. With all of her meds we saw significant improvements for about 3-4 days and then they all sort of 'level out' for lack of a better term and she then will show just average improvements, meaning rages still continue but not for hours and/or not daily. I REALLY have felt since the beginning that Ava has shown signs of ADD/ADHD but was told over and over that BP can present as that but once the BP is pretty much under control, those ADHD symptoms disappear. But Ava's did not. I really stressed this to her pdoc. The big issue was that Ava showed no signs of ADD/ADHD in school. But Ava is a complete ANGEL at school, always. Her pdoc and I decided to go for it with the stimulant - if it wasn't what she needed, then we'd know immediately. Ava took her first dose and about an hour later, fell asleep while reading a book quietly on the couch. WE WERE FLOORED! It is true that stimulants can cause issues for those with BP, as can antidepressants (like Zoloft) but it really depends on the individual. And Ava is a crazy complex case. The tweaking and trial and error we've done will probably go on forever but I'm willing to do whatever it takes. We did notice a significant improvement in Ava's behavior overall upon starting the Concerta. There was suddenly a peace within her - the restlessness, jump-out-of-her-skin feeling you could feel just being around her was gone. However, we noticed HUGE flare ups about 4pm (hence my post before this last one!!!). The pdoc suspects this is because this is about the time the Concerta wears off and so we added 5 mgs of Abilify to balance out the mood swing there in the afternoon. This 4pm dose has done WONDERS. Before this dose we were having HUGE HUGE meltdowns for hours every day for about 2.5 weeks. My theory (take it with a grain of salt!!) with meds is that you treat the symptoms despite what literature says. We are all individuals and so things effect us all differently. My background is actually in research so I'm a huge advocate of it but when it boils down to treating MY child, I'll do what I feel that little voice inside my head is telling me to do - my intuition rules. And if one drug doesn't work, rest assured there are many more in that category that may, so we just keep trying. It's taken forever and I know that with growth spurts and puberty around the corner it will be a never ending battle but I don't care. I'll keep up the fight. Go with your gut, above all else. If your pdoc disagrees, tell he/she why you feel the way you do, ask for a trial period, find another doc, don't give up.
The psycho therapy sessions for Ava have been beyond wonderful. The part that Ellen stressed, more than anything is the importance of Ava knowing that she is NOT a 'bad girl'. She's a wonderful little girl who has a mood disorder. And as Elle tells her, "you are like a great big yummy pie. you have all these pieces that make up the pie and one piece is your mood disorder but that doesn't ruin the rest of the pie, it just makes it you." She stresses her strong characteristics above all else which helps with Ava's depression and anxiety and gives her the boost she needs to fight her BP. I wish we could have started earlier but no one would see her at age 4! And perhaps that would have been too early but I've always figured, the earlier she is educated and introduced to something she'll live with for the rest of her life, the more power she'll have to fight it!