In Jan 2002 my 16yo daughter was prescibed Zoloft for depression but
not given a mood stabilizer. She became psychotic. Her depression
and rage persisted despite many meds. In May she heard voices and was
admitted. Lithobid 600mg and Depakoter ER 1000mg seem to control the mood
swings. However,she's gained 35lbs. Since July 3 she has heard mean
voices even in her sleep every day. Seroquel, Geodon and now 2mg
Resperdal in am and 4mg in pm have not stopped the voices or paranoid delusions.
Total social withdrawal from all but immediate family, fear of being stalked,
thinks phones are tapped, can't go to school, etc. She's being seen
by a fellow in training in child psychiatry (has finished residency). Next
week the doc is going to talk to us about starting on haldol. I'm scared
of haldol. Help!
Dear Ms. S' --
You're learning that although there are a lot of medication alternatives, many
can have nasty side effects, and sometimes they just don't work. This
usually leads to a continued search for a medication that will work without
causing too much trouble. There's some evidence emerging that of all the
mood stabilizing medications, the strongest one -- at least for many people --
(olanzapine). But, as you've probably learned, that has severe weight
gain risks as well.
However, the folks who make Zyprexa are working pretty
hard to try to control that problem. One of the most promising is to give
a routine antidiabetic medication called
(Glucophage) along with the Zyprexa. There is one small study
showing that metformin prevented weight gain in most of the children who took it
(not all); that's work by
and colleagues. If your daughter could be allowed to take Zyprexa
using this strategy, that could open up an option for a medication that acts
both as a mood stabilizer and an antipsychotic at the same time.
I've definitely seen it work when something like Risperidone didn't.
After that it's a matter of working your way through
of mood stabilizers. I understand your concerns about Haldol.
Usually it's better than being psychotic, but that's a pretty faint praise for a
medication. For some people it can be very helpful. Many of my
colleagues and I have selected perphenazine (Trilafon) as our favorite amongst
the "old generation" antipsychotics (which includes Haldol and
numerous others) because it seems to have the fewest side effects in our
experience and patients often tolerate it without trouble, which seems less
often the case with Haldol. You could ask the doctor about trying that one
instead of Haldol, or after Haldol if the results are not
Published December, 2002