A few years back I wrote about how my son (who was 12 at the time) took Abilify as a stand alone medication for a few months and had suicidal thoughts while he was taking it.   This was unusual for him as he is not a suicidal kid in general and when we discontinued the medication due to it giving him tics of odd tongue movements and neck rolls, the suicidal thoughts discontinued-as did the tics.

Over the years since then I have received quite a few emails from people relating to that post and sharing similar issues of suicidal thoughts or tendencies while taking Abilify – either with themselves, their loved ones, or their children.  Because I have no way to verify the legitimacy of these emails, I have not written about them.  However, a few days ago I received an email from a man saying that his fiance completed a suicide attempt and he is now devastated by the loss.  I was struck by that email.   He attributes the suicide to her taking a combination of Pristiq, Abilify and Adderall.

He says:

The pills made her more and more irate, unapproachable, wild, irrational, paranoid, and completely not “herself”…Definitely not the person I met and fell head over heels for. She nose dived in a matter of 2 to 3 months with the biggest hit coming with the addition of the Abilify.

_______

I cannot get this email out of my mind.  As you know, stimulants caused huge issues for my son and Abilify was not good for him either.

If your child or family member is taking stimulants (Ritalin, Adderall, Focalin, Concerta, etc.) and/ or SSRIs or SNRIs (antidepressants like Prozac, Zoloft, Effexor, Paxil, Pristiq) and/or Abilify and they are suicidal and/ or worse than they were before they started the medication and/or simply cannot get stable, PLEASE consider that the medications that are supposed to be helping them could be making them worse.   Do not discount their behavior as simply a part of bipolar behavior or as you having a child that simply cannot get stable.   Stimulant medication and medication with stimulant-like properties does help people that can tolerate it but it can also wreak havoc on people that can’t and even more so on bipolar teens, children, and adults.

This has happened to us, it has happened to others, and it can happen to you.

“Abilify,” I say “that’s the medicine you took to stop hearing things after the Adderall reaction.”

“Oh,” Rye says.  “That’s what I thought.  So, why are they advertising it for depression?”

“Well, they are saying it makes a good add-on for an antidepressant and also in low doses it is considered to be more of an anitdepressant than an antipsychotic.”

“Well, that’s weird,” he says “I don’t understand how they can advertise it to help depression when the medicine makes you think about killing yourself.”

“What?” I say.

“Yea, that medicine makes you think about killing yourself.”

“What?  I thought it helped you,” I say.  “You thought about killing yourself on it?  I never knew that.  Why didn’t you tell me that?  You only said you didn’t want to take it anymore because it made you feel weird.”

“Well, mom,” he says, “that is weird.  Don’t you think?  It’s weird to think about wanting to kill yourself.  That’s why I didn’t like that medicine”

And with that, although Abilify did stop the hallucinations, it is gone as an option in this house.

So, why do I post this?  Well, it’s not to be alarmist.  And it’s not to be anti-medication.  It is to show myself and others how we aren’t ever 100% sure what is going on with our children.  And that our children themselves aren’t always sure how to communicate their feelings or experiences or thoughts to us, no matter how close we are with them.  And this is important to know.

And this is a great concern of mine with medicating children, my own included.  Children, due to their sheer age and level of brain development, don’t always know how to identify what is happening within them and then in turn can’t always effectively communicate about what is going on, even at 12 years old.  If they are really young they are too developmentally immature to know what they should feel or should not feel or what is real and what isn’t simply because of their age.  And the only thing adults have to go on is their behavior.  With Rye, his behavior was actually a lot better on Abilify.  He was less moody, more cooperative, and more even overall.  I had no idea, however, he was having suicidal thoughts.  He later told me that one of the reasons he took the med even when he didn’t want to [keep in mind, he only took it for about 2 months] was because the adults in his life, myself included,  kept telling him how well he was doing on it and he wanted to make us happy.  He did this in spite of having to fight off feelings of wanting to kill himself.  Just to please others, including me.  Thank God nothing terrible happened as a result.  Thank God he started to get the ‘neck roll’ from the med so we stopped it only after about 2 months.  Someone was watching over us, no doubt.

With that I’ve provided the link to the U.S. Full Prescribing Information for Abilify, which does warn that Abilify can induce suicidal thoughts, as well as some links to website providing other people’s experiences with the drug.

http://www.abilify.com/pdf/pi.aspx

http://www.askapatient.com/viewrating.asp?drug=21436&name=ABILIFY

http://www.furiousseasons.com/archives/2008/11/abilify_for_depression_ad_now_airing_on_tv.html

Please always read the full U.S. Prescribing Information provided by the FDA for all medicines you give your child, including all possible side effects and all black box warnings.  Please never think this could never happen to my child.

Because it can.

Anyway, I thought I’d list the ones we tried and when just for the record.

At 5/6 years old:

Ritalin

Adderall

Concerta

Strattera

Risperdal

A whopping combination of Adderall & Risperdal (as yes, even back then when something went wrong or the meds weren’t working they just said “keep upping the dose”) resulted in him becoming psychotic and then dropping onto the ground into a grand mal seizure (the whole event of which was terrifying for me)

This landed him in a psychiatric hospital at 6 where he was given:

Risperdal (yes, even after that had partially caused the problem)

Depakote

Lithium they were staring him on when I demanded they let him out after about 5 days and I’m so glad I did as even today he can recount nearly every darn minute of the time he was there and how scary it all was to him

From 6 years old to 11/12 years old:  No Meds

11/12 years old:

Adderall – started again to help with inability to concentrate at school.  And again, he ended up with a psychotic/manic reaction to this and this landed us on:

Risperdal, which caused him to not be able to breathe after a week

Seroquel, straight dropped him to the ground and knocked him out

Lamictal, made him super hyper within 2 days and gave him a rash

Abilify, did correct the psychosis and worked well for a while (about 2 months) until he started to complain of a stiff neck and started rolling his neck and that was the end of that as those “tics’ can become permanent overnight with no warning and stay forever even once off the meds.  The psychosis has stayed corrected (it is gone) though and he is back to normal.

12 years old: No meds

And so, this is where we are now and why we are on no meds.  And hopefully we will stay here indefinitely or at least until he is older and can make his own informed decisions but one never knows what the future brings.  At least now with Rye I know that everything that is happening with him is organic to him and not the meds or a med reaction or the meds reacting with each other etc. etc.  and this brings me a great deal of peace for now.

http://www.bpkids.org/site/PageServer/PageServer?pagename=fd_pr_jan08

CABF, I think you do some good work but I’m concerned about your response.

You state:

Jacob’s family and doctors stand by his diagnosis of bipolar disorder 14 years after the initial diagnosis and his parents feel he is doing well. While Jacob experiences an unfortunate side of effect of his medication, he is alive, living at home, and enjoying his best year yet instead of being incarcerated in juvenile detention — an all too common outcome for many untreated kids.

This is heartbreaking for me to read.  Jacob has tardive dyskinesia and he is still a minor child.  He is permanently damaged and disabled from the medications he took as a child and continues to take.   He is so mentally distant in his interviews it is concerning.  Fortunately, now that Jacob is getting older and can participate in his own treatment, he seeking alternative treatments and working hard to get off of at least some of the medications.  And you think his only alternative to being medicated was to be in jail?  It seems irresponsible to tell people that.

My son was originally diagnosed as bipolar at 6 years old after a bad reaction to Adderall.  After a short stay in a psychiatric hospital (and only short because I fought like heck to get him out and he was released AMA), doctors tried to convince me that he too had a “debilitating illness” and must be  medicated to make it through life.  I didn’t listen.  It all just sounded wrong.  He is 12 now and did not have one more unmanageable symptom until we tried Adderall again.   And that too has now been corrected.

Is he bipolar?  According to his psychiatrist, yes.  He meets the criteria according to the DSM-IV.  Did he need to be medicated this whole time?  No.

And he’s not in jail and he has not committed suicide.  In fact, he has very high self esteem, tons of friends, and behaves no worse than any other 12 year old boy at school.  And, many of his teachers describe him as being mature for his age.

Now, we’ll see what the future brings.  He may need medication at some point.  And if he does, he will get it.

But I’d hate to see what he would look like now if we had believed his original doctors and bought into the scare tactics and medicated a very young, growng child all along.

He too may have been permanently disabled.

This is the video that came before The Medicated Child, the video about bipolar medication use in children, which I had posted about previously.

Like The Medicated Child, this video is free to view online and is well worth the time to watch it.

Of particular interest are the follow ups of these kids done years after the taping of the original video – be sure to read these.  It is so interesting to see what the kids themselves choose to do about taking their medications as they get older and can make their own decisions regarding medication.   The discussion and interview transcriptions are interesting as well.

http://www.pbs.org/wgbh/pages/frontline/shows/medicating/

Check it out.

As I have been posting and reading over the past few days it has occurred to me, I think we have all missed a key piece in our journey here.

Rye was taking Adderall XR for a brief time before he had the real strange behaviors appear – including seizure-like activity, extreme hyperactivity and agitation, paranoia, and hallucinations. Before these behaviors presented he had, since the age of 6, a diagnosis of ADHD. And although admittedly he had always had a hard time concentrating at school, he had otherwise done fine without medication for years. After the Adderall, however, and after these behaviors showed up, the diagnosis moved to bipolar disorder.

And with that came the start of the atypical antipsychotics.

Now, why this only recently dawned on me, I have no idea. I guess because he really only took the Adderall for two or three months at most. And even then he only took them every so often since he didn’t like the fact that he didn’t eat while taking it and it gave him headaches as well.

Adderall, though, is a stimulant. It is thought to work in part by increasing Dopamine in the brain. Like any medicine it can build up in the system (well, my guess is some people will want to debate this one but I’m holding my ground on this due to the lack of long term use studies on this drug and what I witnessed personally) and consequently, because it is a stimulant, in some people it can cause stimulant psychosis. And Rye had been taking it for more than a few days in a row at the time this all started because he was having end of year state testing for school and needed to be able to concentrate to pass and move on to the next grade (which I realize is completely ridiculous for the 5th grade, or any grade really, but that’s a whole different topic altogether).

So I wonder…could the Adderall be the cause of the symptoms we saw that went beyond the usual ADHD?

The answer might be yes.

It says here that Adderall can induce psychosis in adolescents.

And the FDA says here that Adderall XR can cause new psychotic symptoms, auditory hallucinations, aggression, delusions and thought disorders in children.

So I guess the question then becomes, if the psychotic episode was in fact initiated by the Adderall, is Rye really bipolar?

I don’t know.

Why do psychiatrists say that children/teens that have this reaction to stimulants are bipolar?

I don’t know.

And would this psychosis have ever occurred naturally on its own without stimulant use?

I don’t know.

So, I will keep searching and reading.