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Med Timing Sensitivity? I have a 12yo son who is diagnosed with Bipolar and high functioning autism. He has been stable for about a year and currently takes Lithobid (level of 1.1-1.3), Trileptal and Seroquel. I have noticed that he is very sensitive to medication timing. When only late by as little as an hour it is quite noticeable, even to him. He recognizes and can usually regulate himself until his meds kick in. However, with instances where meds have been late a couple hours, he can be up well past midnight unable to sleep and describing himself as having his “brain way up there and can’t get it to come down.” During these times he displays classic high levels of energy, expending it through goal directed activities such as cleaning his room or doing laundry; other times can reveal less desirable behaviors that are very disruptive to the entire family and can require dosing his prn (Zyprexa Zydis). Greater medication doses, different or additional medications, and alterations on timing have been tried and either result in sedation, cognitive dulling and loss of functional abilities, instability with other or additional medications and as far as timing goes, we currently dose meds three times daily and have found that to work the best for him. What are your thoughts on this type of sensitivity to medication timing and do you have any suggestions other than rigid adherence to dose times that may alleviate this problem to any degree? Thank you, Natalie
Dear Natalie, Wow, you must feel pleased to know you have found medications that are so helpful in stabilizing your son! I guess I would focus most on how to keep the meds on a tight schedule. This will minimize the need for PRN doses (I believe in keeping kids stable on the smallest doses and numbers of meds possible). Some kids simply are exquisitely sensitive, and for them, maintaining routine is the most useful. However, real life can often impede timing. Given that, I would help your son to identify strategies he can use to self-calm, or at least to make choices with his excess energy that are least damaging. The more he can see these as external symptoms to be controlled, rather than some lousy aspect of himself (see the discussion of our Symptom-Self Exercise in Raising a Moody Child) the more effective he will become in being the agent of change. Best wishes, Dr. Fristad |
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