Q. My son was just released for the 4 times last wednesday. He was prescribed Paxil 3 weeks prior and has a reaction (agression). Now they have him on Depakote 750mg bid, Topamax 25mg qhs, Tegratol 150mg bid, Risperdal 2mg in am and 4 in pm and Strattera 40 bid. I wonder if this is too many mood stablizers. Nothings seems to be getting better, just worse. He is only 10 years old and was diagnosised on Sept 2001. In the morning we have having a meeting with he new case manager, Mental & Develpmental Delayed Case Manager, School teacher and principals to consider sending him to day treatment. I am so confused. Please help.

Kelly
Krbutler530@cs.com

A. Kelly, Honestly your question is a little difficult to answer. I will be shocked if these medications, at these doses, were started all at once. The actual dose of each medication is not unreasonable, depending on the weight of the child. Blood levels should give you more of a clue in this area than the actual dosing figures. The number of medications, although seemingly excessive, is not uncommon when treating bipolar disorder, especially in children who often are more resistant to chemical treatment. I do hope these medications were started gradually, and that a close eye is kept both on blood levels and on side effects. Liver function tests should have been performed before beginning these medications, and at regular intervals during treatment.

All of this aside, if your child is feeling worse it should be a red flag that something is not right. Often side effects of medications can make a person feel worse in the beginning, but these should begin to diminish within a few weeks of starting therapy. If your son continues to do poorly, I suggest either altering the doses of the current medications or switching to something else altogether. If you have any more questions or concerns, you are welcome to write in with more information.

Anna