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Many people...find relief from a single medication--usually lithium. Many others will need two or more medications, carefully balanced....


Do not allow your child to start or stop taking any prescription medication without her physician's advice.

Psychiatric Medications


The following excerpt is taken from Chapter 4 of Bipolar Disorders: A Guide to Helping Children and Adolescents by Mitzi Walsh, copyright 2000 by O'Reilly & Associates, Inc. For book orders/information, call (800) 998-9938. Permission is granted to print and distribute this excerpt for noncommercial use as long as the above source is included. The information in this article is meant to educate and should not be used as an alternative for professional medical care.

Many side effects associated with psychiatric medication are fairly minor, and can be handled with changes in diet or over-the-counter medications (always check with your doctor before trying to medicate away a side effect, of course--there is a danger of interactions between psychiatric meds and common home remedies, from Alka-Seltzer to cough syrup.)

Other side effects are signs of serious trouble, and a few are life-threatening. If your child experiences seizures, heart palpitations, blood in the urine or stool, or other symptoms that seem medically serious in nature, call your physician immediately. If your doctor is not available on short notice, report to an emergency room. These symptoms may be related to medication, or they may signify another serious health condition.

Serious side effects related specifically to psychiatric medications or other drugs that affect the nervous system include:

  • Akisthesia. An intense internal sensation of physical restlessness, itchiness, and jumpiness--a need to move constantly. A person with akisthesia will look and feel uncomfortable if she tries to be still.
  • Bradyphrenia. Slowed thought processes.
  • Dystonia. Muscle rigidity and uncontrollable muscle spasms. It is associated primarily with the neuroleptics (also called antipsychotics).
  • Encephalopathic syndrome. Symptoms are similar to those of neuroleptic malignant syndrome (see its description later), of which it may be a variant. Associated with lithium toxicity.
  • Extrapyramidal side effects (EPS). Physical symptoms include tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia. Associated primarily with the neuroleptics.
  • Hyperkinesia. Excessive motor activity, the physical expression of akisthesia. In children this can mimic common hyperactivity, but the movements may seem both driven and purposeless.
  • Neuroleptic malignant syndrome (NMS). This potentially fatal condition is characterized by rigid muscle movements, fever, irregular pulse and heartbeat, rapid heartbeat, irregular blood pressure, heavy sweating, and strange states of mind. Discontinue the medication immediately and call your doctor if these symptoms occur. In extreme cases, the patient may need emergency care at a hospital. Physicians should report episodes of NMS to the Neuroleptic Malignant Syndrome Information Service (http://www.nmsis.org/ ), which has set up a registry to help researchers reduce the incidence of this problem. NMS is associated primarily with neuroleptics, although it may occur with tricyclic antidepressants or other medications.
  • Oculogyric crisis. A patient in the throes of oculogyric crisis has a frozen upward gaze, often a very strange-looking facial expression and eye movements, and has contorted facial and neck muscles.
  • Orthostatic hypotension. Dangerously low blood pressure caused by alpha-adrenergic blockade. Associated primarily with the neuroleptics.
  • Parkinsonian symptoms. These mimic the neurological disorder Parkinson's disease, hence the name. They include a feeling of cognitive slowing, muscle and joint stiffness, tremor, and an unusually stiff and unstable gait. Associated primarily with the neuroleptics.
  • Serotonin syndrome. When the brain has too much serotonin (for example, from combining two antidepressants), patients may experience shivers, headaches, diarrhea, profuse sweating, confusion, and akisthesia. If this happens, stop taking the antidepressant immediately and see your doctor without delay. In extreme cases, serotonin syndrome can be fatal. That's why patients taking SSRIs or other antidepressants should not also take natural antidepressants, such as St. John's Wort.
  • Tardive dyskinesia (TD). This drug-induced movement disorder is characterized by twisting motions of the hands and feet, and smacking or chewing movements of the mouth. Rippling movements of the tongue muscles are considered an early warning sign. Discontinue the medication immediately and call your doctor if these symptoms occur. Between 20 percent and 30 percent of long-term users of the older neuroleptic drugs, such as Haldol and Thorazine, eventually develop this disorder. The new atypical neuroleptics are now preferred to these because they seem far less likely to cause TD. TD has also been associated with tricyclic antidepressants and some mood stabilizers. If TD is caught early, it may reverse itself once the medication is stopped. Entrenched TD is said to be irreversible. Some physicians recommend that people who take drugs that carry a risk for TD also take vitamin E supplements, which appear to stave off the disorder in some people.
  • Tardive dyskensia is a worry for anyone who needs to take a neuroleptic on a long-term basis. Obviously, the atypical neuroleptics are greatly preferred due to their lower TD risk. Low doses are also preferable to high ones.

    For those who are already affected by TD, only one medication is currently known to help: Nitoman (tetrabenezine or TDZ), also marketed under the name Regulin. This drug depletes dopamine in nerve endings, and so it may interact with other drugs that affect dopamine production or use. Although Nitoman is available in Canada, Norway, Sweden, Japan, and the UK, in the US it can only be obtained through compassionate use programs (explained in the next section). Nitoman sometimes causes depression as a side effect, so bipolar patients should use it with caution.

These are serious and painful side effects, the kind that understandably make patients want to stop taking their medicine. Careful medication choice and dosage adjustment should reduce them, and complimentary adjustments to diet, vitamins, supplements, and relaxation techniques may also help.

Medications

Many people with bipolar disorders find relief from a single medication--usually lithium. Many others will need two or more medications, carefully balanced to address their individual symptoms without causing unbearable side effects. Medication types in current use for bipolar disorder and associated symptoms or conditions include mood stabilizers, including several that are also antiseizure medications; antidepressants, neuroleptics (also called antipsychotics), stimulants (for ADD/ADHD), drug and alcohol detox aids, and sometimes other medicines as recommended.

Most of these medications are available in the US and Canada, and are listed under their primary US brand name. Some are available in less-expensive generic forms, while others are not (although all have a generic chemical name). Brand names and formulations may vary in other countries, and some drugs may not be available elsewhere.

Of course, new medications are always under development. In fact, as this book went to press several drug companies were hard at work on new antidepressants and even a couple of new mood stabilizers. There may also be new medications approved for use in Asia or Europe that have not yet made it to North America. If you're curious about an unfamiliar medication, look it up by its generic name to find the names of non-US equivalents, or ask your doctor whether something similar is available where you live.

Sometimes medications that have not been formally approved by government regulators are available under compassionate use laws, including drugs that normally would only be available overseas. It is sometimes possible--if not absolutely legal--for a physician in one country to prescribe a medication available only overseas, and for patients to then have the prescription filled at an overseas pharmacy.

Some as-yet-unapproved drugs are made available to participants in human research trials. If you don't have success with any of the usual treatments for bipolar disorders, this may be an avenue to pursue. The US National Institutes of Mental Health (NIMH) runs many clinical trials each year, and may be aware of others being managed by other research centers or by pharmaceutical companies.

The National Alliance for the Mentally Ill is one of the best resources for information on new drugs for neurological disorders. Its web site ( www.nami.org) often has reviews of new drugs, and previews of medications that are undergoing clinical trials.

Your nearest medical school or major research hospital may also have studies you could take part in.

That said, it's important to know as much as possible about drugs you are prescribed or that you hear about from other parents or patients.

If you experience unusual symptoms after taking medicine, or after combining more than one medication, call your doctor right away. You may also want to consult the drug reference sheet packaged with your medication by the pharmacy.

Be sure to personally check out any medications your child takes using a detailed medication reference, such as those listed under Resources in this center, to make you aware of all possible side effects and interactions.

Here are some more important things to consider:

  • Do not allow your child to start or stop taking any prescription medication without her physician's advice.
  • Make sure your child is careful to follow dosage, time, and other instructions ("take with food," etc.) specifically.
  • If your teenage or adult child is pregnant or breastfeeding, or if she could become pregnant, ask the doctor or pharmacist about any side effects specifically related to female reproduction and nursing.
  • If your teenage or adult child is actively trying to father a child, you may also want to ask about male reproductive side effects.
  • Be sure to tell both the physician and pharmacist about all other medications your child takes, including over-the-counter drugs--even aspirin and cough syrup can cause dangerous side effects when mixed with the wrong medication.
  • Inform the doctor about your child's use of alcohol, tobacco, any illegal drugs, and any vitamins or supplements (other than a regular daily multivitamin).
  • If your child's physician is unsure of how a medication might interact with a supplement, you may need to help the doctor find more information about the chemical action of the supplement. Most doctors are not well informed about nutritional supplements or herbal medicines, but many are willing to work with you on these matters.
  • If you suspect that your child has been given the wrong medication or the wrong dosage, call the pharmacist right away. Such errors do occur, and the pharmacist should be able to either reassure you or fix the problem.

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