autism and psychotropic meds. - Autism Spectrum Message Board

alabamagirl · 01-22-2007, 09:02 PM

My son's new doctor is taking him off (gradually) of Tegretal and Lexapro and is leaving his Depakote.

The process started three weeks ago and my son's behavior is deteriorating: mood swings, crying jags, physical destruction of property and self-injurious behavior. The last two are mild but I am afraid of it escalating.

Over the years, doctors have tried to change his meds. several times -- with disastrious results.

His old doctor (who I loved) says there is no problem taking Tegretal and Depakote at the same time and he has seen it with many developmentally-delayed adults. His new doctor says he has never seen the two prescribed together and it is wrong.

I am wrestling with what to believe and have searched the Internet with not real success on this issue.

Anyone with insight into changing or decreasing or med combinations - I would love your input.

Debbie

smw73 · 01-22-2007, 10:36 PM

I'm an adult who has Autism. I have a lot of trouble with most psychotropic medicines. Some of them have even put me into hospital. My doctor has told me that I'm just extremely sensitive. Everyone has a different physical makeup. A lot of people need to try several different medications until they find the one which is right for them. It's trial and error. Hope some others can provide some more clarification.

Laenini · 01-22-2007, 11:21 PM

Tegretol, Lexapro, and Depakote are a very complex combination of drugs. All 3 of these drugs are capable of interacting with each other and creating toxicities and side effects as they all can interfere with one's capacity to metabolize the others. (this is called a pharmacokinetic drug interaction and many MD's have a poor understanding of what they are and what to do about them as they just don't really cover the topic in any depth in medical school) I agree with your new doctor that they are a bad combination and if used together require careful monitoring. As the doctor decreases the Tegretol, your son may have an increased effect from the Lexapro and the Depakote. His symptoms could be a result of his Depakote level in his bloodstream becoming too high. Is the doctor checking blood levels of these drugs as he withdraws them? If he is not, I think he should be, especially in light of new behavior symptoms.

Truly though, based on your description of symptoms, I think he has lost some of the mood stabilizing effects he was probably getting from the Tegretol. Do you know why the doctor chose to remove the Tegretol rather than the Depakote? Maybe the Tegretol should be left on board and the Depakote withdrawn?

Either way, you need to get in touch with the doctor regarding the new symptoms you are seeing and let him or her make an evaluation of them.

Good Luck!

Laenini · 01-22-2007, 11:33 PM

I just read your other post regarding the terrible situation your son was faced with in a group home recently. The trauma from the abuse he suffered could also have an effect on his behavior. Also, with the broken ribs pain should be considered too as a trigger for his behavior, particularly since he is non-verbal and may not be able to communicate his pain. I am so sorry your son has been through so much! My heart goes out to you both.

alabamagirl · 01-23-2007, 06:32 AM

Thank you! Yes, I've looked over the Drug Digest and see that they can interfere with one another. His blood is drawn every week and what has been interesting to me is that as the Tegretol level decreases, the Depakote level also decreases. They had told me his Depakote level should increase with the Tegretol taper.

DH and I were just talking this AM about the Tegretol versus the Depakote. He has an appointment tomorrow and that is definetly on my list of questions!

Also - I don't think the doctor should have decreased his Lexapro and the same time the Tegretol is being decreased. Now I don't know how much the Lexapro decrease is a factor in the behaviors.

I understand his recent trauma could contribute to some acting out, but the first three weeks he was home with his old med. routine -- he had NO behavior problems. He is just sitting at home now and can't even get into a day program until the med. issues are resolved.

I am willing to do anything for him, but watching him suffer like this on top of the group home abuse is more than we can bear.

Debbie