We took Acadia in to see Dr. D today. Mom came with me. Cadi quit talking as soon as we were in the office. But she tried to express herself by drawing pictures and finding toys to act out her emotions. She was tearing around the office with a lot of energy. Dr. D told us that the citalopram triggered a mixed state.
Here's a description of a Bipolar "mixed" state: "Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.
Sometimes severe mania or depression is accompanied by periods of psychosis. Psychotic symptoms include hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not actually there) and delusions (false fixed beliefs that are not subject to reason or contradictory evidence and are not explained by a person's usual cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time (e.g., grandiosity during mania, worthlessness during depression)."
The problem is that even though it was the medication that triggered this, and it should be out of her system now, the mixed state could continue for weeks. We can try to bring it down with other meds, but there is no guarantee. Dr.D said that if we put her in the hospital she could be monitered and meds could be adjusted quickly. Mom asked if we put Acadia in the hospital if I could be with her. I shook my head, Dr. D said no, and Acadia started crying. We talked about our options for awhile and Acadia clung to me and cried. Dr. D said she would feel better about us keeping her at home if Acadia would talk to her about whether she felt like hurting anyone. Acadia sobbed "I don't want to hurt myself. I don't want to hurt Mom, I just want to stay with her." So we agreed to take her home and give her Seroquel and Ativan in increased doses, and take her to get bloodwork done in the morning for her Lithium level. If we need to we can take her to the ER this weekend, but otherwise we will check in with Dr. D on Monday.
I do have some good news. After we gave Acadia her medications and a warm bath, she started feeling really sleepy. I got her in bed, Suzy read her part of a story, and then she decided she was ready to go to sleep. And now she is asleep in her own bed all by herself! A medical miracle! Something finally knocked her out. Sweet dreams.