Q:  Haldol

In Jan 2002 my 16yo daughter was prescibed Zoloft for depression but not given a mood stabilizer.  She became psychotic.  Her depression and rage persisted despite many meds.  In May she heard voices and was admitted.  Lithobid 600mg and Depakoter ER 1000mg seem to control the mood swings. However,she's gained 35lbs.   Since July 3 she has heard mean voices even in her sleep every day.  Seroquel,  Geodon and now 2mg Resperdal in am and 4mg in pm have not stopped the voices or paranoid delusions.  Total social withdrawal from all but immediate family, fear of being stalked, thinks phones are tapped, can't go to school, etc.  She's being seen by a fellow in training in child psychiatry (has finished residency).  Next week the doc is going to talk to us about starting on haldol.  I'm scared of haldol.  Help!

Dear Ms. S' -- 
You're learning that although there are a lot of medication alternatives, many can have nasty side effects, and sometimes they just don't work.  This usually leads to a continued search for a medication that will work without causing too much trouble.  There's some evidence emerging that of all the mood stabilizing medications, the strongest one -- at least for many people -- may be Zyprexa (olanzapine).  But, as you've probably learned, that has severe weight gain risks as well.  

However, the folks who make Zyprexa are working pretty hard to try to control that problem.  One of the most promising is to give a routine antidiabetic medication called metformin (Glucophage) along with the Zyprexa.  There is one small study showing that metformin prevented weight gain in most of the children who took it (not all); that's work by Morrison and colleagues.  If your daughter could be allowed to take Zyprexa using this strategy, that could open up an option for a medication that acts both as a mood stabilizer and an antipsychotic at the same time.  I've definitely seen it work when something like Risperidone didn't.  

After that it's a matter of working your way through the list of mood stabilizers.  I understand your concerns about Haldol.  Usually it's better than being psychotic, but that's a pretty faint praise for a medication.  For some people it can be very helpful.  Many of my colleagues and I have selected perphenazine (Trilafon) as our favorite amongst the "old generation" antipsychotics (which includes Haldol and numerous others) because it seems to have the fewest side effects in our experience and patients often tolerate it without trouble, which seems less often the case with Haldol.  You could ask the doctor about trying that one instead of Haldol, or after Haldol if the results are not good.   

Dr. Phelps

Published December, 2002