Question:
2 weeks ago my son was hospitalized for threatening suicide, he is 13.
His biological mother and I have been divorced for about 10 years (I
have primary physical custody), and prior to our divorce she was
diagnosed with bipolar disorder. Anyway, he was sent to a treatment
center where the pdoc gave him a diagnosis of bipolar disorder, atypical
depression, ADHD and started meds. One of the meds was Tenex, and
consequently had an adverse effect; made him very aggressive, more
suicidal threats and threats of killing me if I came to the hospital.
The treatment center managed to give him an injection of haldol and a
tab of ativan to settle him. Also the treatment center apparently was
not able to deal with crisis situations so he was shipped off to an
adolescent psych ward at a nearby hospital. I went to see him the day
after he was moved and it was quite emotional for both of us. He was
crying and saying that he just wanted to come home and that he was
afraid that he will spend the rest his life in hospitals. Those 2
statements really wrenched at my heart. I went to see him the next day
and he was very up, figity(sp), inattentive and now was stating that he
does not have a problem he just needs to get out of the hospital. He
said that when he gets out he will never come back to the hospital even
if he has to run from the police. The hospital where he is now has him
on Celexa and Tegretol, his Tegretol serum levels are low 4.2.
Apparently they don't have his meds straight yet.
My son has been in, here in Florida, whats called emotionally
handicapped classroom since 3rd grade and I have been taking him to
counseling for 6 years. He has been thrown out of 4 schools, one of
which was a school affiliated with the mental health center where we
received counseling. While there he received group counseling twice a
day, individual counseling once a week, and family sessions once a week.
In the past 2 years he has been hospitalized 4 times, 5 times if we
count when he was moved from the treatment center to the adolescent
psych ward. While in counseling he has been tried without any long term
noticable results on 6-7 different meds. The insurance we have will only
cover 30 days residential treatment, of which he has 17 left. I suppose
my question, at this point, is 17 days enough to get him stabilized on
his meds? My fear is that the pdocs will tinker with his meds even when
he gets home and I will have to deal with adverse effects, since I think
that while tinkering the meds can trigger even more extreme behaviors
such the one that caused him to be moved.
Answer:
I am not a parent and so cannot relate to your problem with your son as
fully as a parent could, but I think I can grasp some of the anguish you
must feel on his behalf.
What I can address is your question re: meds. 17 days is not long enough
for stabilizing meds unless by some unprecedented stroke of luck the doctor
gets it right the first time. It took my doctor nearly 4 years to get a mix
that keeps me stable most of the time. Children are changing all the time
as they grow, both physically as well as emotionally and psychologically,
and it may be difficult to treat them. What you son is saying about not having it is a typical denial (with
always the possibility that he is right). Teens don't want to be
different, and they certainly don't want to be seen as mentally ill,
and this means you will have to get him into some program or residential
school where they make him take his meds. And best one where he sees
you and a psychiatrist often enough to adjust them. (An additional
benefit is that such programs make it much harder for kids to get
at street drugs, which make things worse.)
I also have to say that his insistance that he just needs to get home,
while touching, brings back to me a lot of memories of how insistant
and charismatic and manipulative a person with mania can be. So
determined, so wearing, so effective, so wrong...
If the diagnosis really is bipolar (meaning that mania is present,
like pressured speech, long runs without sleep, grandiose or
disconnected ideas, etc.) than it probably takes precedence over
the other complaints, because it is more dangerous. The key treatment
is stabilizing the mood, with something like Lithium or depakote.
Some kids like this also respond very well to the newer anti-psychotics
(safer cousins of the haldol, which is very unpleasantly sedative),
such as risperdal, xyprexa. They throw other stuff at problem kids
earlier, because the above-named require medical supervision and
have dangerous side effects, but if the problem is BP, a lot of the
other things, like SSRIs, ritalin, etc. can MAKE IT WORSE.
My heart goes out to you. This is not the fun part of parenting. I
can tell you that my boy is right now the sweetest teenager you'll
ever meet, but he's been in secure and excellent treatment for
more than a year, and it's fragile...
You'll find websites pretty helpful. People here have tried all
the medicines, had all the experiences, and provide each other a kind
of support that makes it a lot easier to clench teeth over the hard
parts. As a parent, I mostly lurk, but maybe we can get up a thread
for parents, since I don't know of anywhere that's happening.
