This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Monday, January 25, 2010

More on Medication


Medications - To Take or Not To Take?

Shame and Stigma
There has historically been secrecy and shame associated with mental illnesses. 
Rose Marie "Rosemary" Kennedy was the older sister of President of the United States John F. Kennedy.
Rosemary experienced mental disabilities and displayed less academic and sporting potential than her siblings; she was slower than all of her siblings when it came to achieving many tasks. However, her disabilities were carefully concealed from the public by her prominent family. In her early young adult years, she also had behavioral problems. Her father arranged one of the first prefrontal lobotomies for her at the age of 23, but it failed and left her permanently incapacitated. 

Hubby grew up in a 'don't take meds or see a doctor unless you're dying' household. I'm not sure if this is because there was a shame about taking medications (being self-reliant is very important in his family) or a lack of affordable healthcare (or both). He rarely even takes a Tylenol for a headache, and will only take an allergy med if he's completely miserable (for those of you who don't know, if you don't have allergies when you come to Texas, Texas will give them to you!). The idea of taking meds for the rest of your life upsets Hubby greatly. 

Hubby has probably been clinically depressed more than once in his life (although he's never seen a therapist or a doctor), but he survived without meds. I don't know if it's a good thing that he's been depressed and understands how it feels or a bad thing because he handled it without meds. When diagnosed with Type 2 Diabetes, he tried very hard to handle it with changes in his diet and lifestyle rather than take medication. While he would definitely prefer not to have to take them at all, he was able to reduce the number of meds he needed. 

Depression is not a sign of weakness, and neither is taking medication for it by Jenna Jones
Today, 1 in 10 Americans take antidepressants, a 400 percent increase from 1998. That’s a hell of a lot of people swallowing pills every day, yet the subject is still somewhat taboo. In addition to politics, sex and money, mental illness is not something most Americans generally discuss.
The idea that medication is for “crazy people” was and is constantly culturally reinforced in media and society at large.
Personally, I’ve dealt with the misunderstanding of well-intentioned people who encouraged me to simply try harder and resist the pharmaceutical industry’s secret plan to get the entire population on happy pills to finally achieve world domination. At the very least, I felt weak for thinking I might need medication.  

I grew up with a mom who was a doctor's daughter and in a military family (meaning we were government human guinea pigs, but seeing a doctor was always free).  So I'm more likely to go to the doctor. I do tend to only take medication for a headache if someone forces me to (luckily I rarely get headaches), if a fever is at least over 103, I'm so stuffed up I'm drowning and nothing else works, and/or if I have an infection... but I'm willing to take meds for my high cholesterol (changing my diet didn't help). I was taking medication for my bipolar disorder only when needed (which was usually only when I was under uber stress... like raising 2 kids with RAD and teens in general), but now that I'm in a stable place, I decided to start taking it on a regular basis to help with my stress and anxiety. I still rarely take OTC meds, but my prescription meds have made a huge difference in my quality of life.


"Biologically-based" vs "Trauma-based" 
Strep, diabetes, pneumonia, ADHD... are diagnoses where you see relatively quickly the results of taking or not taking meds. These type of issues seem more biologically-based (including genetic components). There appears to be less stigma with diagnoses that don't require treatments like therapy and psychiatric hospitalizations when treated effectively with medication. 

I have 2 kids with major trauma and mental illnesses. They take meds for their bipolar disorder, and the one with severe ADHD takes meds for that too.  Like most people, Hubby doesn't have a problem with the children taking medication for things like bipolar disorder (a chemical imbalance), although he does hate the idea of the sheer number of meds they take and the thought that they have to take them for the rest of their lives. 

Mental illness, especially non-biologically based illnesses like C-PTSD and RAD, in addition to not responding well to meds, are often trauma-based diagnoses that cannot be "fixed" by medication. I believe that diagnoses that are less understood, don't respond well to meds, and aren't usually treated by a general practitioner tend to be the diagnoses that have more stigma and shame associated with them. 


Medication Strengthens Healing
Imagine that you've broken your leg in a car accident. The doctor surgically inserts a pin in the leg with the shattered bone, puts on a cast, gives you a crutch, and prescribes major pain meds. The cast keeps things stable while your body works on mending and healing. The crutch helps you be able to do the things you would normally be able to do if you hadn't broken your leg (like walk and go to school). The pin is necessary to give the remaining bones strength and something to heal around. There is scientific evidence that the body heals better when it is not in pain so you need the pain meds.

Some drugs are like the cast and crutches and will not be needed down the road. Other drugs are like the pin and the body won't work right without them. 

Hubby sees meds differently - maybe more like an engineer?
He feels it is possible to heal most things without medication. If you're "strong enough." 

I suppose you could use alternate methods to mend a broken leg that aren't as invasive or long-term as a pin. You don't have to get up and move around so a crutch isn't absolutely necessary. Legs don't have to be straight to work so a pin and/or cast aren't technically required either. In theory, pain won't kill you, so pain relievers aren't needed. Right?!

Image result for mountain rescueWe've all heard the story of "that guy" who was able to drag himself off a mountain and survive with 2 broken legs, 2 broken arms, and nothing but a toothpick and a breath mint... but do you really think he would have suffered all that pain if he'd had the option of immediate access to medical care?



Higher Likelihood of Serious Issues
I think one reason we see a high rate of prescriptions of psychotropic drugs for foster kids is less about overmedicating and more about there being a higher prevalence of serious mental illnesses in our kids.

It's a documented fact that people with "issues" are attracted to other people with "issues" and those people often make choices leading to children. Having 2 parents with bipolar disordered (or alcoholic or emotionally disturbed or whatever) often means scary genetics for the child. Plus, being raised by a mentally ill parent, frequently leads to abuse as well.  All leading back to more children ending up in foster care and starting the cycle again. (I've seen a lot of "Like Attracting Like" with my kids - can you say Kleenex girls?). Like Attracts Like

Not only is my children's birth mother mentally ill, much of which was passed on to my children (bipolar disorder, ADD/ ADHD, GAD, Borderline Personality Disorder, insomnia...)
but they also have brain injuries (from unknown or multiple causes - genetic, FASD, injury during abuse...), were most likely "pickled" in the "toxic soup" of anxiety hormones, drugs and alcohol in utero, and then there's the trauma stuff causing PTSD, RAD, and night terrors. Add in the genetics of their respective biodads and... you get the idea.

Alleviating Symptoms

Experts recommend alleviating symptoms (like insomnia, anxiety, restlessness, irritability...), even though it doesn't cure or affect the actual diagnoses, to give the person time to heal (and in the case of children, time to mature and process). That's why they give highly addictive medications like morphine and hydrocodone to patients right out of surgery. Studies show that people in pain heal slower than those on pain-relievers.

I know a lot of times there is a huge resistance to giving children meds, and while I agree that there are times some foster children are over medicated, I also believe that these kids are struggling and they can't heal if they feel like they are existing as though they are in the middle of a war zone or they are struggling with basic coping skills, unable to function.

In my opinion, you can't work on healing trauma if you can't sleep, focus, sit still, react normally to external stimuli (someone saying, "who left the butter on the counter?", which in my opinion, should not trigger a screaming rage but has)...

Unique Biochemistry
Meds don't work the same for everyone. I tried Lexapro (recently mentioned in a comment by someone it works well for) and it was HORRIBLE for me! True, I was not feeling the overwhelming stress anymore, but I also didn't feel ANYthing! I was like a robot (and robots do not "cuddle" if you know what I mean). Plus, I started having horrible side effects that got even worse as I went off the med (which apparently is common - this is one scary drug). Bear tried Vyvanse which caused a horrible reaction for him (gastrointestinal issues, tics, nausea, dizziness...).  Abilify worked like a miracle drug for Kitty and didn't do diddly squat for me. After about a year and a half, Abilify stopped working for Kitty and we had to start all over looking for a new "miracle" med.

Medication Cocktails
The article makes a big deal about kids taking more than one of the same category of medication. I know that for bipolar people, taking two or more different mood stabilizers is frequently recommended to stabilize the person. Especially when there are multiple diagnoses. Overlapping Diagnoses in Children

It can take a med cocktail to help the child stabilize, and unfortunately, our body chemistries are unique. Finding the right "cocktails" can take years of experimenting as everyone's body is different and changes over time (especially as they enter puberty). Sometimes a new diagnosis was recognized or onset (many mental illnesses have adolescent onset). Sometimes meds stopped working. Sometimes meds have a negative interaction with each other. Sometimes better ones came on the market. Sometimes that issue healed and they didn't need a particular med any more. It's easy to start feeling like a human guinea pig.

Sleep Meds

My kids suffer from PTSD (like most kids of trauma) and sleep is HARD! If you don't get enough sleep, then you can't learn in school and it's harder to control your emotions - sleep deprivation is a common form of torture! If you're living in a war zone in your head (PTSD), or you can't focus (due to ADHD), then you aren't learning (my kids have HUGE gaps in their education). If you're struggling with depression or anger (bipolar, RAD, mood disorder NOS, ODD...) then you're so busy fighting or coping that you can't learn the developmental lessons or how to get along in a family.

Over-Medicating
In recent news, there've been lots of articles about children being overmedicated in foster care.  

In the past, Hubby's opinion was that I have allowed the kids to be over-medicated. I disagree. They are on lots of meds, but it took time to find the right meds and good combinations that worked for their individual body chemistry. They are already taking fewer meds than they did 2 years ago. I think a lot of this is due to the fact that they could focus on internal healing when their outside world didn't feel totally chaotic. (I hope it goes without saying that we are not addressing anyone's needs and issues with ONLY medications). 

I'm not recommending we drug our kids into zombies (although we did have to do that once for a short period of time to keep our son and family safe while we waited for a bed to open up in an RTC), and yes, there are some nasty side effects from medications that aren't tested on children... but without meds, my children would have been virtually unadoptable and I have no doubts that my son would have ended up dead (self-medicating with drugs, gang life, suicide...) or in juvie many years ago. 

When the child is stable, I start looking at lessening or removing their meds (or ramping up therapy treatment) - for as long as they continue to make progress healing.

Years of the right medications gave my son time to mature, learn, and attain coping skills... When he decided to stop taking his medications at 18, he learned very quickly that he needed them, but I also believe that the consequences of his actions off the meds were much less severe because of that time of growing/ healing.


Proper Diagnosis and Medication

When our kids came to us, they weren't properly diagnosed or medicated.  Bear was diagnosed with PTSD, mood disorder NOS and possible conduct disorder.  Kitty was diagnosed with ADHD (unmedicated for some unknown reason - possibly because it killed her appetite and she was underweight already), ODD and "attachment issues" (which the caseworker claimed couldn't be true, because she was such a loving child who always hugged the caseworker - typical RAD), and learning disabilities.

After we'd known them for long enough to get an accurate neuropsychiatric evaluation, they were diagnosed with:

  • Bipolar Disorder (which apparently they'd been diagnosed with before entering foster care and had been removed for some reason - possibly because many doctors don't believe in child-onset bipolar, or maybe because it made them seem less adoptable (but if the latter was the case then they sure left a LOT of other stuff in!).
  • Reactive Attachment Disorder (I asked their therapist from foster care why this wasn't seen before and she claimed not to have seen it - it's possible that in previous foster homes no one had tried to emotionally bond with them or the therapist was not experienced enough with the diagnosis to recognize the symptoms),
  • ADD/ADHD - Kitty was already diagnosed with this, but now Bear is as well.
  • Brain injuries (cerebral dysrhythmia - strongly effecting memory and processing), which is probably tied into Kitty's learning disabilities, but for Kitty also effects her emotions.
  • Complex Post Traumatic Stress Disorder,
  • Emerging personality disorders.

The discrepancy was huge! Their medications were all wrong, the kids were raging and miserable, and their "misbehavior" had made a mess of their lives.  I won't say medications fixed all their problems, but... without it I know we couldn't have adopted Bear - he wasn't safe, and Kitty has come SOOOO far with her healing. Healing that she couldn't have done without alleviating some of her symptoms through medication.

FINDING THE RIGHT MEDS

To help with finding the right Medication Cocktail (since what each person needs is specific to their body chemistry, diagnoses, trauma, current situation - under unusual stress, and even personality) each individual can often feel like a human guinea pig. We preferred the kids to be in a psychiatric hospital or residential treatment center during this process because it can be quite scary.

My kids are bio half sibs with identical diagnoses and they still needed different meds. Some meds stop working after a time. Some work best in combination with others (Abilify is a good example of this). Kids/peoples needs can also change as they hit puberty or have a growth spurt, experience new trauma or begin healing, are under great stress (ex. exams and major life changes like divorce, moves, new siblings, relationship issues...)

GeneSight is a genetic testing company which for a cheek swab and a maximum of $200 (It's sliding scale) will report which meds are unlikely to be metabolized well, which are not likely to work, and which are likely to cause problems.  I have not personally tried it (I found out about it after we found the right meds for my kids), but it's been highly recommended to me.   

4 comments:

Anonymous said...

You said: "Alternately he's argued that I've always been under a lot of stress and had issues like hating my job and insecurities about what other people think about me, and that meds are not helping these and are not designed to help those so why bother."

But some meds *do* help with how you handle stress and anxiety. (Not that any of them are "designed" for anything). I was really suprised at how my social anxiety went down when I started Tegretol. A med can't change the crap your boss hands you, but it can change whether it sucks you down for the whole day vs a brief "bummer".

So ask him, "Gee, honey, would you rather, after a bad day, I sit down to eat dinner w/ you and tell you about the stupid people I dealt with, or I scream at you, kick the dog and tell you to get your own @$% dinner?"

Yeah, not necessary, really. I just wanted to say that.

Mama Drama Times Two said...

Loved you analogy of the crutch cast and pin...I'm guessing Hubby has never had to pass a kidney stone - otherwise I think he might have a whole new perspective on the merits of taking medication. The Other Mother has to practically be bleeding from the ears before she'll take a pill. I, on the other hand, will gladly take one...or two.

blog said...

bipolar depression

Jules said...

Yeah but the thing is, some mental illnesses like depression are caused by an actual, measurable chemical imbalance in the brain and cannot be "healed". It's an illness that needs to be treated with a drug every day to correct it and keep a person from being completely miserable. With respect, I don't get why he doesn't understand this. There is hard, scientific evidence of such imbalances. Does he think such people should just suck it up and deal?

SSRI's aren't an abusable drug either. Meaning, you don't get "high" when you take them. I really am having such a hard time understanding his logic in this situation. You obviously need medication and your kids certainly do as well. What is the advantage to letting mental illness go untreated to avoid taking meds?