Medications - To Take or Not To Take?
Around 1 in 5 of the world's children and adolescents have a mental disorder.
A study by the World Health Organization, or WHO, found that between 30 and 80 percent of people with mental health issues don’t seek treatment.
Shame and Stigma
There has historically been great secrecy and shame associated with mental illnesses. Although we no longer imprison, burn, or kill the mentally ill as in the Middle Ages or in Nazi Germany, most people struggling with mental illness still fear the stigma and shame of admitting they need help. Admitting their problems to doctors, spouses, parents, or even themself can be difficult.
So Why Take Meds If They Won't Fix/Cure Illness?
Medication Strengthens Healing
Technically, 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?!
We've all heard the story of "that guy" who was able to drag himself off a mountain 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?
Alleviating Symptoms Allows Healing
Experts recommend alleviating symptoms (like insomnia, anxiety, restlessness, irritability...), even when it doesn't cure or affect the actual diagnoses. This gives 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 and learn if they feel like they are living 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, and/or react normally to external stimuli (someone saying, "who left the butter on the counter?" should not trigger a screaming rage but has)...
Medicating Kids with Trauma Issues
Higher Likelihood of Serious Issues
Around 1 in 5 of the world's children and adolescents have a mental disorder.
A study by the World Health Organization, or WHO, found that between 30 and 80 percent of people with mental health issues don’t seek treatment.
Shame and Stigma
There has historically been great secrecy and shame associated with mental illnesses. Although we no longer imprison, burn, or kill the mentally ill as in the Middle Ages or in Nazi Germany, most people struggling with mental illness still fear the stigma and shame of admitting they need help. Admitting their problems to doctors, spouses, parents, or even themself can be difficult.
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.
"Biologically-based" vs "Trauma-based"
Asthma, diabetes, pneumonia, ADHD, bipolar disorder... are diagnoses where you can usually see relatively quickly the results of taking or not taking meds. These types of issues are what I call biologically-based (including genetic components). There seems to be less stigma with diagnoses that can be treated effectively with medication, especially if they don't require treatments like therapy and psychiatric hospitalizations.
Mental illnesses, especially non-biologically based illnesses tend to not respond well to medications. Trauma-based diagnoses like C-PTSD and RAD, in addition to not responding well to meds, are less understood and tend to have more stigma and shame associated with them. So Why Take Meds If They Won't Fix/Cure Illness?
Medication Strengthens Healing
Scientific evidence shows that the body heals better when it is not in pain so medication can be an important part of treatment.
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.
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.
Some medications are like the cast and crutches and will not be needed down the road. Other medications are like the pin and the body won't work right without them.
Some people believe it is possible to heal most things without medication. If you're "strong enough" and pull yourself up by your bootstraps.
Technically, 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?!
We've all heard the story of "that guy" who was able to drag himself off a mountain 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?
Alleviating Symptoms Allows Healing
Experts recommend alleviating symptoms (like insomnia, anxiety, restlessness, irritability...), even when it doesn't cure or affect the actual diagnoses. This gives 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 and learn if they feel like they are living 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, and/or react normally to external stimuli (someone saying, "who left the butter on the counter?" should not trigger a screaming rage but has)...
Kids can't heal and learn if their brains are stuck in the middle of a war zone, can't sleep, can't focus, can't function...
EXAMPLE:
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 (ADHD?), then you aren't learning (my kids have HUGE gaps in their education). If you're struggling with depression or anger or anxiety (bipolar, RAD, mood disorder NOS, GAD, ODD...) then you're so busy fighting or coping with symptoms that you can't learn like things like other kids - age-appropriate developmental lessons or how to get along in a family...
Medicating Kids with Trauma Issues
Higher Likelihood of Serious Issues
I think one reason we see a high rate of prescriptions of psychotropic meds 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 tend to make poor choices... which often leads to pregnancy. Having 2 parents with "issues" (such as bipolar disorder, alcoholism, trauma issues...) often means scary genetics for the child. Add in continued drug/alcohol abuse and/or things like stress/anxiety hormones during the pregnancy and the fetus is being "pickled" in "toxic soup." Even if this child is adopted at birth, it is unlikely that the child will be unimpaired. [Like Attracts Like]
If the parent keeps the child and is mentally ill, neglectful, abusive, addicted... this frequently leads to more trauma and damage for the child. All leading back to more children ending up in foster care and starting the cycle over again.
Finding The Right Meds
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 - actually a typical RAD behavior), and learning disabilities.
After we'd known them long enough to get an accurate neuropsychiatric evaluation, they were diagnosed with:
The discrepancy between the previous and current diagnoses was huge! Their medications were all wrong, the kids were raging and miserable, and their "misbehavior" had made a mess of their lives.
FINDING THE RIGHT MEDS
When finding the right Medication Cocktail (each person's needs are specific to their body chemistry, diagnoses, trauma, current situation, stressors, hormones, and even personality), the individual often feels like a human guinea pig. We preferred the kids to be in a psychiatric hospital or residential treatment center during major med changes because their behavior could be quite scary.
Some meds stop working after a time. Some work best only in combination with others (Abilify and Wellbutrin are good examples of this). Kids' needs can 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...)...
I've heard good things about GeneSight - a genetic testing company which with 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 med combos for my kids), but it's been highly recommended to me.
Medications for Children and Adolescents.
Unique Biochemistry
Medication Cocktails
This article about children being overmedicated in foster care makes a big deal about kids taking more than one of the same category of medication.
Especially for people with bipolar disorder, taking two or more different mood stabilizers is frequently recommended to keep the person stabilized. Especially when there are multiple diagnoses. Overlapping Diagnoses in Children
It often takes a medication "cocktail" to help the child get and stay stabilized, and unfortunately, our body chemistries are unique. Finding the right "cocktail" can take years of experimenting as everyone's body is different and changes over time (especially when dealing with puberty), sometimes new diagnoses emerge (many mental illnesses have adolescent-onset). Sometimes meds stop being effective. Sometimes meds have a negative interaction with each other. Sometimes better meds came on the market. Sometimes symptoms healed/subsided and a particular med is no longer needed... It's easy to start feeling like a human guinea pig.
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 finally 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 people medicate their 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.
It's a documented fact that people with "issues" are attracted to other people with "issues" and those people tend to make poor choices... which often leads to pregnancy. Having 2 parents with "issues" (such as bipolar disorder, alcoholism, trauma issues...) often means scary genetics for the child. Add in continued drug/alcohol abuse and/or things like stress/anxiety hormones during the pregnancy and the fetus is being "pickled" in "toxic soup." Even if this child is adopted at birth, it is unlikely that the child will be unimpaired. [Like Attracts Like]
If the parent keeps the child and is mentally ill, neglectful, abusive, addicted... this frequently leads to more trauma and damage for the child. All leading back to more children ending up in foster care and starting the cycle over again.
{Not only is my children's birth mother mentally ill, much of which was genetically passed on to my children (bipolar disorder, ADD/ ADHD, GAD, Borderline Personality Disorder, insomnia...) but they also have brain injuries (from unknown and/or multiple causes - genetic, FASD, injury during abuse...). We have to assume they were most likely "pickled" in the "toxic soup" of anxiety hormones, drugs, and alcohol in utero, and then there's the abuse, neglect, and other trauma-related events causing PTSD, RAD, and night terrors. Add in the genetics of their respective biodads... and you get the idea.}
Finding The Right Meds
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 - actually a typical RAD behavior), and learning disabilities.
First step - a really good Neuropsychiatric Evaluation with a psychologist familiar with trauma issues in children/teens.
After we'd known them 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 previous therapist from foster care why this wasn't diagnosed sooner 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 was as well.
- Brain injuries (cerebral dysrhythmia - strongly affecting memory and processing), which is probably tied into Kitty's learning disabilities, but for Kitty also affects her emotions.
- Complex Post Traumatic Stress Disorder,
- Emerging personality disorders.
The discrepancy between the previous and current diagnoses 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 - his behaviors weren'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
When finding the right Medication Cocktail (each person's needs are specific to their body chemistry, diagnoses, trauma, current situation, stressors, hormones, and even personality), the individual often feels like a human guinea pig. We preferred the kids to be in a psychiatric hospital or residential treatment center during major med changes because their behavior could be quite scary.
Some meds stop working after a time. Some work best only in combination with others (Abilify and Wellbutrin are good examples of this). Kids' needs can 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...)...
I've heard good things about GeneSight - a genetic testing company which with 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 med combos for my kids), but it's been highly recommended to me.
Medications for Children and Adolescents.
Many medications used to treat children and adolescents with mental illness are safe and effective. However, some medications have not been studied or approved for use with children or adolescents.
Still, a doctor can give a young person an FDA-approved medication on an "off-label" basis. This means that the doctor prescribes the medication to help the patient even though the medicine is not approved for the specific mental disorder that is being treated or for use by patients under a certain age. Remember:
It is important to watch children and adolescents who take these medications on an "off-label: basis.
Children may have different reactions and side effects than adults.
Some medications have current FDA warnings about potentially dangerous side effects for younger patients.
In addition to medications, other treatments for children and adolescents should be considered, either to be tried first, with medication added later if necessary, or to be provided along with medication. Psychotherapy, family therapy, educational courses, and behavior management techniques can help everyone involved cope with disorders that affect a child’s mental health. - NIMH
Unique Biochemistry
My kids are bio half-sibs with almost identical diagnoses and yet, they still needed different med combinations and dosages.
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, it helped me stop feeling the overwhelming stress, 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 I discovered is common for this med - this is one scary med). Bear tried Vyvanse which caused a horrible reaction for him (gastrointestinal issues, tics, nausea, dizziness...). Abilify worked like a miracle med 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 (we found it in Lamictal).
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, it helped me stop feeling the overwhelming stress, 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 I discovered is common for this med - this is one scary med). Bear tried Vyvanse which caused a horrible reaction for him (gastrointestinal issues, tics, nausea, dizziness...). Abilify worked like a miracle med 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 (we found it in Lamictal).
This article about children being overmedicated in foster care makes a big deal about kids taking more than one of the same category of medication.
Especially for people with bipolar disorder, taking two or more different mood stabilizers is frequently recommended to keep the person stabilized. Especially when there are multiple diagnoses. Overlapping Diagnoses in Children
It often takes a medication "cocktail" to help the child get and stay stabilized, and unfortunately, our body chemistries are unique. Finding the right "cocktail" can take years of experimenting as everyone's body is different and changes over time (especially when dealing with puberty), sometimes new diagnoses emerge (many mental illnesses have adolescent-onset). Sometimes meds stop being effective. Sometimes meds have a negative interaction with each other. Sometimes better meds came on the market. Sometimes symptoms healed/subsided and a particular med is no longer needed... It's easy to start feeling like a human guinea pig.
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 finally 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 people medicate their 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.
Medication Review:
Bipolar meds specific:
http://www.aacap.org/galleries/default-file/aacap_bipolar_medication_guide.pdf
http://www.aacap.org/galleries/default-file/aacap_bipolar_medication_guide.pdf
4 comments:
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.
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.
bipolar depression
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?
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