psychiatrist Says- Can't Help

[Stef]

difficult child and I went for a "medication management" review with the beloved psychiatrist, and were told that basically nothing more than what's being prescribed will help him. Presently difficult child takes Risperal .5mg x 2/day. We were originally told that .5mg x 2 would be a starting dose, and we'd most likely go up a bit. difficult child was previously on Risperdal, Depakote & Clonidine. The intent was to wean him off the Depakote and Clonidine over ~1 month, and then treat him exclusively with Risperdal. It sounded to us like a good plan. We don't want difficult child on any more medications than necessary. The thing is, difficult child's been quite testy as of late, and I had thought the next step was to increase the Risperdal dosage to level him out. Now psychiatrist says no; that difficult child will ALWAYS act like difficult child, and that no additional medications or increase will help. Huh? Why am I seeing the guy if he basically refuse's to treat him? So..it looks like I might be shopping for a new psychiatrist if difficult child's behavior doesn't level off. He's been on Risperdal about 8 months now. We have seen some improvement, but he still has the edge, and has proven on more than one occasion that he is still quite capable of wreaking havoc. I don't like throwing medications at problems either, but when the psychiatrist says, I can't help him, that doesn't sit well. I told the psychiatrist, is he receiving a therapeutic dosage? I thought the .5mg x 2 was a starting point. He danced around it and thew the difficult child is difficult child and nothing more will help at me. Bullpuckies. Do you think looking for someone else is in order, or do I wait and see with this guy?

Thanks

 

[TerryJ2]

It sounds like he changed his mind, for whatever reason.
I'd switch to someone who's more willing to experiment, excuse the expression, or at least someone who is more creative.
What reasons, specifically, did he give for saying difficult child will always be difficult child? What about talk therapy, in addition to the medications?
Sheesh.

 

[Stef]

difficult child gets monthly psychological counseling from a Licensed Clinical Social Worker (LCSW), and attends a "Changes and Choices" teen group meeting once a week. The psychiatrist just seems to have an attitude toward difficult child, that he can't be helped with medications. That the only way difficult child will change is if difficult child wants to. Now I agree that difficult child must put forth the effort and think. Absolutely. But there is the underlying rage that must be controlled. I'm don't think he can suppress that rage enough without medications. Therefore difficult child won't be able to apply the concepts he learns. He does apply them too. He has told me he trys to, but sometimes he has trouble getting a grip on his emotions in order to do so.

 

[AnnieO]

He has told me he trys to, but sometimes he has trouble getting a grip on his emotions in order to do so.

You could be describing a conversation with my difficult child 1. I agree with Terry that if the psychiatrist is not willing to work with you and difficult child that there might be reason to look for a second opinion. Now I know the psychiatrist may have all the history but sometimes a fresh pair of eyes (ears, brains, etc.) can make all the difference.

Also... Many insurance companies require a second opinion before "major" surgery - when I was a child & had my tonsils out Mom had to do this, take me to someone new for the second opinion. In some cases this is a really good thing. You wouldn't want surgery for a cancerous tumor that turned out to be constipation.

There's also the frustration factor... Even professionals get to a point where they are so frustrated they can't think straight. Is this something that just cropped up? 'Cause maybe that's it. Or, maybe you just need an altogether new one.

(((HUGS))) I do understand... Had to change difficult child 2's pediatrician for similar reasons...

 

[susiestar]

We had similar problems with my difficult child. He has Asperger's and has this amazing amount of rage - due to who knows what.

Because he is physically violent to his sister and I he ended up living with my parents while we tried to find a placement through the courts. The judge and cops kept messing around - cops wouldn't write up my complaint of domestic violence (I will NOT NOT NOT be beaten by ANYONE - ESPECIALLY my CHILD! - it was the cops or I would have eventually killed him - I KNOW myself.) and the judge wouldn't do anything until the cops did.

My dad had just retired from teaching jr high, my child was IN jr high and my dad decided to keep him and work it out of him. He worked that boy in the yard (both of them together trimming trees and cutting out weeds that had 20 years+ to grow) until Wiz finally settled down and started using the tools that he had to cope.

Now wiz is a 16yo senior in High School, getting great grades, doing a technical program to learn to be a machinist, will stay with the program for another year and tehn get a job as a machinist to pay for college! He also has his first job working in a grocery store, is in an anime club at the library, has a Friday Movie club with friends (rotating houses to watch a movie and snack and hang out rather than going to parties or whatever and getting into trouble!) and plays Magic and other games at a local teen hang out that is monitored by an adult and is safe.

So things CAN turn out well, but you MUST provide a physical outlet for the rage. I really think with-o it my son would NOT be outside the "system".

Our therapist really stressed providing a PHYSICAL chore like cutting weeds or scrubbing something for when difficult child was upset or he was in trouble for wreaking his havoc. It was really hard, but it worked.

Maybe something physical would be another way to help your son.

 

[Star*]

Stef,

Hi. I think when Dude was little - I disagreed with "no more medications" logic. Apparently I wasn't alone because in an 11 year period our son was on more than 65 medications. Nothing really helped. Sometimes I thought it did. I was hopeful a bunch, but looking back? Either his system was not mature enough to benefit from the medications, or they were given to adults with results but not recommended for kids and we said to give them anyway (like Zoloft) which resulted in 2 attempted suicide attempts.

Now that we're able to sit and talk to Dude a little more about his life and past - he would tell anyone "NO medications" and mean it. He keeps saying "I want to do this myself." I keep saying "Cars can't run without oil, what is the big deal if you need it and it helps?"

Recently however after about 2 years of NOT taking medications of any kind he went to the doctor. With his current probation, not finding a job, having to look at possible 30 years in jail coming up in a trial, he called on his own and got set up with some Cymbalta. We made NO deal out of it whatsoever. I can't even tell you if he takes it or not. I hope so, he's very depressed since the death of his brother. But - again - I think he sees it as a weakness.

I hoped for years that a pill would cure, then knew it was a joke, and they could only HELP .....IF - behavior modifications were in place. Without the kids' commitment to wanting to deal with his anger? Giving him a pill was like throwing a teaspoon of water on a bonfire. Eventually we figured he would get tired of HIMSELF.....and change. I think backing off and not making suggestions even though it kills me helped the most. If he asks for my advice? I'll help - other wise I'm trying to learn how to back off.

I still, of course, tell him I love him and left the door open to help him in any way if he wanted to improve himself. He insists he just wants to do it by himself.....so for now - that's what he's doing, and Im' glad. If he didn't? How would he ever know that he would be able to or NOT able to? So far - he's able. Less work for me, and bigger sense of accomplishment for him.

Hope something in this ramble helps
Star
I make no bones about the importance I place on a quality therapist - I think a good therapist is and can be much more important to a teen than a psychiatrist. It was for us anyway.

 

[gcvmom]

I would seek a second opinion. 1mg per day is not that high of a dose for Risperdal, and I'm not understanding either why he would just say "that's it" -- especially since he hasn't even TRIED a higher dose to see if it works.

Our psychiatrist would not say something like this unless we had truly exhausted all the options. And even then he would be offering me a detailed explanation for the why's that led us to that end point.

 

[BusynMember]

If a psychiatrist says, "Can't help" I take it mean "*I* can't help, I don't know what to do, and I don't want you to dare have expectations of me." I never accept that from a psychiatrist. I do to another, hopefully better one. I don't believe nobody can help. I think it's his own inadequacy.

 

[Stef]

Thanks for your replies. We're going to stay with the psychiatrist for now as I really hate changing doctors. I don't want to use difficult child as a guinea pig either by having a new doctor start throwing medications at him. That in itself can, and has in the past, been a recipe for disaster. What we'll most likely do is start bending psychiatrist's ear a bit more to get the dosage up a tad. What I could use is some kind of recommeded guidline for an appropriate therapuetic dosage for his age/wt. I've seen the range, but is there a median amount?

 

[gcvmom]

Our psychiatrist typically goes by therapeutic response. He slowly titrates up on an as-needed basis with an eye on the absolute upper limits, but an understanding that some people metabolize drugs at a faster or slower rate. My difficult child 2 is a case in point. He takes a very high dose of Seroquel XR each day, but is functioning fine on it. psychiatrist says if it were too much for him, we'd see it in his behavior.

I think I would just ask for a .5mg increase first and see how your difficult child does on it for a few weeks. If he's not responding or if it's only slight, ask for another bump up. The fact that you've seen SOME improvement on Risperdal makes me think his dosage just isn't high enough yet.

You might also consider a therapist for difficult child if he doesn't have one already. He can learn coping skills to help him manage his anger more appropriately, which will give him extra support besides the medication. Keep in mind, though, that no amount of therapy will work for very long if the underlying neurochemical issues are not addressed. It would be like giving him a squirt gun to manage a forest fire. It's just not going to work.

 

[susiestar]

One thing that can help a whole lot is to keep a daily diary of mood, behavior and the like. There are many charts at sites online, or you can just use a notebook or calendar to write down what happened. I would esp note any violence and the trigger if known. I think it would be excellent to go to the psychiatrist with info such as "he has 4-5 violent outbursts a week where he hits people at home, and an additional 3 - 5 outbursts/rages at school where he hurts someone. These seem to be caused by unexpected events or being told no or asked to do any kind of work. The medicine helped this, but recently seems to be less effective. Can we try an increase in the medicine?

Be SURE you take the notebook or whatever you use with you to the psychiatrist's office. he may want to look at it. It is a good idea to have copies of it at home though, just in case something would happen. You don't want to lose these records in an accident.

 

[totoro]

I think whether or not you choose to increase, medicate or not medicate, your psychiatrist should work with you.
Our psychiatrist always give her suggestions and take ours and K's- then we make a plan.

Right now we are going the least amount of medications and the lowest dose route.
We are working with therapist's, social groups, the SD, our own parenting... anything to not add medications or increase.
Will it work? I have no idea.
But I am willing to try it as long as possible to not over medicate K especially since she has been overmedicated by horrible psychiatrist's who did not know what to do and were not willing to admit it.

But I think a good psychiatrist needs and has to work to work with the WHOLE family.
JMO

 

[WSM]

I'm wondering if the doctor is thinking, it's not so much BiPolar, but personality disorder (even tho he cannot officially be diagnosis'd personality disorder until 18). No drug in the world will help a personality disorder.

That he started with a 'starter dose' but didn't increase it is a bit puzzling. What is the recommendation with difficult child's weight?

I can't advise anything, of course, but I wonder if maybe it would be all right to get a second opinion--not change docs, just supplement?

 

[JLady]

You've gotten good advice here. I just wanted to add that my difficult child takes Rispidal .5mg 3 times a day. We increased it 2 weeks ago from twice a day. It has taken a while to kick in but he seems to be doing pretty well for the time being. I did talk to the psychologist who told me that with AS, medication alone cannot do it all. They need therapy, guidence, patience, and a lot of help. I would get another opinion. We went through 3 psychiatrists until we found one that I was comfortable with.

We too have ADHD and recently went up on that medication as well. It is difficult to find the right medication. Perhaps they can try something else. You need a psychiatrist that you trust.

Good luck.

Jlady