Update, answers to questions, medication cocktail

[mindinggaps]

Hi all, I'm an adult living with ODD, anxiety and depression, originally diagonsed at age 4. I've written about some of my experiences here and in particular have detailed my experiences with medication both very young as an adult. Many people had questions, but unfortunately I was somehow locked out of my account. I am back now and would firstly like to thank @Deni D for helping to resolve this! I'm hoping this post answers some of the common questions I had in many DMs.

One common question which people were curious to know is if I am on medications today and if so, what? Yes, I require medications to manage my condition. Without medication I become angry, violent and am unable to function properly. It is essential for me to be on medication at all times. As a testament to this, a couple of years ago I stopped my medications with near catastrophic result of losing my job and relationship. I grew up taking primarily Prozac, along with a few others but today I take a more complicated cocktail which combines a high dose of Prozac with some other medications (ask if you'd like to know more...). This combination took a while to craft and targets all key symptoms - anger, aggression, depression, anxiety, compulsions, etc.

Many have wondered why Prozac was used for me as a young child. Firstly, Prozac is an amazing medication for ODD and it can curb a lot of issues. However, there is also context here...I was diagnosed when Prozac had just entered the market for adults and there were very limited options for pediatric patients. I was tested to see how it could be used in young children. Nowadays, it would probably be a starting point but other things could be added - mood stabilizers for irritability and anger, ADHD medications for impulse control, etc.

 

[Copabanana]

Hi Mindinggaps

A number of us have been locked out and Deni is getting us back in one by one. I think I was locked out about 4 months but it feels like longer.

I would be grateful if you told us what the other medications you take in your cocktail, and what each of them targets.

I applaud you for having the perseverance, motivation and stamina to work with a psychiatrist(s) to come up with what you needed. It must not have been easy.

I seem to remember when you came to the forum it was around stopping the medication. I remember how frightened your parents were.
You learned from consequences. I know this sounds rationale, but so few of us do.

I think you are a truly extraordinary person and a great resource for us here.

 

[mindinggaps]

Dear @Copabanana - welcome back to the forum. I'm very glad we've been able to resolve the issues with being locked out. I am hopeful that my experiences may provide some insight or information which is useful to those dealing with children suffering from various conduct, mental health and/or behavior issues.

Firstly, indeed you are remembering correctly - when I originally came to the forum, in an act which can only be looked upon in hindsight as defiance, I decided to stop medications. I have been on medications since I was very young and for the most part have remained compliant, which has been a very important factor in my ability to live a stable life. However, there have been times when I have stopped medication, usually (not always) against recommendation. The recent decision to do caused great concern for my parents and rightfully so. Shortly after stopping the medication, things deteriorated quickly - I became volatile, angry, irritable, highly anxious with immediate disruptions to my ability to work. Fortunately, I was able to sense things spiraling out of control and received intervention before permanent damage was done.

One key takeaway from this experience, which I believe is true for many is that psychiatric treatment is mandatory. It does not guarantee success, but without it, there is little chance of living a stable life. For many people in challenging circumstances, step one simply must be ensuring medication compliance because without this, no progress can be made. This is easier said than done since access to quality care can be very hard. I have been fortunate to have had world leading care and feel very lucky for this.

With regards to my current cocktail, it has taken a while to build out successfully, but it is working very well. The components are:

• Prozac 60mg (SSRI) - I have been on this most of my life and continue to rely upon it. It reduces anxiety and depression but also lowers irritability, improves mood and helps with emotional regulation. This is the primary component of the cocktail and other add-ons support its main functioning.
• Abilify 5mg (atypical antipsychotic) - This is a small dose add-on to reduce anxiety and boost the effects of the Prozac. However, the main target is to reduce rage outbursts, anger and aggression.
• Lamictal 100mg (mood stabilizer) - This is a fairly low dose which reduces low mood, stabilizes emotions, reduces impulsive behavior. It also offers added anger control and reduces agitation to help with compliance on the rest of the cocktail.
• Effexor 75mg (SNRI) - The most unusual element, this is an auxiliary antidepressant. It's main goal is to reduce obsessive and compulsive behaviors but it also provides a low level boost to mood and energy levels.
• Vyvanse (stimulant) - General behavior control with a specific target on impulse control

The reality is for those with severe behavior and conduct struggles, many medications which target the various symptoms are required. Please let me know if you have any questions - I am happy to provide additional details and some context on how this cocktail was built.

 

[lovemysons]

Hi Mindinggaps…
I was on 20mgs of Abilify for years after my psychotic break at age 40 in 2007.
Unfortunately I developed a strong gambling addiction while on it, which I still have even though I don’t take Abilify anymore. It got worse after my mentally ill addicted son died 2 years ago.
A side effect of Abilify is a strong gambling compulsion.

Also my son was prescribed Vyvance once and abused it and became psychotic and had to be hospitalized for a week afterwards.

Knowing the side effects of these medications is very important in my opinion. As well as taking them exactly as prescribed.

I no longer take Abilify. I take Lurasidone, Depakote and Lexapro to keep me stable.

Like you, I must take mental illness medication the rest of my life. The doctors told me and my family that if I went psychotic again they may not be able to bring me back. This is very frightening to me as what I went through in my head was horrific!

Just sharing my experience. I’ve enjoyed reading your posts and your own experiences.

 

[mindinggaps]

Dear @lovemysons - thank you for sharing. I'm sorry to hear about your negative experiences with Abilify and Vyvanse. However, I am happy to hear you have a medication combination now which is working for you. Finding the right balance is always a struggle and is a continual process of fine adjustments.

While side effects are always a concern and something which must be mitigated, I personally have not had any negative issues with Abilify, Vyvanse, or any current components of the cocktail - it is working well and having the desired effects. It's also worth mentioning that my Abilify, Lamictal and Vyvanse dosages are relatively low and this is because they are add-ons targeting specific effects. For additional context here it is probably helpful to understand my clinical diagnoses. As a child I was diagnosed with anxiety, depression, Obsessive Compulsive Disorder (OCD) and ODD/conduct disorder. As an adult much of this is the same, however things are a bit more clear now: Generalized Anxiety Disorder (GAD), major depressive disorder, Obsessive Compulsive Disorder (OCD) and intermittent explosive disorder (Intermittent Explosive Disorder (IED)). Adjustment disorder (sub-type disturbance of conduct) has also been posited, but it is difficult to untangle comorbidities.

Based on this, some medications are not used for their main indication. For example, Abilify is an atypical antipsychotic, but in my case it used because in small dosages it boosts treatment of depression and Obsessive Compulsive Disorder (OCD) while also reducing anger and aggression. Likewise, while Lamictal is primarily used as a mood stabilizer, it is extremely useful for Intermittent Explosive Disorder (IED) treatment and effectively neutralizes angry and aggressive outbursts. We've worked hard on finding methods to eliminate dangerous or violent outbursts of anger and a large dose of Prozac with small additions of Abilify and Lamictal has worked amazingly well.

With regards to side effects and taking as prescribed - yes, you are correct, this is extremely important. Fortunately, I have lots of experience and first started psychiatric medications as a small child. I dealt with managing them my whole life. In fact one thing which I think has helped me a lot is that I was medicated young and developed an understanding of the importance of medication. I think for extreme cases of conduct disorder or similar issues in young children early intervention and medication are crucial.

 

[Copabanana]

You know we have had a number of parents come here to the site with very young children. Multiple parents, usually Moms with 5 year olds with rage and aggression. They describe their children as loving and well-attached with this extremely difficult side that renders them unwelcome in school and potentially dangerous with younger children in the house. The parents were desperate and besides themselves.

WE NEVER KNEW WHAT TO TELL THEM. Except I would say, go to a regional Children's Hospital and seek out the behavioral health team and get comprehensive psychological testing and evaluation which involves a treatment team and child psychiatrist.

Oh. If we had only had you here then.

As you look back at your life, do you think that there was some biochemical dysregulation? Do you think there are genetic factors? Do you think it matters (etiology0 or only the treatment and medication compliance.

I think your parents are heroes, too.

 

[lovemysons]

Those are interesting questions Copa. I know for awhile I didn’t want to accept that I had mental illness (stigma). I mean how did I function for 40 years without medication???
Against the tide for 40 years, that’s how.
I also tried quitting my medication and within 5 days was crying hysterically and telling my husband how the world would be okay without me. I realized I absolutely have to take my medicine now.

I know there is a genetic component to my illness through my bio dad that I was not raised by or close to. My son who passed away was the spitting image of my bio dad.

I definitely wish I had known more about mental illness when my sons were young. I was not raised around boys or a father so I didn’t know that I had more than just challenging rambunctiousness boys. It wasn’t till their teenage years when drugs got involved that I was first told about Bipolar Disorder in my son who recently passed away. The medication they gave him made him zombie like and very depressed. I took him off of it and did not take him to see a psychiatrist again for many years. If he had been on medication the whole time…maybe he would have accepted his mental illness and eventually gotten on the right medication.
I’ll never know now.

 

[mindinggaps]

Dear @Copabanana - as always you raise excellent points and ask very good questions. There is lots to discuss here.

You know we have had a number of parents come here to the site with very young children. Multiple parents, usually Moms with 5 year olds with rage and aggression. They describe their children as loving and well-attached with this extremely difficult side that renders them unwelcome in school and potentially dangerous with younger children in the house. The parents were desperate and besides themselves.

WE NEVER KNEW WHAT TO TELL THEM. Except I would say, go to a regional Children's Hospital and seek out the behavioral health team and get comprehensive psychological testing and evaluation which involves a treatment team and child psychiatrist.

Firstly, regarding this recommendation you are spot on in my opinion. The minute high and dangerous levels of rage and aggression are identified, to the best extent possible parents should seek comprehensive psychiatric evaluation and commence treatment as soon as possible. Obliviously, this isn't accessible to all, but lots of research does show that early intervention leads to better longer term outcomes. I believe I am an example of this approach.

My symptoms emerged very young. This was in the late 80s, it was a different time. My parents had to fight hard to seek help and ultimately found experts who were willing to do experimental trials with medications. At this time the usage of psychiatric medications in young children was almost unheard of, but my parents enrolled me in a clinical trial for Prozac because they were worried about the long term impacts of the rage and aggression. I will be forever grateful for this because it gave me a chance. Properly medicated, I was able to exist in normal classrooms, engage in regular activities and proceed through life. Without medical intervention, this would have been impossible and the trajectory may have been very different. Of course, nowadays there are much more standard approaches and medications along with other treatments are more readily accessible. Acting quickly and administering proper treatment is a must in my opinion.

Before answering your question about cause, I'd like to touch upon another subtle benefit of early intervention which is building understanding in the young patient. There is often a desire to sugarcoat issues, but sometimes clear communication on the issue is required and young patients must understand their situation - they need medications in the same way someone with type 1 diabetes requires insulin. Psychiatrists were clear to me regarding this fact and it led to better compliance and deep understanding of the situation. Do not hide it. Growing up, all caregivers and those responsible for me were aware of the Prozac treatment and knew that without it, aggression and rage were inevitable. In conjunction, I knew I needed the medication and did not want to experience rages - as a result I was diligent with adherence and could also sense when dosage adjustments were required, requesting changes as needed. I always had clear discussions with psychiatrists and they also trusted that I would be transparent. This is something which continues to this day because I learned how to do it at a young age.

Typically, a properly medicated patient will want to comply and a good psychiatrist will work to ensure things are going well. I view my cocktail very pragmatically and see it as something which is a constant work in progress. I can provide more details here and have some clear and interesting examples of useful exchanges with the psychiatrist which led to changes in the cocktail - let me know if helpful.

Now, regarding the cause, I believe it is a mixture of biochemical dysregulation, genetics and external factors. Many examples of rage and aggression can be attributed to different activities in areas of the brain stemming from either stress at a young age, stress in the mother during pregnancy or environmental factors. Ultimately, who knows and in some sense I don't think it matters. We can get very caught up asking why, but this doesn't help move the actual situation forward. Knowing the underlying reason is something many parents seek, but it can be a philosophical question rather than a useful one - that energy is likely better spent taking action. Digging for the background also doesn't impact treatment plans, which are often the single most important aspect of long term prognosis. For my parents it was more helpful to know that strict adherence to Prozac prevented rage and aggression than it was to know the background for it.

 

[Copabanana]

My son needs medication. He refuses to take it. He recognizes he is mentally ill to an extent, but only sometimes, begrudgingly, even though he is tortured by his symptoms. He sees causation outside of himself, in paranoid terms, like conspiracy theories, or delusions of being followed, etc. His poor thinking is a consequence of his mental illness, and a barrier to his treatment.

He has never been medication compliant, due to what he says are adverse reactions to medication. For a variety of reasons, he does not have the motivation or stamina to work together with a physician to find the right medication let alone cocktail.

I am wondering too if he enjoys his symptoms. That is common with people with bipolar who can like the mania. But most likely his refusal to take medication is a product of his mental illness itself: Lack of insight, suspicion, and thought distortion.

I am in a situation where I have to watch him deteriorate, and I am helpless. The only thing I can do is to protect myself.

While my son had mild behavioral problems as a child, he did not require the kind of intensive treatment that would have helped him establish the alliance with professionals that is so crucial. My son's really difficult symptoms came as a young adult, at a time when I no longer had control.

 

[mindinggaps]

Dear @Copabanana - First and foremost, I feel for your situation. As difficult as it is, you simply cannot blame yourself for your son's struggles. You have clearly been a positive and supportive parent and have tried to do what you can. However, there is only so much you can do and you must take care of and protect yourself. He is an adult and is ultimately responsible for his mental health. For many situations and classes of mental illness, issues do not appear until adulthood, like for your son. Of course, in these cases, the concepts of very young and early intervention are not possible. There is nothing parents can do.

Once again, you raise many interesting things to think about. Of course, given his situation, the likely reality is that the only pathway to stability for your son is a medication cocktail which would take time, energy, input from quality physicians and crucially some self awareness to build out. At a high level, lack of compliance, often caused by poor thinking should be thought of as a symptom as you correctly mention. However, compliance and its intertwined relationship with side effects and symptoms is a very complex topic. Compliance is very hard and your son's struggle with it is far from unique. Consider the fact that even with a lifetime of experience managing medications, awareness that I require medications and quality care, I have had periods of not being medication compliant.

Unfortunately, remaining compliant can often be what I would describe as a "chicken and egg" problem. A carefully crafted cocktail will often include treatments which target the symptoms that lead to lack of compliance. However, how can you get to this point if the patient isn't willing to engage in treatment? To this day, remaining compliant is a work in progress and something I am continually refining with my psychiatrist. After I most recently stopped my medication, one of the main goals was introducing treatments which specifically would help ensure I did not have the impulsive or compulsive urge to stop medication. I can provide many more thoughts and details on what is required to remain compliant, along with some of my own experiences if it is useful.

However, I did want to touch upon something you brought up which is very important - the possibility he may enjoy his symptoms. This is very possible, perhaps even likely. I can tell you firsthand that there have been many points in my life where I have been deeply excited and entertained by the effects of my rage and aggression. I had a desire to create chaos. This is a symptom. It is a bizarre irony that enjoying the symptoms of the illness is itself a symptom. The goal here has to be building some base level of stability which provides the self-awareness required to identify when this is happening, which can then lead to refinements in treatment, but getting that point is far from easy.

 

[Copabanana]

You raise very interesting points mg, and I am especially intrigued by this: I have been deeply excited and entertained by the effects of my rage and aggression. I had a desire to create chaos.

I have to go to sleep now but you speak here to a mixture of distorted or maladaptive motivations, feelings, as well as thinking. This gives me hope for my son and myself.

In fact, he called me just as I began this post. He seemed manic, but he is listening to me, and seemingly entertaining the possibility of going to begin the process of seeking medication management. (I need to not hold my breath, because that creates problems.)

I would not have had the hope had we not been having this conversation. Really. I was able to say to him when he complained that he was not accomplishing anything, that you're not following through is a symptom.

You see, I can get moralistic, judgmental and punitive. I just shut down. By your speaking to me I was able to stay in a place in myself that was rational, contained, and neutral. Thank you very much.

I will write one more thing. My son did see a psychiatrist, actually a child psychoanalyst who was involved with us for many, many years. He died a year ago and it was devastating particularly to me. My son completely trusted this man who was caring, wise and highly ethical, as well as brilliant. I am reminding myself that this alliance my son had formed from 6th grade on (he is now 34) while not centered on medication, can be a prototype to working with a psychiatrist now. Thank you so much.

 

[mindinggaps]

Dear @Copabanana - Based on what you say, while the future for your son will be filled with uncertainty and challenge, I do believe you must hold onto a glimmer of hope. Deep down, he may have the capability to tackle his illness if he can somehow implement some initial small positive steps which can serve as building blocks for appropriate treatment.

As challenging as it is, you must also be kind to yourself and remember that ultimately initiating medical treatment is his responsibility. He must want to get better and be willing to at least put in effort to become compliant with medications. You can continue to love and support him, but you cannot make him seek medical help. I suspect the best you can do is continue to provide gentle, patient and non-judgemental support while also protecting yourself. With this you can hope that he will one day find what is needed inside himself. Remember that his desire not to seek treatment, his inability to follow through and his previous failures with medication are all underlying symptoms.

Your indication that he had a positive relationship with a child psychoanalyst which was long-standing, mutually beneficial and trustworthy is something which can only be looked at as a positive. It indicates that deep down, your son does potentially have the ability to form a beneficial therapeutic relationship. It is not realistic to expect that he will seek help and be given medications which alleviate all symptoms and provide stability. This takes years of effort, but perhaps a small success like establishing trust with a doctor is feasible.

I would like to expand upon and provide context for the concept that those suffering from mental illness may enjoy their symptoms. It is very common and I personally have enjoyed wallowing in depression, becoming violent, screaming and yelling and watching those around me suffer as a result of my behavior. As you highlight these are maladjusted motivations, feelings, and thinking stemming from illness. Even now with my current cocktail, urges to stew in chaos can bubble to the surface. Of course, they are not acted upon and now I am able to identify and prevent issues, but we are always working to improve.

There have however been points in time where things have become unhinged, typically in my younger years when things were less well controlled. One example which comes to mind is a phase I went through as a pre-teen where I strictly refused my Prozac. Within a few days my rage and aggression became so out of control that I was ejected from classrooms. What is noteworthy here is how much I enjoyed the chaos around me - I loved every second of the mayhem and wanted it to continue. This is very common for ODD and conduct disorders. My parents lost complete control and had to initiate a trip to the hospital where immediate action was taken. My Prozac was increased substantially and Risperidone (which at the time was one of the few options available) was added to both quell aggression and help with compliance. The psychiatrists had a clear hypothesis of what happened here. While Prozac was keeping me under control, I was growing rapidly and thus the medication levels in my body were decreasing. Appropriate adjustments were not made to accommodate and at some point, critically low medication level triggered the emergence of a new symptom - medication refusal. The main point here is that situations can be highly volatile and that medication refusal was clearly seen as a symptom of the illness.

 

[mindinggaps]

Dear @Copabanana - Today I had my regular psychiatry and medication appointment. Since we have been discussing medication management and compliance, in case it is of interest to you or others, I thought I would share a bit about this process.

My appointments take place every 1 to 6 months depending on circumstances and adjustments. My last appointment was 3 months ago and today we reviewed the outcomes of the latest changes and made some minor tweaks to the cocktail. The primary concern is typically Intermittent Explosive Disorder (IED) symptoms - we always begin by reviewing if there have been any breakthrough events of rage. Fortunately, I have been symptom free for some time now. Side effects are discussed and I have the opportunity to raise concerns here. After this, further probing questions are asked to evaluate the situation and I also have the ability to express any thoughts or concerns about behavior.

Lately our primary focus has been managing compliance. At this point it is well known that with appropriate medications, I am able to do well. However, we know that I have aburtly stopped medication with disasterous results - this is viewed as symptom and we work to have treatments which will prevent this from happening again. One thing the psychiatrist monitors is any urges to skip doses and what the underlying reasons are. For the most part there have not been significant issues here, although urges to skip medication or thoughts of enjoying symptoms have not been totally absent. After discussing options we decided to slightly increase the medications specifically targeting compliance and also to boost support for mood control. To accomodate for this without risk of side effects, we lowered some impulse control medication since it is clear this is well managed. The results is a slight increase to Abilify and Lamictal with a lowering of Vyvanse. We will follow-up in 1 month to observe for side effects or adverse events.

One issue which I am sure you can see is that success in this process does require input from the patient, trust between the physician and patient and also some self-awareness and desire to get better from the patient. With my input into the process, there are limitations to what can be achieved.

 

[Deni D]

mindinggaps, it's so nice of you to be here to share your experience with medication. I can tell your psychiatrist is careful with medication increases and doesn't just follow the instructions for dosage and increases. My son's longterm psychiatrist when he was young was very good with that too.

Things got out of hand for him when he got older and into other stuff when he was trying to fit in with a group who were acting out and trying to impress each other. That eventually led to a number of voluntary and involuntary hospital stays. I was shocked with the quick titration of medications and the variety he received most of the time. Basically if someone is hospitalized and they are only there for a few days there's no way to get them stable anyway.

So I'm thinking there are folks here wondering how they can possibly get their loved one from where they are now to where you are now. It takes a longtime of course, and patience with the process, trusting the process. It's a difficult thing for anyone let alone someone who's not able to think right. A couple of things I've learned from my son's experience have been:
1. Social workers in the behavioral health area for both in patient and out patient treatment at hospitals with a good mental health unit help people with resources. They help people with many things around getting them transportation, insurance, linking them up with other organizations for housing, food and things like that.
2. This is a touchy one. I am in no way connected with the medical field so take what I'm saying here as just a layperson's experience for the situation particular to my son. He took Abilify when he was young and is taking it again these days. It's an antipsychotic and calms people's brains down so they can think clearer. It's typically used for people with Bipolar disorder who also have Schizoaffective tendencies and for people with Schizophrenia. When he was hospitalized the last time a couple of years ago they started him on a form of Abilify that's a shot. After the first dose he had the second one two weeks later and then after that it was once a month. It helped him with compliance because it was a once a month shot. At the same time he was also trialing and titrating other medications. He's back to taking the Abilify in pill form now.
3. He still goes to the clinic for behavioral health at the hospital and he likes them there. I would have preferred he switch over to a private psychiatrist. But they give him appointments without a long wait time and deal with the forgetting of appointments and last minute changes he tends to run his life with in general.
4. Therapy, he didn't like the out patient program, but he complied, because they basically dragged him there a few days a week. He didn't feel he was getting much out of it, he had done it before, and felt uncomfortable there. So I offered to pay for a therapist and let him find one he felt was good. He found a therapist who did virtual appointments. It worked for then because all he had to do was take her call at the appointment time so he didn't miss the appointments. He liked her but stopped seeing her after about 6 months. This is something I bring up to him every once in a while when I can. I feel he should be in therapy regularly but of course it's up to him.

mindinggaps, can you think of anything else from the time when you had stopped your medication that helped you to get to deciding to go back to taking your medication? More like outside influences, that could help someone who won't listen to family and maybe doesn't have the history of knowing what the difference is between being stable and not?

Thank you so much for your insight.

 

[lovemysons]

Hi Deni…
How is the Abilify working for your son? I was on 20mgs at the end and had developed compulsive behavior’s…one of them being gambling which is associated with Abilify. Has your son developed any compulsive behaviors? Sounds strange but I also picked on my face relentlessly. Sad…I used to have a beautiful complexion.

Just curious. These medications can have unwanted side affects.

Mindinggaps you are a success story and I am so glad you are. You have a lifetime of experience and now as an adult great insight.
I’m glad you’re here for us all to listen and learn from.
You never know how your experience may help save one of our children out here. Thank you

 

[Deni D]

Lovemysons, yes good point about the side affects with Abilify. He had not developed any compulsive behaviors when he was young and I was in control of everything. I haven't noticed any now that he's older but I'm only so privy into his personal life. But the movement disorder, tardive dyskinesia, he did develop a couple of years ago. He tried medication that was for stopping the movement disorder. It worked but it made him very tired so he stopped. As time when on it gradually slowed down to where he mostly doesn't have it anymore, only once in a while. For him it's his right hand where his fingers move in a sort of sequence, always the same. He was able to just put his hand in his pocket or hold onto something to get it to stop so it didn't bother him so much when it was happening a lot. But for others, from commercials I've seen on TV, it could have much more of an effect on them, like a facial tick or something more noticeable.

My son is very good about taking the Abilify these days and says for him it keeps what he calls intrusive thoughts away daily. And he thinks it's his safety net from ever dealing with the psychosis he experienced a couple of times. From my view it seems to keep his over reactions to things and seemingly wanting a good dramatic argument over nothing away. If he drinks or does any substance other than pot it seems to make his medications stop working immediately until whatever is out of his system. He also takes Lamictal over the last few years, was taking Lithium when he was growing up. His, his father's and his grandfather's type of Bipolar would be considered more of a mixed state in general but they have all had episodes of psychosis.

 

[lovemysons]

Deni

I had a psychotic breakdown in February of 2007 at age 40 and that is when I started taking Abilify. I really did love it because I no longer had any social anxiety problems or deep depression which I had lived with all my life. Overtime it eventually stopped working and I had also developed that gambling problem as well as picking on my face compulsively.

I’m sorry to hear your son developed tardive dyskinesia. But I’m glad it’s only in his fingers and not his face. Sounds like he deals with it as best as he can.

It’s very difficult to butt in and be involved with an adult child’s psychiatric treatment. The fact that your son knows that his medications absolutely make a difference in some areas of his life sound promising for continued treatment though. So that’s a plus!
My son never did. In fact he told me that Meth use was the only thing that made him happy.

Today I take Divalproex 500 mgs,
Lurasidone 60mgs, and Ramelteon 8mgs.

I no longer pick on my face but I still gamble a lot! I recently stopped smoking cigarettes.

Like your son, I never want to experience psychosis again! It was very terrifying! I saw demons, the devil, womens voices turned into mens etc. The scariest thing I have ever experienced!
I will do whatever it takes to avoid another episode!

Mindinggaps…I hope you don’t mind me adding my experience to your thread.

 

[Deni D]

Lovemysons, I'm just so sorry about your son. I'm sure my son has tried about everything under the sun, luckily he has not found anything other than pot that he really likes. It's not the best situation but it doesn't mess with his medications so that part is good. I can tell when he's into something he shouldn't be from the way he starts acting with me. Just recently I think it was drinks with Kratom in it. Now he seems to be off it. I find with my son the more I butt out the better chance he will turn things around himself.

My son was running from demons when he jumped out of a second story window. Luckily he jumped from the back of his apartment onto grass and not the front onto pavement. He was not hurt, or at least if he was somewhat bruised he didn't notice. One of his neighbors saw him jump and called 911, then he went for an involuntary hospitalization, again. He seems to have a lot of luck with things, the grass, and someone saw him because who knows where he would have gone if he had taken off from there.

 

[mindinggaps]

Mindinggaps…I hope you don’t mind me adding my experience to your thread.

@lovemysons - I appreciate your contributions! Your input is very valuable and I am sure your experiences will provide help and insight to others.

@Deni D - Thank you for your post. You sound like an incredible support for your son. He is lucky to have you. Before directly answering your question, I wanted to add a few comments on some of the other points you raised, because I think you touched upon a number of very important things.

Firstly, having a diverse set of supports which includes social workers and therapists alongside psychiatrists is the best recipe for success. Building this out can be very challenging but as your post outlined, each component plays a role. Ideally, with a collaborative approach hospitalizations can be avoided because as you correctly point out, they usually involve rapid and dramatic changes to medications in an attempt to achieve stability. In practice this is hard and can result in problems. What is implemented in a hospital setting likely won't work more broadly and can actually result in longer term setbacks. Medication management is more successful when done gradually and under close monitoring. For compliance, the use of injections is controversial and typically reserved for certain classes of disorders. However, when it is necessary, they can make the difference between life and death. I think it can very often be the right thing to do.

My son is very good about taking the Abilify these days and says for him it keeps what he calls intrusive thoughts away daily.

I was very interested to read about the positive impact Abilify has for you son. I take Abilify for different reasons but find it has a very similar positive impact. In my case, Obsessive Compulsive Disorder (OCD) causes serious intrusive thoughts and obsessions and Abilify when paired with Prozac really helps keep these symptoms away. It also lowers my reactivity, aggression and desire to argue or fight. While some do have paradoxical reactions, I find it to be a very useful medication and nowadays it is used a lot for depression, Obsessive Compulsive Disorder (OCD) and anxiety as an add-on because it is so effective. It is absolutely crucial for my treatment and one of the medications I simply cannot live without.

mindinggaps, can you think of anything else from the time when you had stopped your medication that helped you to get to deciding to go back to taking your medication? More like outside influences, that could help someone who won't listen to family and maybe doesn't have the history of knowing what the difference is between being stable and not?

To directly answer your question, the best situation is when you can realize within yourself that stopping medication is causing serious issues. There have been times when I have stopped and felt my life spiraling out of control and then sought psychiatric care. However, to have the self-awareness and experience required to achieve this is rather challenging. More realistic is additional support systems like you've mentioned. Therapists can be extremely powerful in this regard. They will know what medications you are taking and be able to judge whether or not you are complying properly. The issue here is that therapy can be hard to access and many patients will not want to do it. Friends or partners can also be valuable here - any support system where there is trust and the person is willing to listen. Ideally, the more the better.

For me, perhaps the most important thing was recognizing that compliance was an issue. With that, therapy played a part. We work to identify why there is a desire to stop medications and what can be done to control this. Additionally, as I've mentioned, a good psychiatrist will recognize this as a symptom and build something into the treatment which helps control impulsive behavior. In my case, while I do well on a combination of Prozac and Abilify, I sometimes would have urges to stop. We introduced medications specifically targetted to control this impulse, which combined with therapy and the various other supports has been successful.

 

[Crayola13]

Seroquel and s great for aggression and anger management, but the side effects are horrible. My grandma was given Seroquel at the nursing home because she was punching nurses and throwing things at other patients. It’s not really approved for dementia patients, but doctors at nursing homes prescribe it, anyway, just because it’s so effective.