Gifted Issues Discussion homepage Forums Twice Exceptional How to talk to DS about medication?

We have recently made the decision to take DS16 to see a psychiatrist with the idea of trying drugs for DS's anxiety & depression. The was an option talked about last summer and we have been watching & waiting. I had a discussion with DS's psychologist and she agrees he isn't improving and meds might make a huge difference in his case. When we talked about this as an option the other day DS isn't interested in trying meds but I realized later that this is too big a decision for me to defer to my 16 year old.

I've been on the fence because I hate the idea of medications vs. fixing the environment. It just seems like the only way to make it through H.S. these days is to medicate our kids. But I'm not in the situation to do what helped me at this age which was moving cross-country and getting to completely re-invent myself.

Anyone have any suggestions? Success stories? Strategies for talking with him about it. I'm about to go out of town so nothing is going to happen quickly. Anyone's kids on anxiety meds, I worry that some of the anxiety is good and helps him in testing situations.

Perhaps you could switch to a psychologist who specializes in cognitive behavioral therapy. If you can't fix the environment, it might help him to build cognitive tools and thinking patterns to help deal with the situation in which he finds himself. When I was a highly gifted teen with depression, I did not find SSRIs to be helpful at all. Thinking about stressful and difficult situations as problems to solve can be quite helpful, particularly for gifted kids. If he does not want to take any medications, it might be unwise to force it on him.

http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy

I don't have experience with meds with my own kids, although my ds is very prone to anxiety when he's faced with situations that are tough. We haven't been at the point where we've had to consider meds yet, but I absolutely would - and fwiw, we have talked about it with him. I think with a teen often times it's helpful to have the person who talks about it be someone who's *not* a parent. It's also helpful to be able to talk about other people who've used meds to cope with anxiety and it's helped - or even to find someone who's had personal experience with meds and anxiety to talk to your ds about how it helped them and what their concerns were etc.


"Fixing the environment" isn't a solution for anything, because inevitably you'll run into a situation where you can't manipulate the environment, and as parents we need to give our children the foundation to be able to go out into the real world, whatever that world is going to be for them, and be able to cope. Note - I don't see using accommodations as "fixing the environment" - they are means of coping with the environment when the fit isn't there, same as meds are. Just different means of providing the same thing - the ability to function in a situation made challenging by a disability. Hope that makes sense!

polarbear

Of course, having a real person with personal experience talk to him is better, but there are some excellent printed resources from the Annenberg Center, including first-person accounts of managing anxiety and depression in adolescence and early adulthood. Free downloads of these books and access to many other resources at:

www.copecaredeal.org

direct link to the first-person account on depression:

http://www.copecaredeal.org/Files/Teens/MonochromeDays_EN.pdf

and social anxiety:

http://www.copecaredeal.org/Files/Teens/WhatYouMustThink_EN.pdf

I can't remember now which one it is, but one of the books in this series (includes schizophrenia, eating disorders, OCD, and suicidality) was actually written by a major researcher in the field, who has the same diagnosis as many of his patients.

There are also parent/caregiver versions on the same topics.

Thanks aeh. Those look like good resources.

One thing I'm considering is telling him that going to the psychiatrist while the first step towards medication, simply means they will consider it for his case and it isn't a done deal. Hopefully the doctor I choose will be good and explaining why this is the right thing for him. The recommended Dr. is someone who regularly works with gifted teens, so if we can get in with him perhaps the professionals will do a better job than I.

How long has your child been seeing the psychologist? One additional option is to see if another psychologist might have other ideas that would help. There are different approaches and some are more effective than others for a particular individual.

I don't want to make the decision more difficult for you; I know considering medication is not something that you are doing lightly and I take these illnesses very seriously. I also know people who have taken medications for similar reasons for many years and who have felt the medications were very helpful. So I am not anti-medication.

However, I personally wish I had never tried them. I actually took an SSRI for 10 years and spent much of that time wanting to quit, but found that no one was supportive of that idea. I ended up discontinuing the medication myself prior to pregnancy and have not taken SSRIs since (over 10 years now). It was a very slow and difficult process. I feel like cognitive behavioral therapy gave me tools that have been helpful in the long term in making permanent changes that made dramatic differences. I don't have anything positive to say about my experience with medication.

If you would like to know more about why I disliked the experience, I'd be happy to discuss it via private message. The main thing, though, is I think that there is a tendency for doctors to underplay the difficulty of discontinuing the medications as well as other possible complexities. There is a recent paper discussing how the number of receptors decreases as a compensation and that this may (or may not) have long term effects on susceptibility to depression. One research paper isn't the full story, of course, but my impression is that most doctors and psychiatrists (at least those that I have encountered) underplay these issues. The exact biological basis of these disorders still isn't clear and the evidence for the effectiveness of these medications is more conflicted than one would think from their ubiquity. As a biologist, I can explain more if anyone is interested, but don't want to belabor it.

So my thoughts are that medications may be very helpful for some people, but that it's important to get good information about what to expect. I have actually been thinking I may need to consider them for my daughter at some point because she is in therapy that is not helping sufficiently. However, I would only be willing to work with a psychiatrist who was willing to discuss the costs and benefits in detail to help in the decision. Maybe I have just been unfortunate, but the doctors I've encountered (both as a patient and informally) have focused on the benefits with very little information on costs.

I'm sorry for the novel, but I have thought about this extensively over the years and try to keep up with the research because of my interest.

He doesn't have to commit to meds for life. I don't know about the but when I started high school in tgUStge In0's there were only 7 in a school of 600 in 7th form(12th grade). Many kids left to work at 15 and a generation or 2 before that kids left school at 13 or 14. What I am saying is I think it is the expectations put on the kids that has changed not so much the kids (although probably more walking and fresh woukd help us all).

My opinions on the SSRI and SNRI classes mirror apm's.

My terminal degree was obtained in neuroscience, specifically on the neurotransmitter systems of the midbrain-- and HELL yes, to what apm notes about the relative blind spot in clinicians wrt what researchers in this field know about those meds-- and that it has been known for a long, long time.

There isn't a way to "trial" them. If you take them, you do risk permanent epigenetic impact on that biogenic amine neurotransmitter system. Sorry, but that is so.

I, too, do not mean to make light of the difficulty of medicating using one of those drugs (either in the stimulant class or in the SSRI/SNRI, or MAOI classes), but this is something that was observed in rodent models by people I know personally. The changes induced by use of drugs which modulated reuptake of biogenic amine neurotransmitters lasted longitudinally for the life of the animal.

Clinicians really don't seem to have any idea-- heck, most pharmacologists I've known didn't. It's worrisome as a thing among all psychotropics, if you want my opinion (I know that you didn't ask-- I'm offering ).


Other things which have a great track record with anxiety include non-medication therapeutic interventions like EDMR and CBT, and more specific desensitization strategies.



I did PM you.

EMDR.

Sorry, being nitpicky!

...my opinion on psychotropics is that there are people for whom the severity of their symptoms during a specific period of time prevents them from accessing behavioral or psychoeducational therapies or self-management skills. Rather than allowing them to continue in free-fall, it is sometimes useful to include pharmacological interventions as scaffolding to bring those other strategies within reach.

The costs admitted, sometimes the benefits are worth it for that individual.

Note: I am not an MD or neuroscientist, and my grad work in the biological sciences was restricted to single-celled organisms! I do, however, work with children with behavioral health challenges on a daily basis.

EDIT: Yes, the CBT/DBT/RET family are my first recommendation as well, for anxiety & depression. Done well (meaning, by both clinician and client), they can be as effective as meds.

HowlerKarma, thank you for saying more effectively what I was trying to say diplomatically. I'm not against meds, but think people need to make the decision with high quality information on costs and benefits to genuinely decide whether taking meds is the right decision. I also tend to be hesitant about EMDR (there is empirical support for it, but not specifically for the eye movement component). Regardless, though, the point is that good information is essential so that one can make a careful decision about whether it's the best decision in a particular case.