Disturbing incident in triage .....

happybunny1970 · Jul 18, 2007

While I'm not with Tom Cruise on the issue, I do feel that there are WAY too many people out there trying to 'medicate' their problems (and the perceived 'problems' of their children) rather than to root them out, acknowledge them, and work through them. Heck, I was one of them. I had a serious bout with depression at 30 (turns out there is a strong history of it in the family, significant percentages of psych commitments and suicide, thanks for telling me this in advance Mom & Dad...), so the first thing I did was consult with my physician. This was also the same year I started nursing school (does anyone see where I'm going here? Big life change, stress from school/work/family...).

Joe Doctor doesn't even blink, he just whips out the old Rx pad and writes out a script for Zoloft (very big at the time) and Ambien (he said I'd have trouble sleeping). Seems to help for a bit, then not so much. So he writes for a larger dose. Then he's adding a second medication. Then increasing the doses of both to the max. Then let's try a third. I was a good little patient and took what I was prescribed, figuring he knew what he was doing, and having this blind faith in the field since I was studying to be a part of it.

Long story short, I did make it through school, and did very well there, but things sort of fell apart when I left school for the 'real world.' I eventually ended up seeing a psychiatrist, who then REALLY jacked up all the meds, and tried a couple new ones every month or so. Man, I didn't know WHAT I was doing. The whole point of taking these antidepressants is to alter the way you're thinking and feeling, but nothing ever got better, you know?

Never once in all of this was I asked, "What is it exactly that is troubling you? What is going on in your life?" Therapy was never suggested. Just drugs.

I recognize that these medications, when prescribed and utilized appropriately, can help people quite a bit. But my own experience is that they are just a starting point, and no drug in the world is going to make the circumstances of your life any better.

We went away for a vacation about 4 years into this, and for whatever reason I 'forgot' to take the medications. I was so busy and so involved with my family that they (the drugs) were just an afterthought. What was really amazing to me (after I realized that I hadn't been taking them for a week) was that I had no withdrawal symptoms. I had tried twice in the past to go off the meds on my own because I suspected they were making things worse instead of better, and suffered horrific crying jags and other symptoms. But after this vacation, I came back and decided to try therapy. I found a great lady to talk to, who helped me to find what it was that was making me so unhappy. All of the things I'd bottled up over the years, all the fears I'd had, all the dreams and anxieties I'd had. It took time, it was hard as hell, but after every session I felt so much better, and not only that, things actually GOT better.

Life in these United States is so fast-paced, so involved, so BUSY all the time, and especially with so many two-income or single-parent households, we're all exhausted at the end of the day. So when Junior is misbehaving because he's not getting either the attention he craves or the supervision and direction he needs... and then you throw out all the 'pop-psychology' out there that says they all need medication...

I guess it all boils down to what are we teaching the general public, and in particular our kids? Is it any wonder there's so much substance abuse out there, when there are ads for every psychotropic medication under the sun in all the magazines and on all the TV stations? Feel sad? Aw, heck, that's not necessary! You must be depressed! Take this pill and it will all be better! Have those down days, but sometimes have those really great up days, too, when you feel you're superwoman and just go-go-go until you drop? Oh, my! You must be BiPolar! Here, take this! Junior can't sit still through 8 hours of school, even though the school system took away all but 15 minutes of recess (and they get that at the END of the school day??) We can fix that! We can make it easier for him to concentrate!

Sorry, I'm rambling... But if any of us wants to have a good and fulfilling life, and wants that for our kids as well, we HAVE to find a way to determine what situations really need medication. And no, I do not have that answer. But I think it's a pretty good bet that if drugs are the first option taken, rather than taking a look at the big picture and putting a little mental and emotional work into the issue, then it's probably not the right answer.

DiannaK · Jul 18, 2007

Just to give a little personal experience on this subject.
No I didn't medicate him because I was a bad mom,
No I do not know what the long term effects are, but the benefits definitely outwayed the risks. I do believe some kids are misdiagnosed, but I know in my heart of heart that my son needed and may again need meds. Please if anyone has anything negative to say, don't, I live with my sons illness everyday and prefer not to be judged for doing the only thing that I could.

First of all, thank you for sharing .... and I'm sorry to hear about your son's illness.

I don't believe that anyone has said that people are bad parents for medicating their children, and I'm not judging people. I'm honestly trying to understand why, suddenly, there has been such a gigantic increase in the prescribing/use of anti-depressants, anti-psychotics, anti-anxiety drugs in children/young adults.

In my opinion (and everyone is entitled to their own), I feel like society is pushing us as parents towards "quick fixes", and encourages us to to medicate our children so that they won't be a bother. :angryfire Our power to parent is being taken away, little by little. We need to have support systems to build up our confidence in our parenting skills, not tear them down.

What's the FIRST thing that is said when a little boy is acting up in school?? "better get him tested for ADD/ADHD" I've seen this time, and time again with my close friends and families with young boys. Kids are KIDS ... not tiny adults. You can't treat them the same as adults, nor can you expect them to act as such.

For MoonGirl .... when you were in school .. how often did you have PE? If you were like me, we played in the gym before school, had PE EVERYDAY, and would go home and play outside until dinner. Schools don't have time to fit PE in ... they are too concerned with teaching such wonderfully important things like web page design, and broadcasting.

Do a Google search for 'non-pharmacological treatment for ADD/ADHD' -- know what comes up the most? EXERCISE.....could that be part of the reason that we didn't have ADD/ADHD kids when we were in school? Kind of makes me wonder.

Kstec .. no one is saying you are a bad mom, and quite frankly, I don't think any of us would have wanted to have been in your shoes. I'd be sick, being forced to make those types of decisions.

I'd like to know, did the psychiatrist suggest anything else -- holistic medicine, therapy, behavior modification, for examples; or did he just present the ideas of medications as the only option?? Is your son currently in therapy?

Something else I've noticed, especially with the folks I come in contact with in the ER, is that they look at their child's behavior as an incovenience to them. Many people don't have a clue what normal child development entails. Case in point -- traige-ing a 11m old, in for hives. Asking Mom questions, and baby is crying. She says to baby ... "BE QUIET! Can't you see I'm trying to talk!" WTH?? It's a BABY -- not a tiny adult. This may be a mom who later thinks her 3 yr old is ADD because she "won't listen".

Once again, let me clarify .... I am NOT downplaying/dismissing mental illnesses, nor the need to be treated for such. I am simply stating my OPINION that medication should not be used as a quick fix cure all.

kstec, LPN · Jul 18, 2007

Yes we did therapy with 2 therapists and at home. When he was questioned at 4 as to what he felt and why he behaved this way he had no answers. I was a stay at home mother wiith a wonderful (still have) husband and a younger son. My son had never been abused in anyway, shape or form. After we saw the therapist for a short while she told us it was purely a chemical imbalance. We then took him to another therapist who told us the same thing. I come from a long line of mentally ill people and both therapists came to the conclusion that it was just genetics. I do agree with them because there is no other logical explanation for his behaviors. And yes he is doing wonderful. He hardly shows any signs of OCD at present without meds, I will continue to monitor his behavior close because my family is prone to self medicate (drugs and alcohol) so I want him to always know that therapy and medication is okay and to never feel that he cannot confide in me if he's just not feeling right. And yes agree that some kids are way over medicated, but my son was not medicated for convenienceto me and my husband, but as a neccessity for him to function on a day to day basis. When a parent sees their child suffering and everything they have done up to present has not worked than I strongly believe in therapy and medication.

DiannaK · Jul 18, 2007

I recognize that these medications, when prescribed and utilized appropriately, can help people quite a bit. But my own experience is that they are just a starting point, and no drug in the world is going to make the circumstances of your life any better.
Life in these United States is so fast-paced, so involved, so BUSY all the time, and especially with so many two-income or single-parent households, we're all exhausted at the end of the day. So when Junior is misbehaving because he's not getting either the attention he craves or the supervision and direction he needs... and then you throw out all the 'pop-psychology' out there that says they all need medication...
.

What a fantastic post!! I'd echo a lot of the things you said, and I think I did, in my post, but not quite so eloquently/entertaining!

I'm really shocked that you had no withdrawal! EWW! It's NASTY!! One therapist I saw "diagnosed" me with PMDD, and recommended Prozac. Dosing for PMDD (at least at that time) was to take it for the 14 days before you were supposed to start. So .... 2 weeks on, 2 weeks off. Anyone see what happens here? Eww! So, first time I went through withdrawals, I decided, "OK, guess I'll take it daily." No headaches anymore, but had the dreaded anorgasmia. Switched to Paxil, same story, then over to Celexa. No sexual side effects, but I did not feel as "up" as I did on Prozac. Eventually, over the course of a year or so, ended up going off the meds. Told my therapist I was getting rid of the reason for my depression (exhusband!)

I agree with you ... I fell into the whole "if the doctor says it, it must be true" ... as I have gotten older, I've began to research things more and more, instead of just taking my physicians knowledge at face value.

The comment about "Junior" caught my eye as well ...

I know a nurse who just recently opened a new ER -- 60 hrs/ wk, blah, blah. Guess whose child was diagnosed with ADD shortly thereafter, and is now on meds ......

Ever wonder if we need to start re-thinking our priorities??

keepingmycool30 · Jul 18, 2007

Since when did kids stop being called:hyper, daydreamers, energizer bunnies, thinkers, etc..and start being labled bi-polar,ADD, and ADHD. When I was a kid I was just that a kid being a kid now they have to have a dx if they fall slightly below the norm. I blame this on teachers who cant handle daydreamers, parents who cant handle their own kids, and doctors with a prescription pad wanting to give a quick fix. It takes kids 18 yrs to grow up and sometimes longer than that we need to let kids be just that kids.

keepingmycool30 · Jul 18, 2007

I have one more thing to add. My daughter is ten and is getting very close to hitting puberty (the signs are there) and most women and girls I know start getting mood swings and bouts of the blues, I know I did. I have been talking to her about her feelings and emotions and telling her that this is normal, plus we hit the library like crazy so she can check out books about puberty and letting her know that she is not alone in this. A couple of days ago she decides to talk to her dad (my wonderful but clueless husband) about her feelings, he comes up to me after she is tucked into bed and tells me that we should take her to the doctor for depression and I said "honey this is puberty not depression, if she goes to a doctor more or likely what they will do is give her meds for depression, and what she really needs is her mom to talk her through this rough time in her life" people even my husband want a quick fix and I dont think its in the form of a pill but instead in the form of communicating with our kids and loving them.

meownsmile, BSN, RN · Jul 18, 2007

I dont want to downplay that indeed there are some kids who have behavioral and mental issues that need medicated. No denying that. However, it also seems with such an increase in "diagnosis" it is quickly becoming a crutch and of course in some cases all that is needed is to have a "diagnosis" and you become eligable for all the perks and bene's the government has to offer.

Im not saying all, by any means,, but i actually know people unfortunately that made it a goal to get a diagnosis so they could pad up their SSI monies and government benefits. Thats what really gets rediculous.

phiposurde · Jul 18, 2007

I found this:

"

Ninety percent of the children meeting criteria for mania also had a depressive episode, and 84 percent had the depressive episode overlap with the manic episode into a mixed state. Children will switch in and out of depression, irritable mania with explosions, and euphoric mania throughout the day, almost every day. Because of this switching, it is very difficult to meet the clinical criteria of a "full week of irritability," or "a full week of euphoria." Oddly enough, "only in a minority of the most severe cases do children demonstrate their most abnormal mood states at school or in the outpatient clinician's office."

The mean age of onset was 4.55 years, with 75 percent of parents describing their child's symptoms as beginning under age five. This contrasted with mean age of onset of ADHD at 2.98 years.

Ninety eight percent of the children under age 12 who met criteria for mania also met criteria for ADHD. In contrast, 79 percent of referrals to the clinic met criteria for ADHD without mania. If ADHD rating scales are used, a manic child and a child with ADHD cannot be distinguished from each other. The Mania Rating Scale, on the other hand, can identify manic children. Manic children generally have "greater psychopathology and poorer functioning." The authors note it is also important to look for co-occurring ADHD with mania, and not to mistake these symptoms for residual mania. Other co-occurring conditions include bipolar with conduct disorder and anxiety (52 percent of children with anxiety also have bipolar)."

http://www.mcmanweb.com/article-30.htm

UM Review RN, ASN, RN · Jul 18, 2007

I have also noticed a large number of these folks are collecting disability. I understand it is easier to get disability with a psych diagnosis than a physical one. Check please?????

Ouch, that hurt.

My niece was dx'd as a paranoid schizophrenic when she was 24. The entire family went through hell before she was dx'd, and then after, as she tried to work and was unable to hold a job, keep an apartment, or relationship due to her increasingly bizarre behavior.

It took over three years after the dx, many hospitalizations (without insurance because she was over 21 and jobless), trials on expensive medications, and a disability lawyer before she was able to get disability and get her life back on track.

Before her illness, she had a fantastic credit score, a wonderful job (ironically, at one of the biggest insurance companies in her state, which she quit because she was certain that people were whispering about her behind her back), a boyfriend who was decent to her, a brand new car, a great apartment, and a quirky cat.

Now her credit score is terrible, she lives in a projects where she has to be home before dark because that's when all the crack dealers start coming out, the new car is long gone and we helped her get a used one, she ditched the boyfriend during one of her first psychotic breaks, and the quirky cat is never allowed outdoors.

I have no idea what kind of person would willingly make a trade like that. This girl has tried so hard to get her old life back and while we respect that, it's caused a couple of us to come out of our denial and realize that she will never be the same again. She might not ever be able to hold down a steady job, even though the medications are keeping her fairly stable at this point.

I tell you this only because we know how difficult it is to get disability and how poor a living it is once on it. Please don't act like it's a free ride; you have no idea how much this illness has cost our family, and how difficult it is to help a disabled adult get through all those hoops just to get a subsistence check.

phiposurde · Jul 18, 2007

As for metal illness. Like everything in life, when we do a change we have tendency to go to far on the opposite. We steer L before coming back to the middle. Right now we are to much on the L cause kids and psychiatric disorder is a new thing, a new research domain. So of course there will be alot of false positive. A MD goes to a conference, they them all the new things out here. A kid come in and present himself with some similarity boummmmmmm get a DX. The problem I believe is that, family MD shouldn't treat mental disorder. They should send them to a specialist. Even then, like we all know in our profession, not all specialist are very good. The things with mental disorder is you can't really DX them beside with an HX. I remember in nursing school when we did psychiatry. Every time we learned about a new diseases we thought we had it. Cause if you read the symptoms, we all have some of them. The difference between someone that as the disease is that there at not correctable by itself and they are continuous.

If only, bipolar would turn green when they have episodes. If kids with high dose of WASTKS enzyme( wait a sec this kid is sick enzymes). But we are not there with technology yet. So yes there will be false positive, yes people will try abusing the system. But I think, just like we tell CP to present to the ER, I prefer having them consult and follow up. That way the one that are really sick could get help, cause those disease can create a lot of damage if miss DX. As a society I think we also have a responsibility. We have the responsibility to make our social laws better and increase the quality of living. We blame teacher, doctor, etc to be too quick on " finding" a solution. But yet, we agree of doing 3 jobs. We jump on the overtime when we have a chance. And refuse things like paying a parent who would want to stay home and raise a family.

I think the increase mental disease is a symptom of a much bigger disease. Like we don't treat the cough of the pneumonia but try to treat the pneumonia itself. We should try to change our social perspectives on life and ask ourself some serious question. Then when it come to vote, remembering those decisions and using the power of democracy for creating a better world! Where a 5 years kid could be DX with bipolar but would receive all the help needed( not just pills) and his friend would get some different help, even if his mom is sure of the DX, thanks to the internet.

UM Review RN, ASN, RN · Jul 18, 2007

To the OP:

I agree, it's becoming very common for children to be dx'd with psych illnesses. Very disturbing to me as well.

michigooseBSN · Jul 18, 2007

Excellent thread! Unfortunately, in Massachusetts, we are awaiting trial for a set of parents whose 3 year old daughter died of a massive overdose of psychotropics prescribed for bi-polar disorder. This is a criminal trial and the doctor involved has surrendered her license to practice. When these kinds of serious drugs are given to children by parents wanting to severely sedate the kids, tragedy can happen.