Documentary: The Medicated Child

DocBets,

I don't think this country, this world has yet accepted that the brain is an organ like any other organ in the body. You are so right; why do we still have this sense that if one tries hard enough, they can overcome psychiatric or brain disorders? Why is there no outrage that 2 year olds often need multiple doses of antibiotics for frequent ear infections? Or that children need asthma meds, etc etc?

I'm with ya!

Terry

It just occurred to me that many have "explained" the inequities about this subject in terms of, "As long as it's the body, people accept medication, but not the brain."

Not so. People with seizures are never criticized for taking medication. I think it's because it seems to be about behavior. People forget how much "behavior" is involuntary. And they were never informed that much of what they do habitually is possible because they have capacities for linear, habitual behavior.

Yep, it's because it's behavior. And, there are many professionals in our field who still call AD/HD a "behavior disorder," which it is not. No more than the stomach flu is a behavior disorder because it makes people vomit.

(I know, that was a stretch.)

Hey Pam,

Bipolar is an interesting disorder. When I was 29, I saw a psychiatrist for treatment for depression and AD/HD. He chose to treat the depression first, but chose an anti-depressant that was used to treat depression and AD/HD. The anti-depressant was desipramine.

Within weeks, I experienced my first and only hypomanic episode. I won't go into the details, just trust me when I say the symptoms I experienced were extreme and significantly different from anything I had experience before or since.

I was then diagnosed with bipolar II and began treatment for bipolar disorder. I read everything I could on the subject, submitted to what I believed was appropriate treatment and attempted to move forward with my life. This continued for four years.

Then the doctor informed me that he had done all that he could do and offered to provide maintenance care. Not feeling fine, I found another psychiatrist.

That psychiatrist reviewed my medical records, my journal entries at the time of my original diagnosis, and my self reports. He concluded that there was a possibility that I had been misdiagnosed. He slowly, very slowly took me off the bipolar medication and told me that if I didn't have another hypomanic episode in five years, I could feel confident that I do not have bipolar disorder.

That was ten years ago. 

Here's what actually happened to me. The desipramine caused the hypomanic episode.

In retrospect, what I find most interesting is that a year or so after I was diagnosed with bipolar II, I attended an educational lecture on depression and bipolar disorder. The presenter, a psychiatrist, worked at Harborview Medical Center in Seattle, Washington. When I heard him say that desipramine is known to cause hypomanic episodes in people who do not have bipolar disorder, I was stunned.

Here's the part that's so interesting: I never discussed this information with my psychiatrist even though I saw him for an hour every two weeks for four years. And even now, as I write this, I don't fully understand why. It's as if I so strongly accepted that I had bipolar disorder, I couldn't face the possibility that my doctor had made a misjudgement and that everything I had come to believe about my diagnosis and prognosis wasn't true. I also believed my doctor had harmed me unintentionally, and that the damage was irreversible. I didn't want to make him feel bad. In my defense, I must also say that the medication I was taking affected my cognitive abilities. My friends and family were so relieved when I got off the medication and returned to the person I was prior to treatment. They too regret that they didn't contact and express their concerns to the doctor.

That would not happen to me today.

I'm older now and a lot wiser. I, like you, question everything. Keep questioning Pam.

I have a number of friends who have bipolar disorder. There is absolutely no doubt in my mind that it's real.

I do believe bipolar disorder can occur in adolescents and children. But, if I were the parent of a child experiencing symptoms that extreme, I would do everything I possibly could to rule everything else out first including allergies, sensitivities, and vitamin deficiencies, reactions to other medications, other diagnoses, etc. before I would consider medication for bipolar disorder. And I would research and utilize any behavior therapies that seemed reasonable to me.

That said, if after doing all of the above, my child was still suffering, I would then put my child on a bipolar medication.

Some AD/HD children and adults need medication to function, at the very least, behavioral and educational interventions. I have so much respect for parents who go through this agonizing process and always, always put their child's needs first in an environment in which they are constantly being told by well-meaning and not so well-meaning people what to do or that what they are doing is wrong.  

The research is clear, children with these diagnoses left untreated or under treated are at significantly higher risk for addictions and criminal behavior. I spent a couple of evenings reading the statistics on prison populations last year. It's heart breaking.  

I have yet to meet a doctor that doesn't care about his or her patients, but sadly, they do make mistakes and sometimes provide inappropriate treatments, often times due to lack of information or misinformation, or lack of training. 

Over the last eighteen years, I've learned to

 - seek the best healthcare providers available and treat them respectfully

 - learn everything I can about the condition and its treatment

 - investigate other possible explanations for the symptoms

 - explore all available treatments, both medical and alternative or complimentary

 - commit to a team of treatment providers

 - and finally, to evaluate and re-evaluate the diagnosis and/or treatment periodically.

Keep questioning Pam. With adequate information, you sound like the type of Mom who would do the right thing by their child.

Dear grandma lise,

Wow! Sounds like you had quite a rough time over that anti-depressant and subsequent misdiagnosis. I am so glad that you finally found answers and got your life back. Thank you so much for sharing your story with me.

Would you believe that I also was sent into a manic state caused by a medication? It was Effexor. It was prescribed to me for symptoms of PMS. I discontinued it cold- turkey, because I didn't think it was doing anything for the PMS. Little did I know, this was not a safe thing to do. I was up for 3 days straight, my mind racing... it was awful, as you well know.

I went back to the family doctor who prescribed the Effexor. In one brief, 15-minute appointment, he concluded that I was bipolar, and prescribed me a medication for bipolar!!! I was shocked. I had already considered the possibility that the Effexor was to blame as it started almost immediately after stopping that medication. I asked him if these symptoms could be due to the fact that I quit the Effexor cold-turkey. He looked me right in the eye and said, "No." I hate to say it, but I immediately felt like I was being lied to. He just looked like he was lying. Plus, I was quite old to be diagnosed with bipolar for the first time and I had been a patient in this practice (different doctor) since childhood, and I had never before experienced these symptoms.

I have no idea what his motive could have been for not examining me further or why he would not have immediately referred me to a competent psychiatrist for a complete evaluation if he suspected bipolar. I had insurance, so that wasn't it. Instead he just handed me a prescription for a psychiatric medication with no additional explanation or plan for further treatment. Not only that, he knew I was the only parent in the house with a small child!!! And can you believe that he NEVER ONCE followed up with me? It's been 4 years ago now, and his nurse has never once called. I still can't believe it. It doesn't seem possible that this happened, but it did. Of course, you probably understand, having been in a similar circumstance, and like you, I never reported this physician to anyone or questioned him again about his treatment of me.

I found out soon after leaving his office that the doctor was wrong. The Effexor literature clearly stated that hypomania, among other things, had been reported with abrupt discontinuation of the drug. Thank God, I did have enough presence of mind to go to my pharmacist and speak with her at length about everything that was going on. I never filled the bipolar prescription. Instead, I went back on the Effexor, and with the help of my pharmacist, I cut the dosage a little at a time until I could quit completely. I never experienced mania again. Then, I got a new family physician.

Sometimes I think that doctors overall are not spending enough time with patients to make a good assessment of each person's situation and instill much confidence in them. In my doctor's office, they schedule over-lapping appointments, keep you waiting forever, come rushing in long after the scheduled appointment time, and barely look you over. Then, they seem to want to just go with the first idea that comes to mind and take out their prescription pad and be done with it. I see it at the pediatrician, too, and I hear my friends complain about it with their doctors.

Too bad there aren't more doctors out there, like the one you finally found, who was willing to take the time to read your medical records, journal and self reports. What could be more important in treating an individual than doing that? It seems so simple, yet, I don't think it is happening in many cases...at least not mine or my son's.

I personally wrote a synopsis of my son's behaviors and symptoms for the psychiatrist/therapist that he sees. I'm pretty sure the psychiatrist never read it, and I had to ask the therapist more than once if she had read it, because every session she was asking me all the same questions that I had already answered in the report I wrote. I took a lot of time to write it and edit it. I made sure it was to the point and easy to read, so I don't think my writing was the problem. She just didn't take the time to read it. When she finally read what I had written, I could see a huge difference in her understanding of my child and she started asking some really relevant questions based on his specific history. Then, she began Cognitive Behavior Therapy geared toward his OCD. Now they have made great progress. Too bad we wasted four sessions at $180 an hour before she even read what I wrote.

In addition, we are working with the school on some accommodations for the OCD and ADHD. The psychiatrist doesn't think medication is urgent right now, so I will see how the accommodations work and take it from there. If he needs the medications, he will have them. His older half-brother took them in elementary school and seemed to outgrow the need for them. He stopped taking medication in Middle School and has now graduated from college and is doing well. His older half-sister is still taking them and they still help her a lot. My son is more borderline, so I choose to try some other things first, particularly with him being on other medications already for asthma.

I couldn't agree with you more on the points you made about what you learned to do over the years to ensure good treatment for yourself. It is a GREAT list of suggestions. I think everyone should copy it and tape it to the bathroom mirror or the corner of their computer or wherever it would be easy to refer to. It really sums up what action is needed when you find you have a medical problem. I feel so bad for people who can't do the research due to their poor mental state and/or they don't have friends and family to look out for them or their child. Scary.

Best wishes to you! Pam

Hi Docbets,

You said, "There were two variables most responsible for the reduction in "symptoms" and inappropriate behaviors: the increased domestic structure required in order to follow the diet, and the increased amount of attention paid to the children."

I remember reading that study or another one and thinking the exact same thing- that the parents who were able to follow the diet had to re-structure their lives AND pay more attention to their child, thus the improvements.

I wonder if there have been studies that compare food elimination diets like Feingold with behavioral strategies which requeare similar structure within the home. Interesting...

Terry