Posted by katekite on April 13, 2002, at 22:32:21
In reply to just talked to her nurse...., posted by mom on April 13, 2002, at 19:58:08
I'm glad you are getting to have some input and that someone is communicating with you. That is really good.
I wanted to make sure to say specifically to you I agree that off-label is not experimental....I was taking liberties with that term in my last post and someone was kind enough to point it out. I can get over-zealous about patient rights and anything connected to that.
As far as benzodiazepines being addictive, yes they are, and she is most likely at risk, as most people are at risk of addiction.
This risk does not stop benzodiazepines including the benzo sleep aids to be the most prescribed anti-anxiety drugs in the country. They are incredibly useful. And very few people are actually addicted. At some point most people find they have to up the dose to maintain effectiveness.... and that's the first sign of dependence..... but short term, in the hospital, I think they have great usefullness.
However, some doctors can not be convinced to use them much at all, it is a huge controversy since so many new drugs have come on the market in the last 10 years. There are so many new drugs on the market being pushed hard by pharmaceutical companies saying they treat everything from delusions to PMS, that many of the old standbys, drugs where the side effects are at least well known, have 'gone out of fashion'.
It seems you have encountered a hospital with a policy directing towards this years fad.
This years fad is antipsychotics for everything. Yes for depression too. The thinking there is that in "treatment resistant depression" there have been reports of success with risperdal or xyprexa in addition to a standard antidepressant. No they don't know why. No they don't know the mechanism and no they have no long term studies. Furthermore, the antipsychotic is not usually added until it is clear that an antidepressant is not enough alone and this usually happens at least 8 weeks into treatment if not months and months. So in your daughters case it seems quite premature.
Which doesn't keep individual doctors from experimenting. And here I use the term in the full sense of its meaning. I would not agree with someone who said antipsychotics could be considered first or second line choices with regular major depression in a 15 year old. (Unless her episodes really included hallucinations. Freaking out doesn't count). Because these doctors do not like benzodiazepines, because they can point to them as possibly addictive, they can pretend what they are doing with xyprexa is their only resort when in fact two years ago they would have been open mouth shocked had someone mentioned the idea to them.
What is more dangerous, the possibility of addiction with a well understood drug, or experimentation with this year's fad? Each individual answers this question differently. Your daughter's doctor obviously has answered.
If they would like a benzodiazepine with antidepressant qualities there is klonopin, which is the most serotonergic of the benzodiazepines and may have some mild antidepressant effect and has been used for 10 years as an add on treatment in major depression. Has possibly some mood stabilizing qualities also. Due to its long half life it is considered one of the least addictive of the benzodiazepines.
I am glad that she hasn't had any more episodes, that you've been able to talk to her. Its good she wants to go home. It sounds like she will be home soon and back with her regular doctor.
At least at this point the hospital understands you have voiced an opinion and it sounds like they will listen, that is just great. Good job!
I'm sorry to hear about the insurance. That is an interesting rather sick twist to some insurance policies. I was in the hospital once with a badly infected dog bite and wanted to leave against advice as I could give myself the antibiotics at home, and was told the same thing, as it was worker's compensation paying. I think it certainly could be true.
So at the very least the 20 days will soon be up. And sick as it may sound your daughter will be motivated to stay out of the hospital if she can.
When are the 20 days up?
The one good thing about all this seems to be that she hasn't seen a scale or probably a full length mirror for quite some time! That's very good. You could talk to her therapist at the hospital and see whether they have any tips for home like getting rid of scales and big mirrors or other things to change at home that might help her make a change with the anorexia. It does seem positive that she has to ask you how she looks.
You have done a very good job. You recognized that things were not going as well as you thought they could and now you have gained some aspect of input and this can only help both you and your daughter, now and in the future.
Kate
poster:katekite
thread:102912
URL: http://www.dr-bob.org/babble/20020408/msgs/102996.html