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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by PoohBear on January 27, 2004, at 11:51:33
Hi all:
I have a friend who's 14 year old son attempted suicide in early December and spent 5 weeks in a local children's hospital. They immediately diagnosed him as depressed and placed him on Lexapro.
He was released to his home two weeks ago and his condition has worsened, with his weight dropping to 65 pounds. He won't take his meds and still has suicidal thoughts.
My thought is that he was misdiagnosed from the beginning and may be bipolar and that the Lexapro isn't having any effect, just that his cycles weren't that great in amplitude. One of the articles I read regarding bipolar stated that it was under-dianosed 30% of the time...
I know that for me Effexor stopped my suicidal ideation dead in it's tracks. If he's still thinking this way the medication is having no effect.
His parents are very worried. The young man already had a serious eating disorder (no wheat products) before this happened, and his attempt on his life was rather lame (Excedrin), but they are desperate for input and options.
Any help of links to articles would be appreciated.
Thanks!
Tony
Posted by KathrynLex on January 27, 2004, at 12:19:16
In reply to Question RE: Lexapro for 14 year old, posted by PoohBear on January 27, 2004, at 11:51:33
Hi PoohBear,
My heart goes out to you and your son. Being 14 is so difficult. At that age I wish someone had grabbed me by the shoulders, looked me in the eye and said, "Yes, it's tough...but you're going to be okay." Although at that age I probably wouldn't have listened.
Your son sounds like he is in desperate need of some therapy. I urge you to find a psychiatrist who can spend some time with your son and accurately diagnose his condition. Best of luck to both of you.
K.
Posted by PoohBear on January 27, 2004, at 12:36:54
In reply to Re: Question RE: Lexapro for 14 year old, posted by KathrynLex on January 27, 2004, at 12:19:16
Thanks, but it's not my son... It really is the son of a friend of mine who doesn't know about this board...
Thanks!
TR
Posted by Bill LL on January 28, 2004, at 9:19:45
In reply to Question RE: Lexapro for 14 year old, posted by PoohBear on January 27, 2004, at 11:51:33
Did his condition become worse after being released? Was he feeling better prior to release, and then felt worse after going home? If so, then maybe its because he won't take the Lexapro at home. He needs to be forced to take either his Lexapro or some other drug.
Was he always depressed? Did he have a traumatic event?
Posted by PoohBear on January 28, 2004, at 11:09:38
In reply to Re: Question RE: Lexapro for 14 year old, posted by Bill LL on January 28, 2004, at 9:19:45
Bill:
Though he took the medication in the hospital, his father feels it did little good, as he still thought about suicide throughout his stay there. The hospital stay was also bad in that it exposed him to a number of very hard-core teen-age mental patients: they'd often directly undermine the work of the parents and staff...
Since coming home his refusal to eat has perhaps been the worst thing, as the effecacy of the medication is debatable. He doesn't have celiac disease, but there's some other nephrotic thing going on with his weight and kidneys; has been for several years. At this point the kid's pretty messed up, especially with puberty added in.
I don't know that he was always depressed,, but I have known him since infancy and he has always been quiet and done odd things for attention, like keying the side of their new van, etc. Not a bad kid, just odd. These are two of our best friend from college, a very loving home. All of the 4 kids have been home-schooled.
Tony
> Did his condition become worse after being released? Was he feeling better prior to release, and then felt worse after going home? If so, then maybe its because he won't take the Lexapro at home. He needs to be forced to take either his Lexapro or some other drug.
>
> Was he always depressed? Did he have a traumatic event?
>
>
Posted by LynneDa on January 28, 2004, at 11:22:45
In reply to Re: Question RE: Lexapro for 14 year old » Bill LL, posted by PoohBear on January 28, 2004, at 11:09:38
Hi Tony - I'm certainly no psychiatrist, but if the poor boy is suffering, it seems there is a need to try other meds until something is found to work. We all know the same meds and dosages don't work for everyone. Additionally, sometimes it takes anywhere from 2 to 9 weeks for Lex to make a difference, according to all the folks who post here.
What a scary thing to go through! The parents need to be strong advocates for that child in order to get them to keep trying different methods to help him. He sounds like he may be counseling-resistant, but they sure need to supplement meds with that.
Good luck and you are wonderful for caring so much!
~ LynneBill:
>
> Though he took the medication in the hospital, his father feels it did little good, as he still thought about suicide throughout his stay there. The hospital stay was also bad in that it exposed him to a number of very hard-core teen-age mental patients: they'd often directly undermine the work of the parents and staff...
>
> Since coming home his refusal to eat has perhaps been the worst thing, as the effecacy of the medication is debatable. He doesn't have celiac disease, but there's some other nephrotic thing going on with his weight and kidneys; has been for several years. At this point the kid's pretty messed up, especially with puberty added in.
>
> I don't know that he was always depressed,, but I have known him since infancy and he has always been quiet and done odd things for attention, like keying the side of their new van, etc. Not a bad kid, just odd. These are two of our best friend from college, a very loving home. All of the 4 kids have been home-schooled.
>
> Tony
>
>
>
> > Did his condition become worse after being released? Was he feeling better prior to release, and then felt worse after going home? If so, then maybe its because he won't take the Lexapro at home. He needs to be forced to take either his Lexapro or some other drug.
> >
> > Was he always depressed? Did he have a traumatic event?
> >
> >
>
>
Posted by Bill LL on January 29, 2004, at 9:45:11
In reply to Re: Question RE: Lexapro for 14 year old » Bill LL, posted by PoohBear on January 28, 2004, at 11:09:38
Sounds like a tough situation. You mentioned that there may be a kidney problem. If the kidney or adrenal gland is involved, I don't know to what extent that can cause depression but I'm sure the doctors at the hospital would have checked it out.
I hope that his parents remain very aggessive about having him treated. They can increase his dose of Lexapro and/or give him other very effective antidepressants such as Wellbutrin and Effexor.
Posted by Chairman_MAO on January 29, 2004, at 21:28:26
In reply to Question RE: Lexapro for 14 year old, posted by PoohBear on January 27, 2004, at 11:51:33
IMO (this opinion is one of my few that AREN'T humble) medicating a child or adolescent with an SSRI should only be done as a last resort. The emotional blunting, apathy, and agitation (often all three, gee, what a great thing of an adolescent <sarcasm>) that may result are not worth the possible benefits. How would you like it if someone blunted your emotions and quite possibly your SEXUALITY just as you were coming of age? It sickens me to think that kids these days have to go through that.
A mood stabilizer with minimal effects on cognition should be tried first, alone. Lamictal has antidepressant properties. Trileptal may, too. If an antidepressant is necessary, I'd go with an NE agent--if you're in the US, the only one that's good to use in a kid is Strattera. Another possible choice is Wellbutrin, but this can be quite agitating. It is important that you use the lowest dose of medication possible--these things have side effects that it is unlikely a doctor will talk about--and the drug company, forget about it! For instance, Strattera and other NE agents often potentiate NE activity in the male bladder and reproductive system, leading to urinary retention, possible ejaculatory difficulties/ failure, and impotence. At the tender age of 14, this could be a self-esteem catastrophe. Another important option would be Remeron--raise the dosage carefully, it can be agitating at higher doses--because it would likely stimulate appetite, works quickly, and has no sexual effects.
Your best option would be to avoid drugs altogether unless ABSOLUTELY necessary. Despite what the commercials and some doctors may tell you, depression and suicide attempts are (usually) PSYCHOSPIRITUAL conditions. Warn your friend that if she decides to have her son treated with antidepressants, the course of treatment should be kept as SHORT AS POSSIBLE to minimize the drug's effect on her child's emotional development. Psychotherapy, and, more important, good support systems at home/school should be the primary tools.
Posted by Chairman_MAO on January 29, 2004, at 21:33:16
In reply to Re: Question RE: Lexapro for 14 year old, posted by Bill LL on January 28, 2004, at 9:19:45
> He needs to be forced to take either his > Lexapro or some other drug.
Imagine being a kid these days! "Just say no" in the classroom while they're given speed to calm them down! Perhaps he refuses the drug because it MAKES HIM FEEL WORSE! I encourage everyone interested in this thread to read Thomas Szasz's short essay, "Chemical Straightjackets for Children": http://www.szasz.com/iol5.html
Posted by PoohBear on January 30, 2004, at 10:01:29
In reply to Re: Question RE: Lexapro for 14 year old, posted by Chairman_MAO on January 29, 2004, at 21:28:26
ChairmanMAO:
Thanks for the comments, some really good food for thought. I've forwarded the URL to this thread to my friend. Considering the fact that I put on 12 pounds in two weeks on Remeron and had to get off it QUICK, it might be a good option for my friend's son.
Many good thoughts.
Thanks!
Tony
> IMO (this opinion is one of my few that AREN'T humble) medicating a child or adolescent with an SSRI should only be done as a last resort. The emotional blunting, apathy, and agitation (often all three, gee, what a great thing of an adolescent <sarcasm>) that may result are not worth the possible benefits. How would you like it if someone blunted your emotions and quite possibly your SEXUALITY just as you were coming of age? It sickens me to think that kids these days have to go through that.
>
> A mood stabilizer with minimal effects on cognition should be tried first, alone. Lamictal has antidepressant properties. Trileptal may, too. If an antidepressant is necessary, I'd go with an NE agent--if you're in the US, the only one that's good to use in a kid is Strattera. Another possible choice is Wellbutrin, but this can be quite agitating. It is important that you use the lowest dose of medication possible--these things have side effects that it is unlikely a doctor will talk about--and the drug company, forget about it! For instance, Strattera and other NE agents often potentiate NE activity in the male bladder and reproductive system, leading to urinary retention, possible ejaculatory difficulties/ failure, and impotence. At the tender age of 14, this could be a self-esteem catastrophe. Another important option would be Remeron--raise the dosage carefully, it can be agitating at higher doses--because it would likely stimulate appetite, works quickly, and has no sexual effects.
>
> Your best option would be to avoid drugs altogether unless ABSOLUTELY necessary. Despite what the commercials and some doctors may tell you, depression and suicide attempts are (usually) PSYCHOSPIRITUAL conditions. Warn your friend that if she decides to have her son treated with antidepressants, the course of treatment should be kept as SHORT AS POSSIBLE to minimize the drug's effect on her child's emotional development. Psychotherapy, and, more important, good support systems at home/school should be the primary tools.
Posted by KathrynLex on January 30, 2004, at 13:47:20
In reply to Re: Question RE: Lexapro for 14 year old » Chairman_MAO, posted by PoohBear on January 30, 2004, at 10:01:29
Hi Tony,
Here is another link to information about adolescent depression:
http://www.swmedicalcenter.com/12837.cfm
While I agree with Chairman that psychotherapy and good support systems are key in helping a child through depression, I want to point out that "emotional blunting, apathy and agitation" does not always occur with medications.
I started taking Prozac when I was 15 and it was the best thing that could have happened to me. But every individual case is different, which is why it's important for your friends son to have a VERY good psychiatrist who can identify the problem.
K.
Posted by Truck468 on January 30, 2004, at 14:02:23
In reply to Re: Question RE: Lexapro for 14 year old, posted by Chairman_MAO on January 29, 2004, at 21:28:26
Hello. I am the father of the 14 year old boy. Today is just another in the string of crisis situations we encounter. He should have never been released from the hospital. It was somewhat obvious they had "given up". It also makes me so angry I am ready to sue them! There have been many instances of malpractice involved here.
In any case he refuses to see any therapists but does talk to me when he is not in crisis mode. He is about 50% reasonable and the other 50% very angry and non responsive.
He has been on 30mg daily of Lexapro for about 8 weeks, but I have no idea if it is helping him. His suicidal ideations are still very high on some days. At the moment we have no idea if he has a plan as he will not talk to anyone about it.
The only hospital in the state is full and so that is not an option. The truth is we don't have many options than to just gut it out at home and help him stay alive each day. It is a bit nerve racking!
We are both trying to be as supportive as we can and praying he decides to want to get well. But anorexia is a very problematic disease.
Any other tidbits of wisdom will be helpful.
Thanks
This is the end of the thread.
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