![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by mom on April 12, 2002, at 21:10:13
My daughter, who is 15, was diagnosed 7 months ago with major depressive disorder. She tried to commit suicide. She was originally prescribed Zoloft 100mg. this made her extremely tired, and they added Buspar to help her sleep. She was later taken off of both and put on Wellbutrin 100mg 2x day, and risperadal .05 mg We than began seeing a psychiatrist that d/c'd those meds also. She prescribed effexor 75mg and trazadone 5mg. Well, this was one month ago. A week after the med changes she informed me that she was feeling really suicidal and having thoughts of cutting herself (something she had previously done). I took her to her therapist that day, and she ended up being admitted to the adolescent psyc unit. She is still there today, it has been almost 3 weeks. They have increased her effexor to a total of 300 mg, 150XR am and pm. They also have switched her from trazadone to zyprexa 5mg 6 days ago. Three days ago she had a very out of control episode where she felt like she wanted to hurt someone or herself,and having hallucinations she had a hard time explaining exactly what happened, other than she felt totally out of control. They gave her 2.5mg of zyprexa to "calm" her down. The next day she had another one of these episodes, this time she did become violent, trying to hit hospital workers and punching the wall along with various other things. They had to restrain her and gave her 2.5mg of zyprexa again, along with 1 mg of ativan. She has never had any episodes like this in her life. She is a very calm, relaxed person. I talked with the doctor over concern of her medications and the coincidence in the timing of adding zyprexa, increasing the effexor, and these episodes happening. I was basically told I was an idiot, even though I gave reference info from Mosby's drug book... It was insisted to me that neither drug could cause this behavior. The drug book list Zyprexa of having side effects of agitation, hostility. It also says to assess for hallucinations. For effexor it list side effects of emotional lability hallucinations, hostility, psychosis, it says to assess psychiatric symptoms and suicidal tendancies.
I am truly lost as to what to do as her mother. I have never seen this behavior and it scares me to death. To me she seems no better than when she entered the hospital 3 weeks ago. I need advice on what to do... Has anyone else experienced anything like this when taking either of these drugs, or these drugs in combo? I need help fast! Thanks for any info
Posted by katekite on April 12, 2002, at 22:06:58
In reply to I need help..fast, effexor and zyprexa, posted by mom on April 12, 2002, at 21:10:13
I can not really comment on the meds. I have taken some of them but response to meds is an individual thing. All of these drugs can interfere with how you think and what you feel, can even make it hard to understand what people are saying or what is going on.
I will say that hospitals often can be overzealous in quick changes, trying to make someone better quickly and in doing so create just the opposite effect. I have heard many many horror stories.
The fact that she seems to be doing worse in the hospital is important. Of course almost everyone will do a little worse, because it can in itself be a very stressful experience.
It doesn't seem altogether wise to bring her home. Which you most likely could do, given that she is there voluntarily.
So, barring bringing her home, there are two main options. Find a different hospital and have her discharged from this one and take her to the other. I would at least educate yourself about the particular hospital she is in (look up on the internet if there have been complaints, legal issues etc), and also find out what the alternatives are. There isn't any law saying she has to be in the closest one. There are many more facilities around than you are aware of. Some are expensive private places, others are simply well run small (small is good) wings of regular hospitals.
You may want to visit and try to ask her whether she would rather be in a different hospital. If she feels scared in this place, for example. If nurses are not nice, etc. That matters a lot, especially when you are 15.
Or, go in and talk to this hospital's doctor (whichever person is in charge of her case, not a nurse or nurse practitioner or a social worker etc. The doctor in charge of her case) in person. Make an appointment to discuss her case and say it will take at least 20 minutes. Find out what is going on and what their plan is. Not "work on making her better" but the names of the drugs and the doses and write it all down even if you don't know what you're writing. She is certainly in withdrawal from some of the drugs and it seems changes are being made quickly. Not the fastest I've ever heard of, but certainly quickly. No one can know for sure how she would be if X drug had not been given.
Also, call her doctor from before. If she saw a psychiatrist from before its unlikely that person is having any input at all and they may know her better than the doctors at the hospital. Try to ask them what they think is the best thing for her, drug wise and hospital wise.
Lastly, find a therapist or psychologist that you can schedule an appointment for yourself. If you have a plan by the time you see them then just to talk to a professional in the field who is on your side to talk about, for example, what things should be like when she comes home, or, if you are still formulating a plan, to ask them all about the drugs and what their opinions are of various doctors. So someone local to the hospital would be good. A therapist will often let you know if there are bad things to say about a particular hospital or doctor.
Ok, now I will my own personal recommendation (an unknown person out of millions of internet users, so take it with a grain of salt) is that given that she was taken off wellbutrin and risperdal one week before cracking (though cutting is pretty common and may just reflect anxiety or need for attention), I would ask her doctors to stop all the antipsychotics and either give her wellbutrin and ativan only or effexor and ativan only. At least on wellbutrin she wasn't doing this bad. But she's been on effexor long enough that she might have withdrawal if they just stop it, its like heroin withdrawal. They can ativan her up so that she sleeps all day if they want. Let her body get rid of the multitude of drugs that are still waiting to be excreted. She is most likely still withdrawing from the wellbutrin AND from the zoloft (well at least when she was admitted, probably through the worst now) still. The antipsychotics like risperdal and xyprexa are heavy duty things and it all depends on whether she reports seeing and hearing things if she should have them or not. If she is only angry at this point, only aggressive, then ativan is safer. I wouldn't start with them ever unless a court order forced me.
Your main goal should be to get her stable and out of the hospital, since the hospital is only concerned with making her not a risk to herself and they will use heavy doses of drugs that would stun a horse to do it. For many people these very drugs make them worse.
Please keep in mind I'm only speaking from my own experience taking some and research on others.
You need an advocate. You need someone to talk to that knows drugs, knows the hospital, knows doctors, can communicate what's going on. I would guess a social worker or a psychologist would be the best person.
Make a timeline of what drugs she was given and when, and for the ssris (effexor and zoloft) look at how she was 4 weeks later. For the wellbutrin look at 3 weeks later. For antipsychotics look a couple days later. That's the impression I get on timing of response. In addition, on the time line, look at the same amount of time after a drug was discontinued for it to stop having an effect. Benzodiazepines like ativan are harmless short term.
Ok I hope this helps a little. Please get yourself an advocate. Start calling everyone. Her psychiatrist that saw her before the hospital is a good start. Do not trust that a hospital will be doing what is best for her LONG TERM. They are only interested in short term, ie two days from now. But you and she need to be interested in long term and the drugs she is on now may only be making getting better further away.
kate
Posted by mom on April 12, 2002, at 22:57:53
In reply to Re: I need help..fast, effexor and zyprexa, posted by katekite on April 12, 2002, at 22:06:58
Thanks Kate, An advocate is a good idea.. I didn't realzie I could get one. I will check into it. I did try to have this appointment with the doctor treating her, she basically walked out on me, and told me I was making bad choices for my daughter by wanting to re-evaluate the drugs. I had not thought about the half life of welbutrin, and the posibility of it still being in her system. My true problem of transferring her at this point, is that she has developed a great realtinship with the therapist at the hospital, she trust her and opens up to her. In addition, they told me today that my insurance will not pay for morethan 20 days as inpatient, which is upp in three days. I wonder what happens then? also, I aksed about having her released, and they informed me it would be against medical advice, from what I understand, that menas if I take her out now..the insurance won't cover any ofthe hospitalization thus far. Thanks again..I do feel so terribly desperate.
Posted by jay on April 13, 2002, at 11:48:28
In reply to I need help..fast, effexor and zyprexa, posted by mom on April 12, 2002, at 21:10:13
Hi:I just kinda wanted to relate an (almost) similar situation of mine. My doctor has been using atypical antipsychotics (Zyprexa) as well as Effexor and other antidepressants on me. He has also been using "mood stabalizers" (Depakote, Neurontin, Lithium, etc.)
What I DON'T understand is, these meds seem to have no effect on one of my primary symtoms, which is anxiety. In fact, I am ready to say that anxiety is almost like a cousin of psychotic episodes. The one class of medications that can VERY well handle this is benzodiazepines. (Like Ativan.) I also suspect some of the psychotic reactions where drug-induced, maybe by the Effexor and others, and yes, Zyprexa DOES and can cause agitation. (It is in the PDR....many on here will be able to relate to that.)
If a person responds well to them, I think benzodiazepines should be a maintenance part of treatment, and I think your daughters antidepressants should be greatly lowered. Possibly, a high dose of a benzodiazepine with a low dose and a antidepressant.
You might be best to phone around and talk to as many doctors as possible, and explain your situation. I also think you should ask about benzodiazepines and routine use, as yes there are some good doctors who have no problem with their maintenance treatment.
I'd also lastly like to say benzodiazepines are SO much more safer than antipsychotics (unless there is a 'true' psychotic episode..involving delusion and hallucinations...as defined in the DSM), and still safer than the 'mood stabalizers'..because..well..they just stabalize the mood a heck of a lot better than these other meds.
I am really saddned by these stories, because it shows how incompetent many of our doctors are. Despite all of the garbage they spew out, one of the main reasons for presribing these 'newer' drugs is simply because some drug company rep, and a bunch of questionable studies, hype them as being some kind of panecea.
Anhow...just my .02 cents..best of luck...and please come back for support...
Thanks!
Jay
Posted by mom on April 13, 2002, at 12:18:21
In reply to Re: I need help..fast, effexor and zyprexa » mom, posted by jay on April 13, 2002, at 11:48:28
I have talked to the doctor and with much resistance from them, they are going to make the zyprexa a prn instead of a daily dose. I was informed that she could not be kept there without being on an antipsychotic, due to these "episodes" she has had the last couple of days. I feel like I am talking to a wall in trying to explain that she has NEVER had an "episode" until being in here..nor until being placed on the zyprexa daily. She has no history whatsoever of this!!!! I am so frustrated and feel like I am between a rock and a hard place due to insurance coverage ending in 2 days. I was doing some reading and found a condition called serotonin syndrome, which is a build up of serotonin?? From what I understand, the effexor is a reuptake inhibitor for serotonin, and the zyprexa blocks receptors for serotonin. Isn't this the same thing in essence? I am wondering if she could be suffering from this serotonin syndrome. Symptoms are agitation, confusion, anxiety, hallucinations, and poor concentration. I did mention this to the docotor also. The response was, "we want to build up the serotonin". Can serotonin be build up too quickly by giving her such high doses of effexor along with the zyprexa? Also I have read that both are primarily excreted in the urine. She is anorexic, and her fluid intake is small. They are not measuring her output... so is her body getting rid of the excess?
sorry for all the questions etc. I just want to help her and protect her from unneccessary harm.
Posted by shelliR on April 13, 2002, at 14:03:08
In reply to Re: I need help..fast, effexor and zyprexa, posted by mom on April 12, 2002, at 22:57:53
Hi,
First of all, I would check with your insurance about exactly what they will cover after 20 days. You need to definitively know whether they will cover the twenty days if she checks out against medical advice because her 20 days are up.
You should also check into other alternatives. If this is a private psychiatric hospital, perhaps they will cover a psych unit in a university related all purpose hospital. They are generally cheaper than a private hospital. But only switch hospitals if you can get her in one that you trust. Also find out if there is an supplemental insurance the state would offer her; also what the laws are in your state re parity for psychiatric illness. And you need to check into day programs, as well finding out if her hospital therapist could follow her outside of the hospital. (some do have private practices; others don't) The best thing is to be prepared so that all hell doesn't break loose on day twenty.
I wonder if it would help to get her a consult with another doctor in the hospital, or if all doctors will unconditionally support the original recommendations.
I think you *should* trust your instincts that tell you that your daughter's behavior is very different since she's changed medication. She shouldn't need zyprexa as a prn; any benzo at a high enough dose should calm her down. At least long enough to test your theories. Unfortunately psychiatrists often are the most pompous when it comes to accepting input from others.
sorry, I wish there was more I could advise you to do; I can imagine how tough this is to go through, as her mom. At least your daughter did come to you when she was having very self-destructive thoughts. That's a good sign.
Shelli
Posted by katekite on April 13, 2002, at 16:17:37
In reply to Re: I need help..fast, effexor and zyprexa » mom, posted by shelliR on April 13, 2002, at 14:03:08
Oh you poor thing.
What they have basically done to you, is made you give them the green light for as much xyprexa as they want. By having you say prn is ok. That's like saying use as much as you want. Because how do we know what they define as "as needed?"
I understand their point of view, in that yes she acted agressively with some sort of outburst so they want to prevent that from recurring -- she could hurt herself or others. However, a high dose of benzodiazepine would have the calming effect they want, most likely without as much potential to interfere with her thought processes.
So check and find out if she has been given a prn dose of xyprexa today and find out if it was in response to actually attacking someone. If it wasn't, then she shouldn't have been given it, right? Endangering herself or others is probably what you meant when you said, "well if you really have to".
It would be nice if they would start her on a benzodiazepine twice a day. She will feel better. Almost no one feels worse on benzodiazepines.
If you feel strongly about something you are allowed to type out a statement saying she will remain there only if it is a particular situation. If her former psychiatrist hints they agree I would write out that only the following drugs are to used: effexor, benzodiazepines. That you are to be called and that you must ok any dose of any other drug. That you understand the risks and that you will take her home otherwise. They will cave in and keep her. (They will not release someone they think is in immediate danger because of liability, and they are so very aware of liability that they are quite serious about it.) But this is all your choice! Absolutely yours and yours alone because she is 15 and belongs to you and not them.
I'm not saying that someday a small dose of xyprexa shouldn't be part of her treatment if that is thought to be helpful. It is very common practice for hospitals to throw it around like sugar, but it doesn't make it ok, its not sugar.
Her being anorexic means she has a very lean body, that she should be having probably lower doses of medication than others. So the dose of effexor seems very very high, especially as she's been on it such a short time.
That's a great suggestion about day programs. To ease her transition home. The hospital is NO place to treat depression. A hospital, especially it sounds like this one, is a place to temporarily keep someone who is completely out of control and a danger to themselves or others.
Most therapists that work at hospitals also have private practices. Since she likes this therapist, perhaps she could continue to see them.
If they will agree to a day program it will make it a lot easier to get her out, they will feel more comfortable letting her go if she is coming back the next day. And once she is home, without screaming in the background, she may do a lot better quickly.
Don't forget its not the hospital volunteering to have her there. Its you volunteering to keep her there. Insist that the doctor meet with you personally every day and tell you all the meds she got and why. Unfortunately they are not used to consulting family but you have every right to be a part of the team, after all you are the one dealing with her when she comes home.
Call as many doctors as you can, all of her previous doctors and therapists. Its ok to leave a message as an emergency item, because she's in the hospital and that itself means something urgent is going on. You need more advice. You need second opinions. This hospital has had plenty of time to make her better and she's way worse than when she went in, it sounds. Doctors or shrinks should get back to you this weekend. Dont' feel that you have to stop for the weekend. That's part of their job, to help people they've seen previously (and their guardians).
As to serotonin syndrome -- it is entirely possible but not likely. They should consider it and its excellent you asked about it because it will at least be in the back of the doctors mind now. I have been hospitalized twice. The first time was due to depression. The second time I did have a bizarre episode that was in retrospect caused by serotonin syndrome. I had bursts of anger, I was agitated and tried clumsily to throw myself through a window though I was not in any way suicidal, I then had the only panic attack of my life. It does cause crazy behavior. So though rare, its ironic you should mention it. And the doctors at this university hospital I was in did not put two and two together. They decided I was bipolar and made me sicker than sick with high doses of mood stabilizers one after another until I felt awful and begged my husband to take me home. He did and I was still so crazy I nearly jumped from the car on the way home. It was a very difficult time. And I remained that way for 6 weeks until I got upset with the lack of anything doctors recommended, except more meds that had no helpful effect, and I stopped the meds altogether, and was better the following day, fine two days later. Turns out I am extremely sensitive to serotonin enhancing drugs. But that is a different story and it is an extreme example. However, that same ward had several people who got progressively worse in there, like me. The day I went home a couple of them got transferred to long term facilities. It was scary because I'm sure I would have gotten worse had my husband not rescued me after figuring out I was getting worse.
Now you understand why I feel strongly about these issues. Your daughter is most likely very different from me, but she needs your protection as much as I needed my husband's.
If it were serotonin syndrome with your daughter the way to find out would be to lower the dose of effexor back to 150 a day and see if the outbursts go away in a few days. I think there may be other drugs to use to combat it but none are really proven to help this syndrome that I know of. Instead of adding drugs though I would be lowering them.
Its also possible that it is mostly the overwhelming nature of the hospital experience that has contributed to her having these episodes. A forced environment of tv and therapy with little access to personal space and little outlet for physical energy can be hard on anyone. She was in there a while before it started.
And it is possible, that really she is getting worse. That she would be even worse without xyprexa or a high dose of effexor or the hospital period. To me it seems unlikely. But you never know.
To make a reasonable guess you need to have the opinions of all the professionals she saw before the hospital.
Just ask them what they felt her diagnosis was.
Then ask them what drugs are used on-label to treat those conditions. (All drugs have occasionally been used to treat all conditions but that's not the point, the point is what is usually used and approved to treat what she has.).
When you find out what that is, then call the hospital and demand she not be given drugs off-label. The hospital will have to comply quickly, because to use drugs off-label is experimental and if you know about it and realize you weren't informed about this, then you are free to sue for her emotional damage, or yours, for example. You don't want to, but you want your daughter treated properly. And so does the insurance company. The people who pay, really like drugs used that are FDA approved for her problems. And yes, they are the safest.
Lastly. What does your daughter say? What does she want? Have you been able to visit? What happens during a visit?
What actually is her diagnosis? Anorexia? Anxiety? Depression?
I really feel for both of you. And hope that she feels better very soon.
kate
Posted by mom on April 13, 2002, at 18:08:20
In reply to Re: I need help..fast, effexor and zyprexa, posted by katekite on April 13, 2002, at 16:17:37
Kate, Thanks for everything.. I feel better just talking and get some other thoughts. I did agree do the Zyprexa as prn, but it is under the condition to be given only if she becomes combative or out of control. They have not given any for almost 24 hours now. She has not anymore of the outburst. I will reccommend the benzodiazepine to be used instead.. after all, the doctor did tell me that if I knew so much about meds, for me to pick one :-) Don't think she meant it, but I will follow thru! As for my daughter, the episodes really scared her. She could not describe it to me, but said, "it freaked her out". She seemed almost relieved when I told her it could be a side effect of the medication. She was afraid maybe she was going insane. Her diagnosis is major depressive disorder secondary to eating disorder. She is more than ready to come home. She is embarrassed that I keep "butting" in with the doctor's advice, but I don't feel that is really her decision. She says that she doesn't feel any better with the meds they have added, but she can't say she neccesarily feels worse, other than the "episodes". She likes most of the people there, isn't real crazy about some of the docs. From what she tells me, the doctor is with her for approx 30 seconds a day. Our visits go very well at this point, other than her begging me to tell her her weight. I am allowed to visit twice during the week, for one hour.. and then 2 hours on Sat. and Sun. The therapist there does not have a private practice, but we have a therapist outside that also relates well with my daughter, as well as my daughter with her. She has been going to the hospital and seeing her 2x a week. Also.. If it were just my choice and no other factors considered, I would take her home, and if things don't stay how I agree to them, I will take her home.. but, right now If I take her out against their advice..I did find out that the insurance does not have to pay for any of her stay. Her health is of course more important than any money, don't get me wrong... but we are talking about 50 thou here so far, I have to try and work this out. I have a few appointments set up for Monday to discuss options of her care, and other means of financing it. Her primary psychiatrist is out of town and has been for 2 weeks, and will not be back until Tuesday. She will see her then, I KNOW she will not agree with the care received thus far.
I agree wholeheartedly with the opinion of the hospital stay itself casuing some of this. It is a strict enviroment. I will find out about the "on-label" thing.Her mom
Posted by jane d on April 13, 2002, at 18:35:37
In reply to Re: I need help..fast, effexor and zyprexa, posted by katekite on April 13, 2002, at 16:17:37
> Then ask them what drugs are used on-label to treat those conditions. (All drugs have occasionally been used to treat all conditions but that's not the point, the point is what is usually used and approved to treat what she has.).
Off label use is actually extremely common and is not necessarily experimental. The FDA approves a drug to treat something specific. That means the company can put that usage "on the label" and promote it's use for that purpose. But drugs are often tested, and found to work, for many other "off label" things. The company is not required to go back and ask the FDA to approve a new use so they usually don't. Doctors can prescribe the drugs for any of those other uses and often do. I'm sure there are examples where the off label drug is known to be the better treatment.I'm sure if you look in the archives you can find this process explained in more detail.
Jane
Posted by jane d on April 13, 2002, at 18:55:11
In reply to more info you asked about, posted by mom on April 13, 2002, at 18:08:20
>I did find out that the insurance does not have to pay for any of her stay. Her health is of course more important than any money, don't get me wrong... but we are talking about 50 thou here so far, I have to try and work this out. I have a few
Did your insurance company itself tell you this? I ask because usually insurance companies are delighted to have a hospital stay cut short since that saves them money. I also remember reading of at at least one case where the hospital falsely claimed that the insurer would not leave to prevent someone from leaving. I realize this isn't that important any more since your insurance coverage is almost up and she will be home soon anyway.
Jane
Posted by mom on April 13, 2002, at 19:58:08
In reply to Insurance and leaving hospital AMA » mom, posted by jane d on April 13, 2002, at 18:55:11
I just called the hospital and talked with my daughter's nurse. I explained to her my conversation with the doc, and how she told me to pick a drug. Well I did mention the benzos to her, and she told me that the doctors up there would most likely not prescribe that due to her being depressed, and the fact that it is a "sleeper". I reminded her that is why they were giving the Zyprexa originally. She informed that, yes that was true, but also because of the many benefits for depression????? She said the Benzos are very addictive, and not a good choice. I told her I wanted the info passed to the doc, and they could call me, but I would much prefer her on a benzo than an antipsychotic PERIOD. She told me that the zyprexa is now a PRN for the "episodes" and trazadone is a PRN for insomnia, she will report my request to the doc, but felt it better left alone in her opinion. The thing is I found this thing on the net where you can enter multiple drugs and get reactions they may cause. Trazadone is listed as a "high clinical significance" being taken with effexor, taking them concurrently can increase the effects of trazodone, the metabolism can be inhibited causing "serotonin syndrome" !! I found that really wild, since I had wondered about it earlier. Maybe it was the trazadone with the effexor, and not the zyprexa causing her symptoms?? Anyway, I requested to hold the trazadone. Do doctors ever look at possible interactions with drugs? I am having my doubts at this point. Thanks for letting me air...
Her mom
Posted by katekite on April 13, 2002, at 21:59:14
In reply to Off label use is NOT the same as experimental » katekite, posted by jane d on April 13, 2002, at 18:35:37
That's absolutely true. And there are many many times that off-label use is great. For example most of the bipolar drugs are off-label and people would be much worse off without them.
My point saying that, which I'm sure I overdid and thus kind of screwed up, was just to say that if one is concerned about what drugs are or aren't being prescribed and if one is a beginner at drug knowledge, then one easy way to know if something is a well-known conservative therapy is if its being used on-label.
And I think it is generally true that doctors feel less threatened about liability if they are using a drug on-label and might respond to comments about it with a mindfullness towards conservatism, which in this case I personally feel would be good.
But I definitely did use the word experimental, and I think I should not have used that word. Since many of these drugs have been used off-label for long enough now to know that its not an experiment any more than an on-label drug is an experiment.
I apologize, as I'm sure many people out there are on off-label drugs and doing extremely well on them, and I in no way meant to criticize that.
Sorry -- kate
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
Posted by jay on April 14, 2002, at 0:28:19
In reply to just talked to her nurse...., posted by mom on April 13, 2002, at 19:58:08
I am sorry to hear you got such a crappy response. I REALLY don't see HOW Zyprexa can be used for anything except psychotic depression (delusions..hallucinations), and this is coming from an ex-Zyprexa user. I even question it's use in 'mania', as I think it can switch one to depression.Plus, pumping her up with a high dose Effexor in her current state may be like adding fuel to a fire. Could they not start with an antidepressant the had more calming properties, even still the "official" antidepressant of the World Health Organization, which is imipramine. (Tonafrinil)sp? There is also clomipramine, which has an amazing capacity for anxious depressives. But, even though study after study shows almost NO advantage of older vs. newer, doctor seem to want to go after these new, *expensive* drugs...often because they where whoooed in by drug-company reps saying how wonderful they are.(Even from my experience, I still have ONLY ever found relief from a few of the older antidepressants.) I may do some medline research, post it here for you, and you can keep it on hand to show the docs if you want. I am warning you, you will have to be very, very assertive.
I'd also agree, yes, DITCH the antipsychotics. After being clean now from the, I didn't realize just how horribly YUCKKY, irritated, and miserable they can make you feel. A benzo a day with a calming antidepressant, and I am much more 'alive' that I have been in years.
Anyhow...please keep posting...there are great folks here with some excellent stories. Doctors rely on research, which is often flawed, and we have every right to advocate for what WE (or a parent) wants! I am REALLY starting to despise drug companies for their trickery in making a profit. I am as pro-med, and take them, as anybody, but I am strongly against drugs being used just because they are "new".
Best wishes...
Jay
Posted by katekite on April 14, 2002, at 9:55:49
In reply to Re: just talked to her nurse.... » mom, posted by jay on April 14, 2002, at 0:28:19
Hi Jay,
I had two hospital experiences. The first hospital was what I would rate excellent, the second fair to poor.
The first hospital was suicidal depression. I went as a preventative measure and was the one to suggest it and was completely coherent etc on arrival, although really depressed. A darn good thing I could think clearly. After I gave my medication history to the doctor, he ignored my saying I had had severe side effects to a medication and put me on a combo of 3 meds including the one I get severely ill from. I refused and argued and argued and he changed the offending one to one I had also taken before with no good result. It seems some doctors have standard combinations they like, and he wasn't about to try to work with me. He also disagreed with what my psychiatrist at the time told him he thought would be good. The godsend at this place was the nursing staff, who informed me I was allowed to refuse any med I felt like, and were actually supportive of this knowing that this particular doctor was a little nuts himself. So I thought about it and decided to refuse all but one (a new one I hadn't been on previously), so that I could at least see what effect which medication had. It turned out to be somewhat helpful and I felt much better after 4 days and went home (although every single day the doctor came and told me what the heck was I doing etc, arguing, mad....shocked anyone would not take his advice).
My second experience was a university hospital. In retrospect what sent me there was likely serotonin syndrome, definitely serotonin toxicity although I can't say it qualified for sure as "the syndrome". At this place, after suddenly discontinuing all my meds, doing an EEG and mri and interview they concluded I was bipolar (I'm not, I'm ADD) and started me on bipolar drugs as well as restarting all my former meds. Then while I was newly drugged I took the mmpi assessment test. I came out as completely normal, LOL, did not rate depressed or even neurotic. So we know right there something was off, LOL. My serotonin syndrome briefly abated due to them having discontinued the meds I came in on. So I at least felt better. They tried a few other bipolar drugs and when I began to do worse sent me home. I was also assaulted by another patient. I read the report from them to my own psychiatrist, and they failed to record most of the symptoms I told them I had, they altered my chief complaint from flushing and chills, to mood swings, and they said I had come in with a general function score of 25 (practically catatonic) and left with a 70. When really I left lower than I came in. Anyone who drives themself there, stops at Borders to buy some reading material and run errands for batteries for their walkman etc, is not a 25. Anyhow, that's my story. In retrospect I should have gone to an ER and not arranged to be an inpatient because I was no risk, and my problems were more 'medical' if that's possible to say.
That second experience frightened me off of hospitals for good. Actually not completely true, I've done some research and found a few places that sound ok, in other states. If it comes to it I will travel there -- insurance would not need to know I wasn't on vacation in that state.
As far as xyprexa, I was given a low dose as I had been diagnosed with GAD. I literally could not stand up and felt frantic, could not think well at all. So I had a poor experience. I know that some people with anxiety have great benefit (I think I'm probably more sensitive to the cognitive effects than someone without ADD). It just doesn't sound like something to start in the hospital unless there is clear indication.
I'm curious to hear your experience with hospitals if you have one to share. Both good and bad.
Thanks for listening,
kate
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