I agree that seeing a therapist/psychologist and the PCP right away is a good idea. Get all the forms signed so that they can trade info with each other to coordinate care. They can get the ball rolling with an initial med if warranted, and to pursue appropriate diagnoses and neuropsych testing if necessary.
The PCP (in consultation with the therapist/psychologist) will often advise booking an intake appointment with a psychiatrist, which usually takes months. Then if you discover in the meantime that the psychiatrist isnât needed, the appointment can be cancelled or pushed to a later date. This often happens when the diagnosis is more complicated, and/or the patient needs 2 or more meds.
If the treatment/diagnoses are fairly straightforward and/or only 1 med is necessary, a psychiatrist isnât always needed.
Iâm sorry to the OP and their child for this hardship. Itâs clear that you care deeply for your kid and are seeking good advice. Youâre doing the right thing, and I think things will work out. We push our kids to be independent, and Iâd bring my kid home indefinitely in this situation. Please drop by for updates if you can â best wishes to you.
Agree with Coldâs suggestion. Best case, your kid has an easily treated thyroid condition which is causing the lethargy, fatigue, âbrain fogâ. You donât need a therapist or psychiatrist in that case-- so you cancel out the appointments. But waiting for the evaluation-- while your kid is miserable- ainât fun.
Been there (in a bit different situation but close enough to make suggestions from experience.)
Do what @thumper1 said. Get from ANY doctor a note (even Pediatrician can evaluate him and give a note) and get medical withdrawal. Also any urgent care or online service can give him some note sufficient for medical withdrawal.
Take your child home. You have a âgoodâ situation, your child asked for help!
Immediately find at least online psychiatrist (some insurances have online help. It is not the best and they cannot prescribe everything online but better than nothingâŠ)
Find near your home good Psychiatrist. Unfortunately, it will take time. They are overloaded always and even more with many people having problems after long-term Covid.
Take time to get situation under control. It may take months to find the correct medications. I think âweâ tried 3 or 4âŠ
If your child was truly happy at the above college (it actually could be the case), he was simply overwhelmed given his mental condition. You need to find a balance in how to address it.
Do not rush to transfer out student to a local place and or withdraw permanently. Consider sending a student back part-time. But with ACCOMMODATIONS (that should be registered with office of disability or teachers will not honor it) and medicine. Also, find in THAT state (it is tricky, since psychiatrists can practice only where they are licensed) at list online psychiatrist that your son could âmeetâ at least once a month.
Hugs. It may be very difficult now. Just do not panic. Your child needs you to be a rock now. There is hope.
Also, there is a thing called incomplete! Basically you take medical leave but need to finish classes by the end of next semester. You will need to negotiate speed and terms how to do it, and not all teachers are good at it. However, it will help to finish quarter without Ds or Fs⊠If scholarship requires your son to stay full-time, I would think twice before going back. It maybe too risky.
So far weâve only found psychiatric help through zoom, and itâs just to get meds prescribed, he meets with his therapist almost weekly through zoom (and itâs out of network). I donât think we had to provide proof for a medical withdrawal, but needed it for the tuition insurance.
re: the time to find the right meds/combo â look to see if your insurance will cover genetic testing. We discovered our child was on a medication with zero efficacy for him & the next 3 that the doctor would have tried also had no efficacy. It was a game changer and very likely a lifesaver.
Sorry I havenât taken the time to read all the replies. Thank goodness he contacted you and told you enough that you know how serious it is.
You need to fly out there today and be with him. Get there, bring him to stay in the hotel with you, go with him to see the Dean of Students, figure out how to best do the withdrawal, then bring him home. Keep a very close eye on him, get in to see a psychiatrist (call your pediatrician for help getting him in immediately), probably need to get him back on an antidepressant, help him to figure out his next move, be it work, transfer to a very nearby school, or even hospitalization. You just donât know. He may tell a doctor what he might not tell you. Right now, salvaging his grades, the lost tuition, itâs all secondary to making sure that he is okay. When someone is so depressed that theyâre not getting out of bed to go to classes, they need a family member to come and help them.
So sorry to read this. I can only imagine what it feels like to be a parent. The diagnosis comes later. Right now, you just need to bring him home and get him help.
I am glad to hear that your child found the right medication for him â thatâs wonderful. It can be hard and scary and exhausting to get that dialed in. I donât want to get too far off topic, but I want to avoid people doing extra things when theyâre in triage mode.
I have read quite a lot of primary research on genetic testing for psych meds (such as GeneSight). A physician mentioned it to my own family member and I asked about the data. The doctor said that a company rep came by the practice to sell the tests to them, and they started offering them because insurance sometimes covers it. They actually asked me to research it for the practice, because Iâm a neurophysiology professor. I did and reported back to the practice.
The American Academy of Child and Adolescent Psychiatry recommends: âClinicians avoid using pharmacogenetic testing to select psychotropic medications in children and adolescentsâ and âFuture high-quality prospective studies to assess the clinical significance of pharmacodynamic and combinatorial pharmacogenomic testing in children and adolescents.â
A journal published by the American Psychiatric Association states âThe FDA released a consumer warning about genetic tests that claim to predict patientsâ responses to specific medications. The warning⊠holds particular importance for psychiatryâŠAlthough manufacturers market pharmacogenomic tests to clinicians as being able to predict (and thus improve) antidepressant outcomes, the currently available evidence does not support such claimsâ.
We elected not to do it for our own family member, despite it being covered by insurance. In their case, we did not want it to distract from other evidence-based treatments that might be helpful. The family member stayed on their first med, and pursued additional diagnoses and corresponding care that has helped a lot. That involved adding an additional med for an additional diagnosis. Their first med was managing that first diagnosis quite effectively and changing it would not have solved their particular issues, which were from an undiagnosed issue.
I say this mostly for those who may come across this thread and be interested in this type of testing. Of course, anyone can choose to do this testing for any reason if theyâd like. I just want to put info out there that helps folks make informed decisions.
Youâll need a doctors note for the medical withdrawal, but any doctor may be able to write it. Contact the school, and also tuition insurance for exact requirements. Many need to be submitted through the students school email.
Youâll definitely need to get in to see a psychiatrist so start the search and wait. Some areas have walk-in urgent mental health care. You just show up early in the morning for urgent care!!
Thereâs a change in regulation coming that will prohibit zoom controlled substance prescribing in June 2023âitâs going to be a very foolish change since so many mental health doctors have waiting lists. But video prescribing is going to be tough for some meds now.
Agree with all the comments. This is probably way more common than you think, and the feedback here has been excellent.
Depending on the relationship you have with him, I also think flying there to be with himâwhether you bring him home or notâis good. I had to do that for one of mine and it was good (for both of us) for me to be close by for a few days.
One other comment: this sounds like âhead in the sandâ syndrome, which we have seen in some of our families and quite a few times here on CC. I would not explicitly pathologize what is going on until you know, and there are diplomatic ways to present evaluations to encourage compliance. A kid over 18 does not have to comply,legally.
Thank you for this excellent summary regarding this testing including the relevant links.
I have seen these tests cause a lot of problems because these tests do not accurately predict a personâs response to psychiatric medications, but patients are told that they do. I have seen patients leave excellent psychiatrists, because they happen to see a primary care doctor who recommends the test and then they doubt their psychiatrist figuring they must be behind the times or lazy. What they donât realize is that the doctor who gave them the test is the one who hasnât read the studies, and who unfortunately has fallen for the hype that the test rep sold them.
I have met patients who have finally found the right med after years of avoiding this med because âThe GeneSight test said it wouldnât work.â Tragic.
Youâve already gotten lots of great advice above. Best of luck to you and your son.
I work at a university and I wanted to make sure it was clear to you that the school is not going to want to refund your tuition and will probably not be flexible about this. (If you get money back depends on if you have tuition insurance and their guidelines.) On the other hand, universities have a lot more flexibility with granting medical withdrawals. Withdrawing from all his classing will be probably be much better than receiving Dâs and Fs, so you ask for this to happen ASAP. Many colleges will grant this with any type of doctorâs note, as they donât want to deal with the liability around mental health issues if they say âno.â
OP here. Just want to thank everyone for their help and compassion. So many great ideas. Hereâs our latest update.
He is still at school. He had decided he does not want to leave his friends and he is definitely mentally stable. His sibling is going out there this weekend to spend time with him and he is coming home midweek next week. He is getting some work done (he just turned in a small project) and said he is feeling better about himself. Obviously we all realize he is not magically cured.
Spoke to Provost and the head of advising and they were great. They are going to reach out to his professors to try to get him an incomplete in his classes so he can finish them in the coming months. This would only apply to 2/4 of his classes but still better than getting Fâs. He could also do a medical waiver retroactively depending on whether he can get the incompletes or not. He will most likely be placed on Academic probation but will not lose his scholarship and can return in the fall (or even the spring but thatâs not happening). We are aware that we wonât get our tuition back. Heâll most likely be on academic probation but we think that sa good thing as it will require weekly check-ins.
I have him set up for a neuropsych evaluation in April and an appt with his PCP when he gets home. Iâve spoken to several psychologists over the past week and they all agreed this would be the correct next step. I am also actively working to get him a therapist. Most psychiatrists around here just seem to dole out meds, very few do any actual therapy. He has agreed that he needs help. He really wants to go back in the fall but thatâll be a decision for the future, right now we are taking it one day at a time.
Like any physician, or therapist, you really need to âshop aroundâ and find one that your kid is comfortable with. Any one who does not require at least one session before the prescribe med is obviously not a good choice (for anyone).
I do agree that meds should not be the first choice for depression, anxiety, or ADHD unless theyâre incapacitating.
That sounds like an excellent idea - especially since your other child will be able to see first hand how well your kid is doing.
Sounds like a solid plan and hoping it works out for your family!
Just be aware that it is hard to guage someoneâs real level of depression (IF that happens to be the case). Your kid may ârallyâ with attention on them and fall back immediately when left alone. They want to please you and be better and put forth that effort to succeed. Sometimes that rally is enough to get them over a hump. Sometimes not. Itâs tough. It can be a rollercoaster of emotions for everyoneâespecially parents who want the best for their kids.
I donât think any psychiatrist or psychiatric NP would prescribe meds without an intake, but after that they pretty much âseeâ the patient once a month to determine if the meds need to be adjusted. My daughterâs therapist doesnât think she needs medication, however when she did an intake of my son and forwarded her report to the psychiatrists in her practice, tbey wouldnât touch him with a 10 foot pole, unfortunately.
Looking from my experience (but it is your choice for sure), I would:
Take student from classes now. Leaving him there is aka gambling on my books.
Ask for incomplete for all classes (you do not lose tuition that way) or ask to complete the ones he is not behind remotely.
Make an appointment with Psychiatrist now. I am sorry but PCP will not cut here.
Work with the school to allow to complete incomplete remotely.
Get meds and accommodations.
Work on completing incomplete one at a time. Ask to do if over some time (before fall) if possible.
If you will follow above, most likely your son will be able to come back in fall.
I will not enroll my child fulltime in Fall even if he would lose scholarship after that experience even on meds. Way to risky.
By sending your child part-time he will progress with studies, will feel that he can do it, will have time and energy to do both school work and participate in EC or whatever he likes to do in that school.
It is super important to have the opportunity to progress and enjoy life in a case like that.
Again that is me, and everyone has a different approach.