Please compare notes on students' mental health

Parents Forum
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<p>Hello, parents.
I was reading through a thread last night, called "Please help.....depressed teenager". One particular response, from Teenmom55,
"Is there a rule against discussing medications on public forums? I wonder why you received several offers for information through pm's. I am interested to know the specifics of what worked for others",
had me thinking that I would be very interested also in hearing other parents' experiences with (hopefully) resolution of mental health issues that might have cropped up for their children. I know that there have been quite a few threads about these issues, but it would be helpful for me to have a specific thread where parents can relay how they went about trying to help their child work with this issue, and what has worked and not worked.
IS there are a rule against discussing particulars of medications? If so, I apologize, and assume that a moderator will act accordingly.
I do know that each and every situation is unique, but I'm going to describe my child's situation, in as few words as possible:</p>

<p>My daughter started at a small LAC, doing a program for Freshmen that started in very early August. She seemed to be doing well and keeping up with the work and enjoying it. On the phone, twice, she told me that she was feeling "stressed", but we talked through it and she seemed fine. Then, on August 28th, she called, sobbing, almost inchoate, saying that she had been feeling v/ depressed; had been depressed all summer (which I had begun to wonder about in the summer, tried to talk to her about and which she had denied - her saying: just wanting to relax, nervous about college, etc - I suggested a therapist, she refused.........Too long a story to go into here.). She agreed to call her old therapist. We set up an immediate appointment. After another 2 weeks of seeing her therapist, she decided to try medication. I found her a highly recommended psychopharmacologist who worked with young people. She started on Sertraline (generic Zoloft): gradually built up, over 11 days, to 100 mg; then, after another 12 days, to 150mg. During this time, she came home for 11 days: we considered that she might need to take a Medical Leave; we had a meeting with administrators at college; she decided to continue to try at school (she did a W for one class - she had taken 4 v/ difficult, writing-intensive classes, and had managed to continue to do pretty well, but was beginning to lose pace w/ keeping up on assignments). She went back, but came home on weekends and to see her therapist. Also, she had nightly phone "check-ins" with her therapist and with me.
After some initial but minor betterment, she seemed in a holding pattern: still suffering. But, the psychiatrist said this took time. Then, on the night of 10/10, she handed me the phone: she was on with her therapist, having told her that she was running a bath and had a razor blade and wanted to kill herself. She gave me the blade; I spent the night in her room; we three discussed potential admittance to hospital. Horrible, horrible night, to see my daughter in such pain. Met with the psychiatrist next day: he added generic form of Wellbutrin: 150 mg. In the first few days, she felt "75%" better, but didn't continue feeling better beyond that. At her next appointment on 11/1, psychiatrist upped Wellbutrin to 150mg (what he termed the clinical dose) (It was discussed that, after my daughter was at, hopefully, "100%" for a while, we would revisit if the Sertraline could be eliminated.) As she felt better, my daughter said that she didn't want to do the nightly check-ins with me, and I agreed with much trepidation. Although continuing with weekly sessions with her therapist, they have also discontinued nightly check-ins, with the promise that my daughter will call her if anything moves toward the negative.
Although she said (as of 11/2, the day of last psych appointment, so I don't know if she's feeling any improvement w/ the upping of Wellbutrin dosage. I will see her on Sunday, when I take her to her therapy appointment) that she was still having some feelings of sadness and difficulty with motivation, she just got an A in a thesis paper from a teacher who is a tough grader, so she is definitely hanging in there. It's been quite something to see the strength she has exhibited while going through this, while feeling on the one hand so hopeless: still working so hard to get through it. I have tried to "hold" the bigger picture for her: that there is life and joy beyond this, and that we would do whatever was necessary to get her through this. As I've read extensively on depression since this started, I know that this can be a life-long issue, and am looking at the bigger picture with that. She's trying to get back to exercising (running), because she knows this helps. She refuses to consider meditation (which seems to be a big contributor to continuing abatement of depression), but I understand that she feels overwhelmed. I'm just trying to learn as much as I can, so that if things come up I can be as knowledgable as possible in giving her the support she might need.
One note of caution, from our experience: My daughter has a difficult time sleeping, both with getting to sleep and staying asleep; this has been exacerbated by the depression. We tried natural solutions, to no avail. The psychiatrist prescribed first Ativan and then something else. My daughter was very uncomfortable (thankfully!) with taking meds for sleep, and tried them with much caution. When neither worked, the psych prescribed Ambien. Aware that it could become addictive, she decided to try it only if she had gone a few nights w/ very bad sleep. She finally took it one night, and had a mild hallucinatory experience!!! She and I brought this up to the doctor - he said it happens v/ rarely. This is a highly recommended doctor. I actually had an appointment w/ the (even more highly recommended) psychopharmacologist who recommended him - who is herself an "integrative" psychiatrist - and she agreed with his protocol (this was just before the Ambien was added). Since then, I've read that Ambien can be hallucinogenic. This has convinced me even more about the value of becoming as knowledgable as possible.
Another issue has been that she is 18 years old, and so legally an adult. Throughout this experience, she and I have walked the fine line of her wanting independence, at a time when she has also needed help from her parent. That's been tough also.</p>

<p>So, this - so far - is the story of our experience. I would really appreciate hearing other families' experiences along with their paths to hopeful resolution.</p>

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<p>Has she always had difficulty sleeping? The reason I’m asking is my son was recently diagnosed with a sleep disorder (narcolepsy). Ambien is known to cause hallucinations in people with narcolepsy (actually people with narcolepsy can get sleep related hallucinations without taking anything at all but Ambien is known to make it worse or set them off.)</p>

<p>What we found out with our son is things like ADHD and sleep disorders can cause people to feel really down in a way that makes them feel depressed. One of the medications used to treat ADHD is Wellbutrin. Also, sleep disorders in particular can do this. Has she had a full physical recently?</p>

<p>My son complained of mild depression in hs. His biggest complaints have been lack of concentration and feeling tired and low energy all the time. Last summer I became determined to help him solve this. We did the ADHD testing and found, while he’s a high performer, he does have the inattentive type of ADHD. Then we did the sleep study because he complained of not being able to sleep. That’s when the narcolepsy was found (onset is usually in teenagers). We still aren’t clear whether the narcolepsy is causing the ADHD symptoms or not. But he is on medication (Wellbutrin & Provigil) and is feeling better. He will be starting a special sleep medication used for narcolepsy at Christmas break. </p>

<p>My point is also look for physical causes of the depression. There can be many including thyroid issues.</p>

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<p>Ambien is a weird drug, my sister would sleepwalk, eat, and would have physical fights with her (grown) son- not remembering any of it in the morning. </p>

<p>Agree with momlive about physical causes, not only thyroid disease, but other issues, like anemia, low iron, low B12…</p>

<p>Also, really try to get her to schedule regular exercise if there is any way to do that. It really does make a difference with the endorphins. However, initiation of that when you are depressed is very difficult!</p>

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<p>Thank you for starting this thread! We derive a lot of useful information on CC based on anecdotal stories, and mental health should be no exception. I suspect many are reluctant to post details because of the continued stigma against antidepressants. I am also concerned about privacy, so I have changed some details (including gender!) of my child in some of my previous posts on the topic. </p>

<p>Before I forget, I have found that the effective dose for Ambien is actually much lower than the 10 mg commonly prescribed. If I have trouble sleeping for more than a few nights, I take only 1/4 tablet (2.5mg) and it is usually enough for a good night’s sleep. There is at least one publication that reports 2 mg dissolved under the tongue is effective. That said, I have never given Ambien to my child because it works so well it can lead to dependence. I have given antihistamines suggested by a Dr. with limited success.</p>

<p>My child began to exhibit signs of depression in middle school. We went through a turbulent time of failing grades and poor communication before realizing that the problem was not laziness or some lack of character. We visited several therapists, and our level of communication improved. However child came across as well rounded wonderful bright kid in meetings with therapists, and I couldn’t convince them there was a deeper problem. One told me point blank that there was nothing at all they could do if child did not acknowledge a problem and express a desire to seek help. </p>

<p>Fast forward to 9th grade, and child would come home sobbing for real or imagined insults received on campus. Grades were suffering, and child seemed to just not care about anything. After a few more visits with therapists we were referred to a Psychiatrist, whose sole function seemed to be writing prescriptions. She told us that Prozac was the only drug approved for children under 18. Child started on 10 mg Prozac and seemed to improve for the next 6 months. Then doses were occasionally forgotten and eventually stopped. Child decided they did not want to be dependent on the medications, and suggested we should join a fitness club because studies had shown that exercise can lessen depression. Also, child had major issues with self-image and struggled with an eating disorder. We joined the gym, and that provided a very positive influence for both of us. However the eating disorder worsened to the point we had to schedule an appointment with the psych. again. Meds were suggested, but child still refuses to consider them at this point. Child is now in therapy every week and sees a dietician once per month. </p>

<p>I have heard good things about Wellbutrin from at least 4 different people now, in terms of the minimal negative side-effects and good results with mood improvement. Zoloft has resulted in major weight gain for 2 acquaintances, so I know child would not consider it. </p>

<p>I hope others will share their experience with medications.</p>

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<p>I don’t know if others’ experience w/meds is really helpful, because people respond so differently. My daughter was diagnosed with depression in October of her sophomore year in HS. Her descent was really scary. She was crying every day, cutting herself, so exhausted she couldn’t get out of bed some mornings, unable to complete many assignments, etc. She started on Lexapro (10 mg). It helped a little, but then her dose was upped to 15 mg. It is not perfect, because she has some fatigue, a common side-effect, but nothing like what she had last year.</p>

<p>We also changed schools, a component of her treatment that I really don’t want to overlook, because some environments are absolutely toxic to people with depression and the best thing they can do is leave. This was a definitely a big factor for her. It is also why choosing a college that is a good match will be so important!</p>

<p>Another factor was light therapy, which we began last month, using a 10,000 lux white-light box with a UV filter, as prescribed by her psych. She doesn’t have enough time in the morning to use it for the full 30 minutes, but usually gets about 20 minutes of light, and sometimes comments that she feels euphoric afterwards. </p>

<p>She runs cross country, which she also sees as an important part of treatment, partly because it keeps her weight down, which is good for her self-image, but also because of the increased endorphins. People who cut get addicted to that endorphin rush, and they really need to replace it with exercise as they are healing.</p>

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<p>I think PM’ing feels more comfortable around these issues for many.</p>

<p>I just want to say that for some people, starting at very low doses of meds works better. We have been told by clinicians that some patients suffer side effects at the normal starting dose, and then get off the meds, when starting at, say 1/4 the normal starting dose, and ramping up slowly, might actually make the drug palatable.</p>

<p>The other thing is that I hope people are aware, and tell their kids, that withdrawal from some of these meds can be a big deal. For sensitive people, it can take months to get off very, very slowly, in tiny increments, and even then there are some symptoms.
This is not to say, don’t take them, only that suddenly stopping is often not a good idea.</p>

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<p>

You know, I almost replied to OP by describing my D’s experience–which spans many years–but then reconsidered. I don’t agree that this thread would be useful except to the extent it might reassure OP that he/she is not alone in dealing with this type of issue. Each person is unique, and any mental health problems he or she may have are specific to that individual. The fact that a particular parental approach or type of therapy or medication may have been successful or unsuccessful in one instance tells you nothing about what will be successful or unsuccessful in another. You just can’t generalize, and hearing the details of another parent’s journey won’t be useful to OP. Certainly the bulk of research shows that a combination of meds and therapy, particularly cognitive behavioral therapy, shows the most promise for many psychological problems, so it seems as if treatment by a therapist and attention from a psychopharmacologist is the right way to go. I’ll add that it can take much trial and error to discover the right medication (or combination of meds) and dosages–a great deal of patience may be required. I wish the best to OP and other parents whose children suffer from mental health issues. It’s as tough road to travel.</p>

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<p>Two years ago this weekend my daughter attempted suicide for the first time. Today, she is healthy, happy and off all medication. She is still in high school. She had always been a good student with a somewhat challenging personality. Her period of significant depression started, as is often the case, with anxiety- social anxiety to be specific. It was almost a year from the stressor which caused severe anxiety to the onset of severe depression.</p>

<p>Here is what didn’t help (these were not always sustained issues, but they were all issues at some point):

  1. Using a sub-optimal therapist who ascribed her issues to ‘adjustment’ and ‘anger with her parents’ but who was not able to accurately assess the depth of her issues.
  2. Using medications without an adequate trial at a given dosage and without adequate review by a psychiatrist. We were seeing a psychiatrist, he was just too busy to really give her the time she needed. On the day she first tried to kill herself both the therapist and psychiatrist had seen her and had described her as ‘better.’
  3. Waiting- to pull the plug on a bad situation. .
  4. The school psychologist who was very narrow in his interpretation of her issues. She was functional in school until the day she took an overdose.
  5. Assuming the issues were an ‘extreme of normal’…
  6. Prioritizing anything but her mental health
  7. Seeing a GP and a Pediatrician who did not really understand the nature of somatic issues or her endocrinological needs. </p>

<p>What did help (in no particular order):

  1. Reducing ‘normal stress’ by pulling her out of school.
  2. Making a huge family change so that she could get adequate mental health services.
  3. Getting a triage assessment by a very sophisticated psychiatrist who took the time to hear the whole story and to really understand her.
  4. Working twice a week with a psychiatrist whom my daughter respected and liked… and who ultimately helped to recognize when outpatient care was not enough and helped her to know why she deserved a better life, when she could not feel it for herself.
  5. Higher dosages of an SSRI and anti anxiety med than the original psychiatrist was willing to do.
  6. Recognizing that my daughter also had PCOS (poly cystic ovary disease) and treating this with hormone therapy. We saw an adolescent medicine specialist ultimately who diagnosed this.<br>
  7. Wilderness treatment at a phenomenal program for 12 weeks to help her to begin to grasp her own self worth, capacity for change and to regain a sense of possibility for her life. Her program also was massively important for our whole family.
  8. An unbelievable therapeutic boarding school program. She has now finished 13/18 or so months. She is off meds, getting all A’s, mentoring another student, playing sports, in student council… etc. She is incredibly perceptive about herself and others, she knows she is not doomed to being sick for her whole life. She understands how to cope. She is, in total, the person whom she could always have been. Our whole family has been positively impacted not only by her changes, but by the processes involved in these sorts of treatment programs.
  9. Working with an educational consultant who has understood all her needs and all her options. He has been able to point out to us not only the programs, but the therapists in the programs who would be most helpful to her.
  10. Our decision as a family to listen, to change, to buy in, to hope, to love, to sacrifice.
  11. Support from SOME friends and family. Not everyone has been there for us or for her, but that is okay…
  12. Getting a very sophisticated neuropsychological assessment which delineated her many strengths and subtle challenges. </p>

<p>In short, getting her well has been a family project and has required huge amounts of effort, time and money – coupled with amazing professional care and the recognition that, often times, medication and a few hours a week with a mental health professional are just not enough.</p>

<p>We are amazingly fortunate we have been able to do this. Her school and her wilderness program have cost much more than any university program, and have been worth every penny. We have not had any medical insurance coverage, etc, for this… but it is a huge deduction for our taxes (always a bright side). </p>

<p>There are probably many paths to wellness… but for our child, this holistic approach has been vital, we feel.</p>

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<p>I admire the resiliance and strength that all of those who have helped their loved ones through these most challenging times. I do agree with the above posters that all of us are so different that what helps each individual will also be unique.</p>

<p>I wish all of you the very best–please remember that your hard work CAN lead to great things and health.</p>

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<p>It can be possible to get insurance coverage for some or even much of the excellent list above. Even for out of network providers, and providers who do not take insurance.</p>

<p>First rule is not to take the first “no” from front line customer service, and ask for a care advocate. Make it clear that you are not complaining, and compliment the customer service rep to the higher up to make sure that going over his or her head did not imply bad service on the front line.</p>

<p>Get MD’s, psychologists, and therapists involved in getting coverage. Tie mental health/health to the need for neuro-psych. evaluations rather than addressing educational issues alone.</p>

<p>Go through whatever hoops insurance wants, meaning one appt. with a local psychiatrist, looking at free studies, calling therapists on their list and even trying one. Document all this, and then tell the care advocate that you have not yet found a person who fits.</p>

<p>Write a nice letter to insurance, telling them you want to work with them on keeping costs down but your child needs the services. Again, detail your efforts to paly by their rules but say that your child needs something else ( a male/female therapist, therapist specializing in transition, a therapist good with chronic illness, a psychiatrist specializing in adolescent bipolar disorder, whatever, a neuro-psych. evaluator specializing in mental health, etc. etc.).</p>

<p>Stay in communication with the care advocate. Develop a relationship. Thank them sincerely when something good happens with coverage.</p>

<p>Often insurance companies are willing to cover a lot more than we think, because outpatient services that are appropriate and qualified help them avoid much more expensive inpatient services.</p>

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<p>Thanks, everyone. </p>

<p>MommaJ, although I understand that each person’s psychology and physiology is different, the specifics have been helpful. </p>

<p>Momlive: She has always gone through phases with trouble sleeping; in retrospect, I’ve wondered if this was due to incipient depression; except that, even as a baby, she didn’t sleep as the “experts” advised. Re narcolepsy symptoms you described: she’s never described what I’d call “hallucinations” before. Upon reading your response, I looked up narcolepsy, and the symptoms don’t seem to apply to her. But, I have been thinking that she should go for a sleep clinic evaluation, if the sleep doesn’t resolve. Right now, she doesn’t want to add one more thing to her plate; although I truly understand, I do wish she’s try some form of meditation…maybe later. Your description of your son’s “inattentive type of ADHD” has me interested in exploring this possibility (because my daughter always had trouble with completing papers in a timely manner - mostly due to her perfectionism, but now I wonder…); is there a good internet site that you’d recommend?</p>

<p>Momlive and Vlines, my daughter did have blood work-up done this past summer, but before depression became a known issue. Now, I’ve read that the typical thyroid test can be not specific enough to spot levels that can impact depression. I read an interesting book with an annoying (IMO) name, about the integrative approach to depression: “The Breakthrough Depression Solution”, by James Greenblatt, a physician who practices on the East coast. He writes about possible physical causes. Has anyone else read this book and, if so, tried any of the approaches suggested? My daughter is now taking extra vitamins, like B, C, Iron, Omega-3. My daughter really does see the value of exercise, and getting back to running consistently is her goal.</p>

<p>Re the Ambien: it just sounds too intense. My daughter and her psychiatrist discussed more natural ways, and she will try these - mainly, I suspect, her getting back to exercising …although that itself is a process with depression. I hope that they discussed “sleep hygiene” also. My daughter only wants to discuss so much with me; she says that she’s so sick of talking about all this - something which I understand also. It’s such a fine line, this process.</p>

<p>Re sleep hygiene: I’m thinking of getting eyeglasses that block short-wavelength blue light (“CET’s recommended fitover and non-fitover eyewear to block short-wavelength blue light. Enhances evening melatonin onset, circadian rhythm adjustment, and visibility in dim light. Useful also for calming “hyper” mood states and minimizing aversive visual glare and drug photosensitization of the retina”), for her to wear when on the computer…because she does work on homework on the computer before sleep. Has anyone had experience with this? </p>

<p>Massmomm, thanks for the reminder about light therapy, because this led me to the glasses mentioned above. I’ve thought of suggesting light therapy to my daughter (although she doesn’t seem to have SAD, it is said to perhaps help with general depression); but, she is not willing to consider taking on another “therapy” right now. There seems to be a good source about this: [url=&lt;a href=“http://www.cet.org/]CET”&gt;http://www.cet.org/]CET</a> - Center for Environmental Therapeutics<a href=“%22The%20Center%20for%20Environmental%20Therapeutics%20is%20a%20501(c)(3)%20nonprofit%20organization%20founded%20in%201994%20in%20response%20to%20accelerating%20international%20interest%20in%20new%20environmental%20therapies.%20The%20Center%20is%20made%20up%20of%20a%20multidisciplinary%20team%20of%20eminent%20researchers%20and%20clinicians%20%C2%97%20experts%20in%20mental%20health,%20ophthalmology%20and%20optical%20physics,%20electrical%20engineering,%20biochemistry,%20physiology%20and%20gerontology%20%C2%97%20who%20are%20committed%20to%20pooling%20their%20efforts%20toward%20the%20development%20and%20application%20of%20effective%20environmental%20therapies%22”>/url</a>.</p>

<p>TheThirdTime, thank you for your in-depth and inspirational story. Could you explain what a “neuropsychological assessment” is?</p>

<p>Thanks, HImom.</p>

<p>Compmom, my daughter’s psychiatrist said that he doesn’t accept insurance. Are you saying that there might still be a way for my insurance to cover his (extremely high!) fees?</p>

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<p>I know of several parents who have been able to get insurance to cover out of network treatment. One was able to get her insurance to cover an out of network adolescent psychiatrist by using the reason that the Dr’s on their plan did not specialize in teens.
Another documented all the local Dr’s and therapists they had seen without an result and they were able to get the inpatient program covered. In this case the Mom had wonderful assistance from the benefits manager at her place of employment.</p>

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<h1>11 The blublocker glasses can be uncomfortable. If you try them, I was told to wear them for 3 hrs before bedtime.</h1>

<p>I’ve found that staying off of the computer is more effective - reading a book or Kindle at bedtime. There are also computers that can be set to block the blue light spectrum, I have heard.</p>

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<p>A neuropsychologist does conventional testing (such as IQ, academic testing) plus extensive testing of personality, behavioral/emotional status, thinking and cognitive patterns, projective testing. Some neuropsychologists specialize in teens with difficult behavior. Others specialize in other things such as people who have had head injuries, trauma, etc. </p>

<p>Our medical insurance doesn’t cover any outpatient medical care at all unless it is a follow up to hospitalization and it does not cover any psychiatric care in or outpatient, so we have been out of luck.</p>

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<p>TheThirdTime, that was an excellent post about your experience.</p>

<p>My son has also had good luck with taking magnesium. He takes UltraMag. I get it at whole foods. He says that really seems to help with his concentration. He’s also taking some other supplements but I am not sure at the moment what they are. I will see him tomorrow and will ask him.</p>

<p>My son had none of the conventional symptoms of Narcolepsy except he always feels tired. He did tell me after the diagnosis that he experienced some sleep paralysis in high school. We were surprised whe he got that diagnosis. But he’s always had sleep issues…since birth. It’s worth doing a sleep study because they look for a lot of things. It’s just one night in a sleep lab. </p>

<p>The sleep specialist also talked to son a lot about sleep hygiene. I think it’s slowly sinking in but getting good sleep can be very difficult in a dorm setting. I’ve also been trying to get son to try meditation. The student health center recommended it to him.</p>

<p>I knew someone who does the ADHD testing and was able to get my son in pretty quickly. Normally she has a wait list of 6 months to a year. Your daughter’s pyschiatrist should be able to recommend someone. </p>

<p>I think my son saw himself as somewhat ‘defective’ before the ADHD and narcolpepsy diagnosis. Both the psychologist who did the ADHD testing and the sleep specialist emphasized to son that he was not crazy or at fault for feeling the way he did. That has done wonders for son’s confidence and mood.</p>