31
Oct 25

Easing Antidepressant Withdrawal

Teenager“Do not be afraid to spend an extra week or even month titrating if it makes it easier on you.”

Antidepressants are famous for producing flu-like symptoms when you stop taking it.  If you miss a dose, or come off of it too quickly, you can get a headache, nausea, or dizziness. This is especially true of antidepressants with a short half-life, such as Effexor, Lexapro, and Paxil.  These medicines are often accused of being “addicting” because a poorly-handled withdrawal regimen can cause such misery that the patient goes back on a drug they were trying to quit.

If you want to stop your antidepressant, the psychiatrist will recommend a titration schedule. If you get withdrawal symptoms, you will need to slow down the titration. Often, things go pretty well for the first half of the dosage and then cause problems near the end. Do not be afraid to spend an extra week or even month titrating if it makes it easier on you.

Still, sometimes even the mildest cut will trigger severe withdrawal symptoms. Sometimes, the psychiatrist will replace the offending drug with Prozac. This removes the withdrawal symptoms and once the previous antidepressant is gone, the patient can easily remove the Prozac, which has a long half-life and is much more forgiving.  Your psychiatrist will tell you if such a regimen is appropriate for your teen.


26
Oct 25

When to Call the Police on Your Mentally Ill Teen

Relapse“If your teen’s behavior is so erratic that you think there is a risk of a neighbor calling the police, seize control and call first.”

Parents with mentally ill teens find themselves calling the police for various emergencies, ranging from suicide attempts to threatening behavior. As distressing as it is to have to call the police, the possibility is worth preparing for. Every year, the police shoot to death people who are in the throes of a manic or psychotic episode and are judged to be dangerous. If your teen’s behavior is so erratic that you think there is a risk of a neighbor calling the police, seize control and call first. Many police forces now have personnel trained to deal with psychotic individuals. Do not wait for a neighbor or your landlord or someone else to call because they are unlikely to deliver the full story. If you are still hesitant, ask yourself this: if things escalate and the police do appear, would you rather they take your child to the hospital or to jail?

Let the police know that your teen is in a psychiatric emergency. If there is a weapon involved, tell them; they’ll know to keep their distance rather than walking in there and reacting after being taken by surprise. If your teen has been treated at a particular hospital before, provide the name of the hospital and the name of your teen’s psychiatrist. If your teen is taken to the hospital, call his psychiatrist and leave a message. I recommend that you carry either on your cell phone or on a credit card-sized piece of paper in your wallet, the contact numbers for anyone you might need, including:

  • Psychiatrist
  • Therapist
  • Hospital intake
  • Police psychiatric emergency number

If your teen is arrested, the courts may step in and force treatment. This can be a painful thing for a parent to watch, but it may be the best opportunity your teen ever gets. Your teen will be referred to a mental health professional, who will take over for you so you don’t have to fight with your teen anymore. The court may force medicine. If you do feel that your teen’s rights are being violated, you may choose to consult with a lawyer. Just be clear with the attorney that your goal is for your teen to be treated.

Let’s hope you never encounter such a situation, but an emergency plan is an important safeguard. Keep medicines locked up and absolutely no guns in the house. If you get new health insurance, call and make sure that it covers your treatment team and the local hospital you want to use in case of a psychiatric hospitalization. You don’t want your teen taken to a hospital that is not in your insurance network.

The best resource I have found for preparing for psychiatric emergencies is in a book by Francis Mark Mondimore MD titled, Adolescent Depression: A Guide for Parents. The suggestions in this chapter on handling emergencies helped me come up with my own plan and gave me a great deal of reassurance and comfort.

Recommended Books:
Adolescent Depression: A Guide for Parents, by Francis Mark Mondimore M.D.
When Someone You Love Has a Mental Illness, by Rebecca Woolis, M.F.T.