We met with the new psychiatrist this week.  Or what may become the new psychiatrist.  I say ‘may’ because I have also made an appointment with another psychiatrist so we’ll see who we like better.

So, how was he?  Well, ok, I guess.  This one is fairly young.  He’s less than 10 years out of med school and he’s young, energetic and tried really hard to be ‘hip’ and connect with Rye.  And Rye seemed to like that.  As for me, though, I was a little more leery.  I tend to like older, more tried and true doctors who have seen it all.  Rye’s previous psychiatrist had well over 35 years of experience (he technically could have retired if he had wanted to) and I felt like he was very good at what he does and was very mellow as well.  He didn’t get all hung up in the vernacular of things and was good at seeing the bigger picture.  The new pdoc?  Well, he’s newish in his career and associated with a hospital (he’s on hospital staff) so he has to follow a bunch of criteria whether he wants to or not.  And he has to answer to a bunch of people whether he wants to or not.  And that can get kind of annoying.

For example, he does not like to use the term ‘bipolar’ and feels unsure that Rye really has ‘bipolar’ because after all, he has known us for all of 2 minutes now and do we, as a society, really know what bipolar looks like in a child?  So, he uses the term “Mood Disorder NOS” and gave us a whole mini lecture about it.  Dude, wtf, who the crap cares what you call it? If it makes you feel better to call it Mood Disorder NOS, go for it.   Call it ‘Der Wienerschnitzel’ if you want but let’s not mess with what’s working.    And honestly, let’s not debate what bipolar looks like in a teen.  If your child gets so hyper that they can’t attend school, can’t concentrate, make terrible decisions, engage in dangerous behavior, have no peace of mind, racing thoughts, racing speech, superhuman strength, can’t sleep, can’t relax, get delusional, get paranoid, hear things, see things, have debilitating nightmares…it’s not just a case of the ‘hypers’.  For peet’s sake.  Let’s not reinvent the wheel here.

Another thing, because this psychiatrist is on hospital staff, he has no say in his schedule.  In other words, we saw him for an hour for our initial appointment and going forward we will only be able to see him for 20 minute increments for med checks.  Even if we wanted to see him for hour long appointments and pay out of pocket to get more out of the experience or get more help, we can’t.  He’s not allowed to do that.   So, our fate rests in the hands of someone who knows us not at all and who really can’t get to know us either, even if we wanted to.  Even if we wanted to pay extra for it.  I don’t like the inflexibility of that.

Also, he asked for records.  All of Rye’s records from the dawn of time.  Why?  Because apparently he is going to look them all over and decide if all of these ‘diagnosing’ doctors (his colleagues with much more experience than himself) are right in their diagnosis .  And, because he says it will take their hospital staff 100 years to get the records if we leave it to them (not very reassuring), I need to do it all myself.   Apparently it is out of the question to just pick up the phone and call Rye’s previous pdoc for 5 minutes to get the run-down, colleague to colleague.  And to this end, getting Rye’s records is a pain but overall no big deal and all sounds good and great but let’s think about this…given the fact that we have now already had our allotted one hour appointment and from now on we get 20 minutes every month or up to every 3 months (our choice) to see him in total every year, this record seeking journey hardly seems worth my time.  When is he going to look these records over and when is he going to discuss his findings with us?  In the 3 hours total a year he sees us (of which we’ve already used 1 hour up)?  It’s never going to happen.  Also, he expressed concern that Rye’s learning disabilites may be causing his ‘bipolar’ like behavior.  Ummm, no.  Let’s not be ridiculous.  Learning disabilities don’t land kids in hospitals with crazy erratic behavior and audio and visual hallucinations, etc. etc, etc.

Anyway, the good news?  He is very nice and personable.  And I know he means well.  He appears to be a sweet person.  And Rye really likes him.  And he’s close to our house.  And he’s covered by insurance.  So, we’ll keep him in the running.  And, most importantly, he didn’t change the meds or even ask about changing them.  So that’s good.

Let’s not try and fix what isn’t broken.

He is that stable.

One of the things I have noticed recently is that due to the long length of stability he has had now (almost a year) in conjunction with growing a little older, he has really matured emotionally.  And he has become so much more independent this summer it is incredible.  He takes his meds on his own even while he is away at friend’s houses, he is not scared to go away with kids he does not know (summer camp), and he went on a trip to New York with Don by themselves and he loved it.  Seemingly he didn’t miss me at all.  This is a far, far cry from where he was a year ago when he was unstable and would barely leave my side.

I’m happy for him.  Very happy.

Looking back I can say there was a point last year when I wondered how independent he would ever be.  I was scared.  And saying this is odd because he was very independent as a young child.  Fearless, really.  All through elementary school he was very outgoing, perky, lots of fun to be with, everyone’s friend.  And then came middle school and the bipolar really set in and that all went to hell.  Well, no, I take that back.  When he was manic he was fearless too but that was in a different way.  A destructive way.  A scary way.  And then there was the mood swings, and the rages, the crying, the suicide threats, and the hallucinations and the thought disturbances.  I honestly didn’t know if we would ever make it out of that.

And yet,  here we are.  In a place I never thought we would be just one year later.  He is now himself again, like a more mature version of the boy he was before the bipolar emerged.  He is back to good.

Will this last? Who knows.  No one can predict.  But I can say I am glad for this time.  Glad for him to get a taste of independence and self confidence after having been so unstable.  Glad for him to have the opportunity to take ownership of his need to take meds and need to monitor himself some (he tells everyone he is around that he is bipolar and has to take his meds).  Glad for him to tell his doctor everything that is going own in his own words and work together with his doctor to get what he needs.  Glad for him to mature emotionally and see what it feels like to be ‘him’ again, only better.  Older, stronger and more capable.   To have control of himself, his emotions, and his life.

And the best part?  Now, going forward, in times when he does become unstable [and chances are most likely he will have these times throughout his life] he will know.  He will know what stability feels like.  He has this experience under his belt and will know that although he may be struggling at that moment and he may be out of his mind at that moment, stability is achievable for him.  He will know somewhere within himself what he is striving for.

And this is it.

_______

As for Dr. Stuart Kaplan and his Newsweek article, here are my thoughts.

Thank you Newsweek Magazine for your cutting edge journalism and breaking scientific studies but Dr. Kaplan is about 20-30 years late to this party.   Childhood bipolar disorder exists.   Is it common?  No.  Is it overdiagnosed and overmedicated in very young children?  Possibly.  But does it exist?  Yes.  And you don’t need an MD or a PhD to figure this out.  Ask any large group of adults with bipolar disorder when their symptoms began and many will tell you in childhood.  Period.  And most of these adults wanted help as children but no one believed them thanks to people like  Dr. Kaplan, propagating the idea that their symptoms were all phony or should be chalked up to something else.   Many of these children attempted suicide.   Some completed their suicide attempts and are no longer around to tell their stories.

Children with ADHD and/or ODD (and is this, ODD, really even a diagnosis?  people aren’t just assholes for no good reason, there is an underlying mood component to this) don’t experience psychosis.  They don’t experience visual and/or auditory hallucinations, they don’t experience incapacitating depression or attempt suicide, they don’t become homicidal, paranoid, delusional, experience thought dysfunction, hypersexuality, and on and on.  And the idea that we can fix these symptoms with stimulants as you would use to treat ADHD ??  Yikes.  There could not be a worse path to take.

And, as for bipolar disorder being trendy. When did this happen??  I can tell you from personal experience, tell people your child is bipolar and about the last response you will get is…’cool!   How can I get on that train? ‘

I know about 5 kids (children and teens) in total with bipolar disorder in our entire community.  And all of them have a direct biological relative with bipolar disorder.  In contrast, 1 in 10 kids now are diagnosed with ADHD.   Teach in any school in America and at least 10% (and sometimes up to 25%) of your class with be on stimulant medication.  Now that is trendy.  And sad.  You can’t tell me that 10%-25% of American children as young as 5 years old need to take speed to function and learn.

Ring, ring…

Dr. Kaplan, the 1980’s are calling and they want your professional opinion on childhood bipolar disorder…

Every teacher and tutor Rye has ever had will tell you very clearly, he has ADHD.  I know it, we know, his pdoc knows it.  It’s obvious.  And has been since he was about 5 years old.  He has a very short attention span when it comes to traditional learning and it takes a very patient teacher to teach him.

So, do we medicate the ADHD?

No, we don’t.

Why?

Well, we’ve tried.  A few times.  And we had good results for a few months and then ultimately had disastrous results.  Mania, psychosis, hospitalization.

With Rye having bipolar disorder and ADHD we choose to make a choice.  We have great stability now with the bipolar disorder and it took us over a year to get to this point.  Rye takes 2 medicines, Depakote & Seroquel.  Seroquel scares the crap out of me and I thank God every day that he is able to be stable on such a low dose (50mg).  I wish he didn’t need it at all.  That said,  there ain’t no way in hell I plan to add more meds to the mix and jeopordize that stability he has just so he can pay attention for longer to do schoolwork.  No way.  Forget it.  Not happening.

Does this make doing schoolwork hard?  Yes.

Does this impede his academic performance?  Yes.

Is this a contributing factor to us homeschooling him?  Yes.

Does it take great patience to teach him?  Yes.

But, so what?

To us, it’s worth it.

He is very active and we keep him very active in sports and other outdoor acitivities.  He needs and loves a lot of physical activity and a lot of time outdoors.

He’s happy most of the time, he’s healthy, and he’s living a very full, loving,  productive life.    That’s what matters to us.

The rest is just book work.

And I am disheartened.

This week I was asked to speak on a health panel for parents blogging about their kids with health issues and I declined.  Why?  Well, anonymity for one.  But more to the point, I am not an expert.   I guess it’s true you could say I am a health activist (it was a health activism group).  Kind of.  I am a parent who blogs.  I blog about our experiences to keep track.  I blog to journal.  I blog for fun.  And for an outlet.  I blog to think out loud.  I blog to hold myself accountable.  To check myself that I am always working in the best interest of my child.  And I blog to let people know that raising a bipolar child can be fun.  And wonderful.  And these kids have a lot to offer the world, given the right treatment and environment.  But I don’t blog to advise (although I have given advice in other blogs’ comments section but I’m not going to do that anymore for reasons I’ll list below).  When Rye is a grown man and self sufficient and stable and happy, I will be in a place to give advice on raising a bipolar child.  But not now.  We aren’t there yet.  Nowhere near it.

Now, I will say that unlike the average blogger, I do have a very experienced pdoc in my immediate family.  So in addition to Rye’s pdoc (who is great and also extremely experienced) and our family doc, I do get better than average advice.  And I feel very fortunate for this.  I get great insight into what it is like [the inner workings of the brain] to be manic, depressed, psychotic, etc.  And daily if I need it.  Hourly, if I need it.  So that helps.  A lot.  A whole lot.  And I have learned so much that I never would have known or been aware of otherwise.  And honestly, I don’t think Rye would be as stable as he is today without this.  But I, myself, am not an expert.

In my reading I’ve learned that what is ok and acceptable for one family will not be for another.  And this is why advice is a tricky game.  For one family, it might be ok for their child to go in an out of psychosis and threaten suicide as long as they are happy the next day. This may just all be a part of ‘it’ for them.  For another family, it may be ok for their young child to be endlessly hospitalized and adjusted on new meds and continue to hope and pray that psychiatric hospitals will heal them.  And never look for another option or consider another scenario.  For another, it may be ok to subject their young child to clinical trials for psychiatric medicines even though there is no known evidence that said meds will work and no guarantee that the meds, if they do get them, won’t cause permanent damage to their child’s body and their child’s mind.  Because after all, there is no research on the meds, hence the study.

But for me?  For us? For our family?  For Rye?  No way.  If my child is having times of distorted reality, I am not ok with that.  I feel the need to fix that. That is no way to live if it can be helped (which I realize it can’t always and that is a different matter).  If my child is in a psychiatric hospital, I do not ever believe that that hospital will heal my child.  Ever.  Psychiatric hospitals do not heal children.  They keep them safe temporarily but can also often do more harm than good.  Ask my son – he’s been twice.   If my child needs meds, I am going to go with the ones that have been studied, if possible.  The ones that have known good results and won’t try many others until those options have been exhausted (learned my lesson on that one with Abilify which has only been studied for a few weeks and almost caused my son permanent tics).   I was reading recently on one blog about a child who has spent the good part of the past few years in and out of psych hospitals for bipolar disorder and now the child expressed an external desire in the hospital to kill himself and kill another child.  And everyone is shocked.  I don’t understand why they are shocked.  At all.  They take this as a sign of how mentally ill he is and that this is an expression of his bipolar disorder.  But it is?  Maybe.  I can tell you though with certainty that if I spent ages 5-7 or so  constantly scared and institutionalized, in and out of psych hospitals and on varying psych meds so my mind was all over the place and with no end in sight because every time I freaked out my mom hospitalized me, I would want to kill myself and someone else too.  Seems to me this shows the kid is more sane than insane.

I’ve also noticed that many bloggers confuse symptoms of one diagnosis for another.  For example, confusing the symptoms of autism spectrum disorders with the symptoms of bipolar disorder. These two disorders are nothing alike and yet I see people blogging that the symptoms that their children have from Asperger’s, for example, are due to bipolar disorder.  And professing the truth of this.  No, no, and no.  This is all wrong.   Autism spectrum disorders and bipolar disorder, although they may coexist, are not the same.  At all.  Not at all the same.

Anyway, I could go on and on but I would say read blogs for fun.  Read blogs for enjoyment.  Read blogs to hear people vent and learn from other people’s mistakes.  Learn from my mistakes.  And when asking for advice or seeking guidance, consider your source.  Bloggers are not experts.  I am not an expert.  Not by a long shot.  Bloggers are simply parents sharing their experiences.  And although there can be great value in this,  if the person you are seeking guidance from has a child that is 6, or 7, or even 10 – anything before puberty hits -  and they are just beginning their journey, these folks don’t have much experience yet.  Don’t let the blind lead the blind.  My son is only 13 and I don’t have a lot of experience yet.  We have been at this for 7 years and I consider myself to be an amateur.  So take it for what it is.  I know nothing, really.

Take the best and leave the rest.

And last but not least,  always be leary of anyone trying to make a name for themselves from their children’s illnesses before their children are old enough to give proper legal consent and tell their side of the story as an adult who realizes the long-term ramifications of what they are doing. Honestly, I don’t care if I ever get one more comment on this blog, ever, for saying this but it’s just creepy for a child that may ever live independently to have their right to privacy regarding mental health issues violated on a global scale by their own parents.

Would you want your parents to do that to you?

____________

I’ll admit, because we do not watch much television I had no idea this show was on until I read about it on the internet.   And my first thought when I saw that the show was coming on was, What happened to HIPPA and Children’s Right To Privacy?  I really don’t understand why these apply to insurance companies, schools, medical facilities, correction facilities and the court systems but not to the internet and social media.

Anyway, on to the show.   I did not watch the whole show.  I did, however, watch all of the clips available on Oprah’s  website (www.oprah.com) and read the transcripts that are available.

What did I think?

Well, wow.  I’m not really sure what to think.  The show itself was a bit unclear to me as to what Zach’s actual diagnosis is and what the family is doing to help him until I read this.  This is a comment posted by the mom, Laurie, in reaction to some comments on one of the clips:

Posted: Sat 2/19/2011 5:42 PM

LaurieFerris : This is Zach’s mom. I’d like to clarify a few things. He was diagnosed with Sensory Integration Disorder, Severe ADHD, Unspecified Mood Disorder and Tourette’s. Zach was on a variety of psychotropic drugs in the early years which for the most part did not help. He has been off of all medications for the past year and 1/2. We are strong believers in alternative and holistic approaches to helping these children besides using drugs. Proper nutrition, exercise and limited exposure to television, computers and violence are also important. The reason he is living away from home with me is so that he can attend a special school that utilizes alternative approaches such as energy work, yoga, vegetarian diet, meditation etc. to help him with his attention and focus issues, which are also greatly improved. The tics are a result of his Tourette’s, and they are actually much milder than they used to be several years ago. What has helped Zach the most has been “energy work” that he has done for the past two years with an extraordinary counselor who taught Zach to shift his thoughts from negative to positive ones. We believe that Zach is an “energetically sensitive child” and that he has great potential to do wonderful things in the world as long as he stays positive and in the light. Thanks to all who have taken the time to post comments on Oprah’s site.. For more information, you can contact me on facebook at SavingZach or at laurie@energeticallysensitivechild.com.

http://www.oprah.com/oprahshow/An-Explosive-Child-Learns-How-to-Cope-Video

So,  Zach was having terrible rages, was violent towards the mom (hence the title of a 7 year old trying to kill his mom), destructive towards the house, etc., etc.  A fairly typical story of an unstable child with a mood disorder.  And especially typical of a child with other brain impairment issues/autism spectrum issues in addition to a mood disorder.  I guess they tried psychiatric medicines and those didn’t work like they wanted [remember, these medications are made for adults, not children, so this often happens - and often times the medications that don't work well on children work really well on those same individuals as teens and adults].  Mom now feels like Zach has holes in his memory due to the meds he took [note: this memory loss could be from the psychosis itself which can cause periods of blackout] and that the meds impaired his learning so they only want to use natural, alternative methods to heal him.  They now rely on Zach (still a child) using visualization techniques and encasing himself in white light to protect himself from the ‘creepy’ voices that tell him to do bad things [voices that can morph into the same voices as his parents and caregivers which adds a complex dimension to trying to shut them out].

Interesting.

In agreement with Laurie, I would argue that all bipolar children and/or autistic and/or spectrum children are “energetically sensitive”.  No doubt about it.  These kids are more in tune with the energies around them and the emotions of those around them than anyone other than them can even imagine.   And this is why it is so incredibly important how one parents these kids and why the environments they are in on a daily basis are so important.   That said,  no child can live in a bubble.  And no parents can be perfect.  And no school can be perfect.  And no environment can be perfect and perfectly stress free.  And Laurie herself admits that Zach used to rage for hours literally no reason at all.  So how is one to control that?

For them, they say a special school, a special diet, no computers, no tv, yoga, mediation, and visualizing the white light are the answer.

Does this seem dangerous to me?  Yes.  Will it work in the long term?  Only time will tell.  It is my personal opinion that leaving a psychotic child’s fate in his own hands and counting on his ability to be able to outsmart and/or out think his mental illness is not an option. After all, prisons, residential treatment centers and psychiatric care facilities are full of people that have tried to do this.  Is it ideal to hope that he can control his own mental illness?  Yes.  Do I understand where mom and dad are coming from in not wanting to use psychiatric drugs with many side effects on their son?  Absolutely. We have been there and did just that.  We took our son off of medications for years from 6-12 years old with success [that said, our son's behaviors were not anywhere near as extreme as Zach's at that age and our son was not hearing voices].  And it worked for us until puberty hit.

As he is still young yet and has not hit the teen years and early adulthood, I think we have not heard the end of the story with Zach.

When I watched Oprah interview Zach and watched her really press him about the voices he hears, poor Zach seemed to be really struggling.  He was extremely tense and did not seem ‘calm and relaxed’ at all, in my opinion.  And he seemed to have a lot going on in his head.  It made me wonder what the voices were saying to him at that moment and I felt really bad for him.  I then felt even worse when Oprah talked about how he is such a positive kid with such good positive energy and how sometimes she interviews really bad, negative people in prison.  People who have tried to kill people.  People who have killed people.  Wait…you mean like Zach?  After all, he is on the show for trying to kill his mom.  He hears voices that tell him to do really bad things.  Things so bad he won’t share with Oprah (or probably anyone else, for that matter) what they say.  And don’t think for a minute that Zach didn’t pick up on that.  These kids are smart as whips.  As are their voices.

Herein lies the danger of these interviews.

Anyway, I wish the best for Zach and his family and I hope for their sake and for Zach’s sake that their chosen treatment method works for them.   We all want what is best for our children and it is true that not all children are significantly helped by psychiatric medications.  Especially ones with complex psychosis.

For us?  We are sticking to the psychiatric medications that are working for our son.  I am grateful every single day that our son is stable on the meds he takes now and he is living a great life.  And I love, love, love it that Brit came on and gave such a good message of hope for Zach and his family.   Brit has bipolar disorder and was apparently on Oprah years ago as a child for exhibiting behaviors similar to Zach.  Brit now says that due to getting a correct diagnosis of bipolar disorder and being on the right medication he is stable and happy and in college living out his dreams.  You can see the clip here:

http://www.oprah.com/oprahshow/Brits-Triumph-Over-Childhood-Mental-Illness-Video/topic/oprahshow

Brit is an inspiration and a true success story.  And I wish only the best for Zach and his family.

One lesson we learned the hard way last year is that for Rye there is a direct correlation between repeated exposure to or engagement in adrenaline producing activities and the rise of mania.   And for us, this is definitely something that needs to be watched because this kid seeks out adrenaline producing activities and absolutely loves them.

So, how do we deal with this?  We still let him do the activities he wants to do (within reason, of course) but we limit his overall exposure so that he does not have too many of these activities in too short of a time frame (for example, riding the four wheeler is one of the activities that really get him going so he still rides often enough to have a lot of fun but not for days on end at a time).  We also have him take a little extra Seroquel if we see him ramping up too much and this keeps his system more in check and allows his brain to relax and keeps the mania away.

Living and learning.  Always living and learning with this one.

And I’ve come to the realization that one of the greatest accomplishments we made as a family in 2010 was coming to a place of true acceptance of Rye’s diagnosis.  He has bipolar disorder.  He tends on the manic side.  He needs to take medications.  He will always have bipolar disorder, or manic depression, whatever you want to call it.  Throughout his life he will have times of stability.  Possibly years at a time of stability.  But his mind will always be susceptible to times of mania and times of depression.  And he will have times of instability.

And we are ok with that.  It is a part of him.  It is not all of him.  Just a part.  But we do need to be aware of it and we do need to help him manage it.  And we accept that now.  He accepts that now.  We are all on the same page.

Rye is an incredible person.  He has a million great attributes and he is a ton of fun to be around.   He has many interests and many strengths and is capable of doing great things.  Given the right environment and the right support system, his possibilities are endless.

I’m curious to see what the future holds for him.

if Rye is going to have a hard time making good decisions for himself as he gets older.  And sometimes it really scares me.  It’s tricky because at times he can be such a  mature and astute kid and can make really good decisions, is a good conversationalist and seems to really have his head on right.  When we travel or are at dinner parties, gatherings, etc. he always gets compliments  from adults on how well he interacts with adults and they are always impressed with how outgoing, level headed and mature he seems for his age.  However, at other times you just wonder what in the blessed world he is thinking and why he makes the choices he does.  Especially after he’s been around a lot of kids his own age.  And even more especially when he’s around the kids from his [previous] school.  It’s like he loses half of his brain cells.  And I know a part of that is just being 13 years old.  And I know a part of it is just the intermittent immaturity of growing up.  But a part of it is just him as well.  He is so greatly influenced by his environment it’s incredible.  And it can be a bit nerve racking at times.

Nerve racking.

Because we really have to work hard to control his environment.  He is truly a chameleon that completely changes completely according to what environment he’s in.  I mean completely changes.   I’m just so glad he is out of public school.  He learned more bad stuff there then I ever could have even imagined.  It’s crazy.  And I know there are millions of kids that do great in public school and for them I am so happy,  but mine was just not one of them.

Definitely not one of them.

Oh dear.  I cannot even express to you how horrified I am by this column.  I started with his advice on Serotonin Syndrome and it went from there.  Here was my journey:

_________

Reader Question: What antidepressants help serotonin syndrome sufferers?

Dr. Raison Answer:

The answer is: Try an antidepressant that does not have appreciable serotonin activity. The most obvious choice in this regard would be bupropion (brand name Wellbutrin), an antidepressant that affects the norepinephrine and dopamine systems, but leaves serotonin untouched. Another option would be an older antidepressant called desipramine (brand name Norpramin).

My Response:

According to the Mayo Clinic, Wellbutrin can be a prime contributor to Serotonin Syndrome. As the Mayo Clinic describes:

A number of over-the-counter and prescription drugs can lead to serotonin syndrome, especially antidepressants. Illicit drugs and dietary supplements also can cause the condition. These drugs and supplements include but aren’t limited to:

• Serotonin reuptake inhibitors (SSRIs), antidepressants such as citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine, paroxetine (Paxil) and sertraline (Zoloft)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), antidepressants such as trazodone and venlafaxine (Effexor)
• Bupropion, an antidepressant and tobacco-addiction medication (Wellbutrin, Zyban)
• Monoamine oxidase inhibitors (MAOIs), antidepressants such as isocarboxazid (Marplan) and phenelzine (Nardil)
• Anti-migraine medications such as almotriptan (Axert), naratriptan (Amerge), sumatriptan (Imitrex) and zolmitriptan (Zomig)
• Pain medications such as fentanyl (Sublimaze), meperidine (Demerol), pentazocine, (Talwin) and tramadol (Ultram)
• Lithium (Eskalith, Lithobid), a mood stabilizer
• Illicit drugs, including LSD, Ecstasy, cocaine and amphetamines
• Herbal supplements, including St. John’s wort and ginseng
• Over-the-counter cough and cold medications containing dextromethorphan (Robitussin DM, Sudal DM)
• Anti-nausea medications such as granisetron (Kytril), metoclopramide (Reglan) and ondansetron (Zofran)
• Linezolid (Zyvox), an antibiotic
• Ritonavir (Norvir), an anti-retroviral medication used to treat HIV/AIDS

My bet is with the Mayo Clinic.  How about you?

__________

Reader Question:  How can I stop using Paxil without the side effects?

Dr. Raison Answer:

The good news is that only about 20 percent of patients who take antidepressants experience these type of withdrawal symptoms when they discontinue the medications, and when experienced, these symptoms are usually mild and resolve in a week or two…

But remember that most people can stop an antidepressant cold and won’t have symptoms.

My Response:

This advice is irresponsible and horribly misleading.   Antidepressants are more often than not quite hard to discontinue.  And some people never are able to discontinue.   Most people cannot stop them cold and have no symptoms.  And especially not Paxil.  Just ask all of the thousands of people at www.paxilprogress.org or Phil Lawrence who made an entire documentary film about this called Numb.  Search the internet for Effexor withdrawal or Zoloft withdrawal.  Search YouTube for video accounts.  Read the accounts of people trying to withdraw on Furious Seasons or Beyond Meds. Read accounts of people discontinuing at www.crazyboards.org

And to make someone asking for advice feel like “most people” can discontinue with no issues is unethical and immoral.  Period.

_____________

Reader Question: My son hears suicidal voices.  What can I do?

Dr. Raison Answer:

I’ve seen thousands of patients over the years, and I can assure you that the most powerful factor in good outcomes for people with serious mental illness is the commitment of family members to keep on trying…

When you do feel discouraged, try to imagine all the patients I have treated, or advised on, who had their lives turned around for the better when the right treatment for that particular patient was finally found and instituted.

My Response:

As a mom of a child who has heard voices, I feel particularly drawn to this question.  First, Dr. Raison gives no actual advice or help here but tells how childhood psychosis is uncommon and urges the writer to keep trying to get help.  This in and of itself shows the ridiculousness and dangerousness of even having these serious questions and answers in an online advice column.  Second, if your son is hearing suicidal voices and you have no treatment plan of action with your home psychiatrist, your child is in grave danger and you need to get the child to the hospital where they can be evaluated.  The voices could have an organic origin, they could be caused by medication prescribed for a psychiatric diagnosis (they mentioned ADHD in the question).  It could be a number of things.  But the child is not safe.  Dr. Raison never once says this.  The child is not safe while hearing these voices.  I know.  I’ve been there.  And you would expect a sound psychiatrist to point this out.

As for the end of his response when Dr. Raison tells the parent not to get discouraged and to think of all of the patients he has seen over the years and how they have all been helped.  How does this help this parent?  Especially when he has offered them no actual advice but to keep trying.  This response is so incredibly arrogant and disgusting it is almost mind boggling.   The ego that has to involved for someone to write this to a parent whose child is hearing voices telling them to kill himself is so vile it makes me sick to my stomach.  Obviously the family involved does not have the right treatment right now or they would not be in this predicament.  If they had the right treatment, they would know what to do when this happens.   And mistakenly they are writing to Dr. Raison for advice regarding help on how to get a plan.

I guess if the child goes ahead and kills himself it is due to the parents just not trying hard enough.

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These were only the first three questions and answers I happened upon as they were linked to each other.

I didn’t have the heart to read more.