Friday, November 14, 2014


     Lately its been quiet difficult in our household. For the last 2 months or so Ally has been on the road of what I like to call a decompensation.  When you have a mental illness it is inevitable that you are going to have set backs. Set backs usually consists of problems with a medication dose, growth spurts that cause hormonal changes and fluctuations that affect a person’s mood and behaviors, as well as school or home life becomes difficult for the person and the stress causes a set back. 

     Usually if an adult is stable on medication these fluctuations don't cause to much duress and they can handle it by talking to their family, friends or therapist for advice. But in a child that is a whole different story. Their little bodies are still growing and hormonal changes are happening on a daily basis. A medication dose that worked for them 6 months ago may not be what they need now. Also each child is uniquely made, no two children are alike not even twins. Medication studies and trials have shown that even identical twins react differently to the same drug even though they were diagnosed with the same mental illness. On that note a child can be expected to respond a certain way to a medication but they maybe one of the 10% that responds negatively to it. This is the reason why it is so important to read the patient educational handouts that come with the medication the pharmacy send you home with.

    On that note in order for children to be on a correct dose it is extremely important for parents to observe their moods and behaviors. The best way I have found for this to work is to keep a journal. If your child is in a decompensation, like Ally is I find it more beneficial to do this on a daily basis. When it is really bad I journal her mood and behaviors in the morning, afternoons and before she goes to bed. This is helpful for two reasons, a lot of the time when you go to see their psychiatrist you end up forgetting a lot of valuable and useful information and also it is very therapeutic for you as their parent. And when it gets really really REALLY bad I video tape it, because sometimes I need them to be able to see what I am describing. If I say Ally has been raging and saying she wants to die for over 30 min, it much more believable if I caught that on tape.

    Don’t change the dose yourself. We are not Doctors. Although it is tempting to up the dose before your next visit this isn't the wisest idea.  7 years ago when I went to nursing school we learned that in the elderly population and in children “we always go low and start slow.” Which basically means that doctors like to start at the lowest possible dose and then slowly add to it. The rationale behind this again is because their bodies are growing and these mental health drugs were created for adults and are being used in pediatrics. So there aren't to many studies on how growth and development is affected by taking these medications.  I cant tell you how many of my friends have confided in me that they don't wait for their doctors to "UP" their child’s ADHD medications they just dot it themselves and little Johnny is no worse for the wear. And inwardly I cringe because you have no idea how it can negatively affect your child. These drugs are processed through the liver and excreted through the kidneys, you don't want to damage either one of these vital organs. Additionally these drugs can either have an activating effect on the neurotransmitters or a deactivating effects. If the dose is too high it can cause your child to be more unstable and unable to focus, not the behavior you where looking for. Always consult with your physician before making any changes.

   Ally setback started with a growth spurt which in turn caused her stability on her medication to go out the window. She started to have problems with her attention and focus at school. Her mood stability also took a dive. Ally’s mood disorder is consider to be they type that is ultra rapid in that she cycles through multiple different mood several times a day. Normally she was able to keep it together at school but with her decompensation it started to affect her there as well. She is lucky that she is followed by school behavioral health so her psychiatrist, social worker, counselor, and behavioral therapist all talk to each other.  After upping her antipsychotic medication it was decided that she could benefit from the use of a mood stabilizer. So we are now on that path. It is a slow process. We are only on week two of lithium. As much as I would love to wave my magic wand and have the Ally that is a happy focused little girl I know the wisdom of taking your time with adjustment. For now we are strapped into our seats for the emotional roller coaster ride that is finding the right medication cocktail that will work for her. Ally being uniquely made and responding differently to medications only time will tell what will be the right ones for her.

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