Thursday, September 29, 2016

Mental Health

OK, I got permission to write about this from my daughter.

Remember how many posts back I mentioned that we had been dealing with some heavy stuff that I couldn't write about just yet? This is it. 
Over the last year, Catherine has been dealing with depression. Suicidal thoughts. Self harm and thoughts of self harm. We've been doing what it takes to get her well again, including inpatient hospital stays, outpatient daily therapy, and a therapy program that meets with the family 3x weekly. She's on medication. We've added nutritional supplements. She has a safety plan. We do what it takes.
The first week of September, something happened that shook us all up a bit. I'm finally at a place where I can write about it without cursing like a sailor.
She had been dealing with signs that her body had adapted to her medication dose, and was experiencing another depression slide. (Those of you who have had depression know what I mean.) I called her psychiatrist's office and begged them to move up her med check appointment, and they were able to get her in sooner, but it was still a week away. Meanwhile I added niacin, b-complex, and vitamin D to her daily regimen, after checking to make sure that there were no interactions and we wouldn't overdose on vitamins. I wanted to make sure that she didn't have to go inpatient when a simple med adjustment might do the trick - I was willing to try vitamins to boost her along. Heck, I was willing to load her down with Mt Dew and chocolate if it helped, but vitamins seemed healthier.
It helped. Noticeably so. In fact, I was starting to second-guess taking her to the psych, since she was doing so much better. But I figured it would seem odd if I had begged for an earlier appt and not taken her in, so we went.
The doctor was horrified that we were giving her niacin, b-complex, and vitamin D. She fretted that Catherine would develop liver problems, and that there would be interactions with the lexapro. I had checked, it would take a much heavier dose than she was taking before liver damage would be a problem. But fine, doctors get nervous about things like that. It's their job to be cautious.
Then she spoke with Catherine for 10 minutes, and called me in to inform me that in her opinion, Catherine needed to go into the hospital immediately. Why? She had had self harm thoughts the night before. Not suicidal thoughts, and she did not self harm. But the doctor insisted that the self harm thoughts were essentially suicidal thoughts, and she would not be safe anywhere but in the hospital. She also mentioned that she thought Lithium would be the next step in medication.
I was shocked. I explained that with her therapy team, we had successfully helped her stay safe outside the hospital during a previous crisis that was much more obvious than this. The doctor didn't want to hear it. I asked if her therapy team could be called. The doctor told me that if I did that, and they second-guessed her determination that Catherine needed to be in the hospital, she would have a serious problem with that. No direct statements were made, but I started getting nervous that this doctor would do things to make sure that I checked Catherine in, or would see to it that she was removed from the house. Maybe those fears were unfounded, but I was very much on edge. I was unable to get a hold of my husband, because he was at work - had he been there with me, I think this would have turned out differently.
I was finally bullied into agreeing to the admission. I knew the staff at this hospital, and I knew that if Catherine needed the help, they would take care of her, but they wouldn't keep her or medicate her with anything too heavy if it wasn't needed. That was Wednesday the 7th.
On Thursday, we went in to talk with the hospital doctor, nurses, etc, and brought our therapy team. Everyone seemed baffled as to why Catherine had been admitted in the first place. She was stable, in fairly good spirits, and completely lucid. The doctor there agreed that she could go home on Friday, before the requisite 72 hours had even passed. He agreed that Lithium was far too heavy, and that the current dose of Lexapro with our vitamin regimen would be fine. (Of course, if it weren't we were encouraged to come back via the ER if needed.) The therapy team helped us score an appointment with a highly recommended child psych in the next two months.
We were very lucky. There are other hospitals that are known for over-medicating patients. There are other doctors that are not as understanding as the hospital doctor. Many families do not have the therapy team in place that we do. Catherine could still be in there, over-medicated, unheard, trapped. We would be at the mercy of the system. All thanks to the abrupt decision of a doctor who didn't want to listen to the possibility that Catherine could be feeling better, and that she could be safe at home.