Nonetheless, I chose to add medications to our treatment plans, and any reservations I had quickly dissipated after witnessing undeniable, SIGNIFICANT results.
Of course, that doesn't mean I love doling out psychotropic medications any more than I like my kid's melatonin habit. However, I defer to the age-old wisdom: if your child needs a wheelchair, you provide the wheelchair. Yes, you also offer therapy, rehab, counseling, sporn flushing, and so on, but you must provide the wheelchair.
Anyhoo, I've become somewhat of a preachy busybody on this topic because I screw up a lot, and it makes me feel much better to pretend I've learned something from it. So, as much as I support the use of psychiatric medications when needed, I am militant about the following pointers. If you have others, please share them below, because I'm pretty sure we will continue to be a poster household for Big Pharma for many years to come.
- ONE PHARMACY: Try to stick with one pharmacy for all of the obvious reasons (automatic refills; location; medication interaction flags), but also because they will get to know you. And this is critical when it is Labor Day weekend and the pharmacy is about to close and you are out of refills on your rx and your doctor is on vacation in Aruba. If they know you as well as ours knows us, they just MIGHT be willing to advance you enough pills to take you through Tuesday. (I'm just guessing here.)
- ONE SPECIALIST: There are many wonderful doctors out there, and many are capable of writing perfectly legal prescriptions. Maybe your neurologist prescribes anti-seizure meds; and your developmental ped recommends an SSRI; and then your pediatrician scribbles out an ADHD scrip...you can see that this is going to get ugly. Select one doctor to prescribe (or at least manage) your medication cocktail. And, at some point, you will want to consider whether that person should be a psychiatrist, preferably one who is educated, experienced and reputable when it comes to pharmaceuticals - but not in bed with big pharma. It's okay to ask that dev ped or that neurologist who they recommend and discuss adding a specialist to the team. I've had people tell me they are afraid of offending their doctor. I'm sorry: GET OVER IT. Focus on what's best for you and the kid!
- CHOOSE WISELY: Perhaps your pediatrician is your drug dealer of choice. (Again, as long as they source or know they are the ones "managing" the meds, fine.) Whomever you choose, choose wisely. Think about these questions:
- Is this their specialty?
- Do they stay current with the latest research on medications - including off-label uses - and do they have an academic and practical understanding of interactions, dosing and side effects.
- Are they easily accessible for questions, concerns, issues, and even last-minute, emergency refills - the bane of everyone's existence? Our psychiatrist actually emails us responses to questions and feedback on minor medication changes. I love him!
- BE PATIENT: When you finally make the decision to use a magical pill, if you are anything like me, you are ready to jump in and see results. Not so fast, Nelly. It's a sloooooow process. Or rather it should be. Most meds require us to ease in and ease out. You need to titrate up or wean down. I'm impatient, so I really, really, really hate that. But it's obviously imperative because we want our kids on the lowest possible dose of stuff while getting the best possible outcomes. That also means some trial and error. Titrate up a tad bit, wait, analyze. Titrate, wait, analyze. Ugh. All while suffering through the same unwanted behavior that made us seek the drug in the first place. Or a new insufferable behavior. Still, completely necessary.
(Except when it comes to ADHD medications. Parents spend months deliberating over these, often justifiably, but really, they're pretty easy to test. Most of these stimulants work quickly and only for a few hours. In fact, you'll probably know by the end of the day if it's helping, and whether you want to stick with it. Really, when it comes to quick fixes, this is the med that I think of first - and obviously, for better or worse, so do many others, as evidenced by the market saturation.)
- ONE CHANGE AT A TIME: On the same note, I've learned that - even and especially when undergoing an entire medication overhaul - you should only make one. change. at. a. time. Whether it's increasing or decreasing a med. Adding or eliminating a med. Or even beginning a new form of therapy. It's as excruciating as waiting for the meds to kick in. But how else can you determine how each step contributes to the big picture. This is the best, most scientific way of mixing the perfect cocktail and understanding what is contributing to your positive results - or lack thereof.
- STICK TO ONE BRAND: This also applies to generic brands. Do you know which lab your current generic med comes from? It very well could be different from your last bottle...especially if you used a different pharmacy (refer back to my one pharmacy rule!). Obviously, the differences are slight and usually don't matter - but when dealing with children using itty, bitty doses in the first place, slight variations in ingredients and quality control can make a noticeable difference.
Same dose. Two different generic brands. Behavioral differences and side effects noted. True story.
- IT'S OKAY TO MOVE ON: Adding is not always the answer. Granted, sometimes your problems can be solved with a simple bump of the dose. Sometimes we try to supplement with a complementary medication. Sometimes, we keep doing this and wake up to find that a 10-year-old is taking 10 different meds that all are supposed to do the same thing - but not one of them is! Maybe it's time to move on. No matter how much of a lifesaver Prozac has been for the kid for the past 5 years, things have changed.
Time to say:"It's not you, Prozac, it's me. I'll never forget the fun times we had, but we've grown apart."
Wean off slowly, and embrace the new. For all we know, we don't need the new. I mean, in our case, we very much needed the new, but perhaps in your case, you won't.
- RECORD EVERYTHING! Ironically, I'm really, really bad at this. Do as a I say not as I do, and be super-diligent with this from the start. Use your calendar, Evernote, an app (I've actually modified BabyConnect to help me track this stuff - as well as weight and height), whatever...but journal it. I know that you KNOW you will remember that you used Pill A for two weeks and it didn't work, so you moved to Pill B and it was great on Dose 1 but not on Dose 2...but you won't remember it. Not when you've moved on to Pills C, D and Q. Write it all down: doses, meds, why prescribed and behavioral nuances.
I've learned that it really helps to target some very specific, measurable behaviors to track. Think of something that represents the overall challenge. (For example, OCD behaviors like switching lights on and off or hand-washing repetition; or specific acts of aggressive behavior like scratching a teacher). Write down the goals and progress. Take my word for it: six months and six meds later, you will NOT remember.
- DO A BLIND STUDY: Of course you must tell primary caretakers about major medication changes and tweaks for everyone's safety and proper treatment, but also try to target some "blind" sources. Maybe you don't spill the beans to the music teacher or an assistant teacher that your child's starting Risperdal. A few weeks later, when they comment that little Johnny is such a "joy to teach" and cite specific improvements, you know something magical is happening independent of any of their preconceived ideas of the meds you have or have not selected.
- TEACH THE KID TO SWALLOW PILLS. I don't know how we managed this and failed to teach them how to tie their shoes, but my kids can take a handful of pills and guzzle them with hardly a sip of water. I'm pretty sure the girl still chews some of them by choice (she has some odd taste buds), but they go in and down. I won't be bragging about this on Circle of Moms or anything, but it sure does make things easier. Let's face it: that cream soda flavoring does NOT make nasty, liquid medicine taste like cream soda. Or bubblegum. Or chocolate. In fact, it arguably tastes more disgusting than the medicine alone. My kid told me that as soon as he could talk, and he was delighted when he learned about the tablet alternative. You'll need a good pill slicer and the precision of an air traffic controller to dose out some of these meds, but it's been a welcome change from sticky, oddly colored, fake-cream-soda liquids being spat in my face.
- FOLLOW YOUR INSTINCTS: I should have led with this. I probably should have named my blog with this. Be thoughtful; educate yourself with open eyes; and then do what works best for your family. Seek out opinions, resources and testimonials (if you mention meds, you'll get opinions whether you like it or not), but ultimately, follow your instincts. Also, know that as soon as you think you've got it all figured out (if that happens, lucky dog), everything will change and you'll have to start anew. For most of us, medicating is a very personal choice, and a hard one to reconcile. But when we get the cocktail right, WOW. That's why we do it.
I know I am helping my child cope with his or her challenges to clear the path for their true, triumphant selves to shine. I am giving my child an inner wheelchair.
