Medication Stuff and Stories

Another interminable medication-waffling post here. I thought about posting something political or even talking about the temporary ban on short selling, but the medication is what's really on my mind.

We're starting to taper it down. We're still giving him one pill at night every night, but only giving him the other pill every other morning. This is kind of hard and I lost track of a day last week. Here's how it went:

Monday: No Pill. Green sticker at school.
Tuesday: Pill. Yellow sticker.
Wednesday: No Pill. Yellow sticker.
Thursday: No pill. RED sticker! Sunny mentioned he was feeling very "wound up".
Friday: Pill. TBD.

Sunny gets in trouble for not following instructions and talking with his friends too much. He has to receive many reminders in order to get a yellow, and even more to get a red.

Thursday was obviously a bad day for him at school. But after school, he did very well at soccer practice with his dad. He had a crying pout at dinner because we firmly stopped him from engaging in some very bad behavior (pretending he was dropping his vegetables so our dog would eat them). Then after we had dinner, I took him to swim class, where he also did well. So it was a mixed bag... it's not like he completely went off the deep end.

We watched a Frontline special a few nights ago called "The Medicated Child". It concentrated heavily on the explosion of bipolar diagnoses for young children. Even though I'm 99% sure Sunny doesn't have childhood bipolar, and about 75% sure he doesn't have ADHD, shows like this are very informative and helpful. Sunny's medication is an atypical antipsychotic, the class of drugs which are typically prescribed for childhood bipolar.

They showed one teenager who'd been on up to eight different medications since the age of five. He had tardive dyskinesia -- uncontrollable tics -- as a permanent side effect. The effects of long-term atypical antipsychotics on children haven't been studied well.

One of the experts cited, Dr. Kiki Chang, is a big proponent of medication. He argues that with the right medication, childhood bipolar can keep from progressing into adult bipolar. That's based on a theory called "kindling". It makes sense. A major manic episode can hit the brain like an addictive drug. If it happens once, it's a lot more likely to happen again.

Even Dr. Chang thinks a lot of kids are over-medicated, though.

So who's responsible for the overmedicating? Is it pediatricians unsure of what they're doing?

I don't know really. There's some studies looking at that. Overall, I'd have to say it is probably folks who don't have access to good psychosocial interventions or good family-based programs in their communities. There's not enough money in poorer areas, so they have to rely on medications more.

I would say it is possibly folks who don't have a child psychiatry background. In a lot of places general psychiatrists who have no child psychiatry training are forced to treat kids because there's no one else to do it. Pediatricians too, but I don't see that as much as general psychiatrists. So again, if they had more proper training, I think they could do a pretty good job with it.

What needs to change?

We need more funds. We need to develop more child psychiatrists. It's amazing how few child psychiatrists really are out there.

I already blogged about the extremely pathetic encounter we had with the child psychiatrist. I saw what went into his "diagnosis". He barely even looked at Sunny. There were no tests, just a few incoherent questions and some small talk.

If we went to a top-flight child psychiatrist and paid a bunch of our own money, I'm sure we could get better. But I just don't think we need to, since I don't think Sunny has bipolar. I'm not sure he has any kind of pin-point-able anxiety or PTSD disorder, since he sleeps so well at night.

I do think that he has some kind of an anxiety problem that is being treated by an atypical antipsychotic untested in children. I guess that's "off-off-label". I wish I knew more of the ramifications. From reading accounts of adults with bipolar, they say a lot of mixed things. Sometimes the medication decreases anxiety, sometimes it does nothing, sometimes it makes it worse. Sunny's foster mother has said his medication was the first one that really worked for him, with no side effects, and that it decreased his tantrums and really improved his ability to concentrate in school.

I'm going to rely a lot on our (private) therapist, who is more anti-medication than I am. We'll see what she thinks once he's tapered down to almost half-dosage level. But if the medication is really helping him in school, he'll need to go back to the full dosage.

In other Sunny news, he's been telling some stories!

"Once upon a time. There was a boy named Jeff. He used to live in Georgia. But then he moved to British Columbia. He had some chickens. Aliens killed his chickens with ray guns. Then he went to the future and brought back some chicken eggs. But then the aliens killed his eggs with ray guns. The end."

"Once upon a time, there was a boy named... Jeff. He used to live in ___ but then he moved to North Carolina. Then he went to Jupiter. Then he fell in a black hole and went back through time. The end."

"Once upon a time there was a boy named Jeff. A tornado was coming, so he ran to the basement of his house with his family and his dog. The tornado stopped and everyone was safe. He left the basement. The end."

"One upon a time there was a boy named (you guessed it) Jeff. He went to California and he had a kid and he joined a rock band. The rock band was called The Jonas Brothers (insert our objections about possible copyright infringement). NO, I SAID THEY WERE CALLED THE JONAS BROTHERS NOT THE JEFF BROTHERS! Then his kid came to live with him because his mom died... of old age. The end."

The stories aren't that great, plot-wise. They're the same story seasoned with different nouns. But they show how much Sunny loves new words and mimicry and playing with words. He's always asking what words mean and how to use them.