Monday, 18 June 2012
This is part two of the Question and Answer period of our Teen Depression Webinar that took place on June 6th, facilitated by Dr. Mary Fristad. For the first part of Dr. Fristad’s session, click here.
What are some general recommendations for a family trying to find the right medication for a teen and having to try several different things?
Fristad: The first thing is to make sure you’re working with somebody who knows what they’re doing. So a primary care physician might be that person, but not necessarily is that person. I’m married to a pediatrician; I hear these stories all the time. Some pediatricians have gotten good training, have gotten supplemental training, but I can tell you that for very, very many primary care physicians, they’ve not gotten very much training in mental health care, so whatever drug rep has come and talked to them might be the medicine that’s on their mind, which isn’t the greatest way to proceed. So if you’ve started out with your PCP and you’ve tried a medicine or two and it doesn’t seem to be working, it might be time to see a specialist. And again, you would do that in any other field; you would do that if it was a GI issue, you would do that if it was a sports medicine issue; if the basic intervention doesn’t work, it might be time to see a specialist. So that would be the time to get a specialist. And again, this is where you would want to get some kind of referral information to make sure that the provider you’re going to go see has a good reputation in terms of their psychopharmacology management, and just in terms of their ability to communicate with families. Because it might be that you are a genius in knowing the right medicine, but if kids can’t stand to talk to you, you’re not going to get the message across. So if it’s at all possible, talk to the PCP, they’re probably frustrated too, if things aren’t getting better. They’d probably welcome the chance to have you referred onto a specialist. And again, talk to the school professionals, they can give you recommendations, and really try to fight the concern about stigma and ask friends and family and relatives who might make a good provider.
Related to that question, how high should the dose be, and how quickly you increase the dose, and what issues might come up with that?
Fristad: Right, and you know that’s really serious. And that’s when you want to make sure you’re working with someone who knows what they’re doing. Different medicines have different appropriate prescribing patterns, so with some medicines you can raise the dose relatively quickly, and with others you need to really methodically plow through in a slower manner. There are examples in every practice area of overmedication and undermedication, of never giving an adequate dose of a medication, or pushing doses far beyond what there’s any evidence for, where medications are no longer increasingly efficacious but the severity of the side effects goes up. So we—I’m sure you’ve seen, and we’ve got callers and participants across the country, and I would guess that there’s no region that’s immune to this, where there’s both over-prescribing and under-prescribing, and the key is to find a practitioner that’s truly knowledgeable in this. And it doesn’t hurt to do a little bit—not that you’re going to become the junior prescriber yourself, but the more that a parent can become educated, about quality care, the more likely you are to receive quality care for your family members, not in a know-it-all kind of way, but to be knowledgeable about what the effective treatments are and how they are best monitored.
What options do school professionals have when helping kids under the age of eighteen that clearly need help, but who have parents that are not willing to be involved?
Fristad: That is such a sticky issue. And again, in different practice areas, there are some practice areas where there are school health clinics, where kids can get treatment; that certainly is not routinely available for all kids. In some communities, if there’s medical neglect, you can contact local children’s services. That goes over better in some communities than others. In some communities that are overrun with children’s services requests, those often don’t reach the top of the pile. I think bringing the family in, or at least getting them on the phone, and expressing the reason for your concern, the severity of your concern, making it really clear that you’re not blaming anybody—parents spend a lot of their emotional energy being defensive, if they think somebody’s going to criticize them for their parenting, and they often times can get very defensive when they hear about problems from school, even if the school personnel has done nothing to engage that defensiveness, it can just simply be there. So for a school nurse to call, or preferably have a face to face meeting with the parent, which doesn’t always happen, again, sharing your level of concern and maybe having some practical tips, you know: “Here’s a clinic that I believe your daughter might really benefit from going to,” again, having the practical information, the name, address, phone number so that it would be less difficult for the family to follow through; to kind of grease those wheels as much as possible. Families often times have multiple stressors, as you gave in your example of the multiple family members in the picture. There can be multiple stressors going on in the family, and so we want to truly facilitate that as much as we can.
How can traumatic brain injuries affect someone who’s already got, or has been experiencing, symptoms of anxiety or depression?
Fristad: It’s always bad to have more things go wrong with your brain. The genetics are probably the number one reason that people develop a mood disorder, but you can also have a mood disorder due to a general medical condition, often times head trauma. It’s bad to jumble up your brain. Wear a helmet when you’re engaged in sports activities that require helmets, avoid concussions. You know, be careful about trauma to the head. It makes things worse. And if you’ve got it, the likelihood of having more complications is very real. It also might mean that different medications might be differentially beneficial, depending on the nature of the head injury and that’s where a psychiatrist and/or neurologist might be important to be part of the treatment team, or at least part of the consultation team.
You can still watch the archived copy of the entire webinar here. If you fill out the post survey, you will receive free copies of our Depression and Bipolar Wellness Guides for Parents and Teens. To see the teen videos again, click on the following link: Teen Depression Webinar Videos.
We are so grateful to Dr. Fristad for taking the time to answer these great questions. Do you have some questions of your own, or want more updates on future webinars and other events? “Like” our Facebook page, or follow us on Twitter for up-to-the-minute information on our latest projects.