Posted by katekite on April 13, 2002, at 16:17:37
In reply to Re: I need help..fast, effexor and zyprexa » mom, posted by shelliR on April 13, 2002, at 14:03:08
Oh you poor thing.
What they have basically done to you, is made you give them the green light for as much xyprexa as they want. By having you say prn is ok. That's like saying use as much as you want. Because how do we know what they define as "as needed?"
I understand their point of view, in that yes she acted agressively with some sort of outburst so they want to prevent that from recurring -- she could hurt herself or others. However, a high dose of benzodiazepine would have the calming effect they want, most likely without as much potential to interfere with her thought processes.
So check and find out if she has been given a prn dose of xyprexa today and find out if it was in response to actually attacking someone. If it wasn't, then she shouldn't have been given it, right? Endangering herself or others is probably what you meant when you said, "well if you really have to".
It would be nice if they would start her on a benzodiazepine twice a day. She will feel better. Almost no one feels worse on benzodiazepines.
If you feel strongly about something you are allowed to type out a statement saying she will remain there only if it is a particular situation. If her former psychiatrist hints they agree I would write out that only the following drugs are to used: effexor, benzodiazepines. That you are to be called and that you must ok any dose of any other drug. That you understand the risks and that you will take her home otherwise. They will cave in and keep her. (They will not release someone they think is in immediate danger because of liability, and they are so very aware of liability that they are quite serious about it.) But this is all your choice! Absolutely yours and yours alone because she is 15 and belongs to you and not them.
I'm not saying that someday a small dose of xyprexa shouldn't be part of her treatment if that is thought to be helpful. It is very common practice for hospitals to throw it around like sugar, but it doesn't make it ok, its not sugar.
Her being anorexic means she has a very lean body, that she should be having probably lower doses of medication than others. So the dose of effexor seems very very high, especially as she's been on it such a short time.
That's a great suggestion about day programs. To ease her transition home. The hospital is NO place to treat depression. A hospital, especially it sounds like this one, is a place to temporarily keep someone who is completely out of control and a danger to themselves or others.
Most therapists that work at hospitals also have private practices. Since she likes this therapist, perhaps she could continue to see them.
If they will agree to a day program it will make it a lot easier to get her out, they will feel more comfortable letting her go if she is coming back the next day. And once she is home, without screaming in the background, she may do a lot better quickly.
Don't forget its not the hospital volunteering to have her there. Its you volunteering to keep her there. Insist that the doctor meet with you personally every day and tell you all the meds she got and why. Unfortunately they are not used to consulting family but you have every right to be a part of the team, after all you are the one dealing with her when she comes home.
Call as many doctors as you can, all of her previous doctors and therapists. Its ok to leave a message as an emergency item, because she's in the hospital and that itself means something urgent is going on. You need more advice. You need second opinions. This hospital has had plenty of time to make her better and she's way worse than when she went in, it sounds. Doctors or shrinks should get back to you this weekend. Dont' feel that you have to stop for the weekend. That's part of their job, to help people they've seen previously (and their guardians).
As to serotonin syndrome -- it is entirely possible but not likely. They should consider it and its excellent you asked about it because it will at least be in the back of the doctors mind now. I have been hospitalized twice. The first time was due to depression. The second time I did have a bizarre episode that was in retrospect caused by serotonin syndrome. I had bursts of anger, I was agitated and tried clumsily to throw myself through a window though I was not in any way suicidal, I then had the only panic attack of my life. It does cause crazy behavior. So though rare, its ironic you should mention it. And the doctors at this university hospital I was in did not put two and two together. They decided I was bipolar and made me sicker than sick with high doses of mood stabilizers one after another until I felt awful and begged my husband to take me home. He did and I was still so crazy I nearly jumped from the car on the way home. It was a very difficult time. And I remained that way for 6 weeks until I got upset with the lack of anything doctors recommended, except more meds that had no helpful effect, and I stopped the meds altogether, and was better the following day, fine two days later. Turns out I am extremely sensitive to serotonin enhancing drugs. But that is a different story and it is an extreme example. However, that same ward had several people who got progressively worse in there, like me. The day I went home a couple of them got transferred to long term facilities. It was scary because I'm sure I would have gotten worse had my husband not rescued me after figuring out I was getting worse.
Now you understand why I feel strongly about these issues. Your daughter is most likely very different from me, but she needs your protection as much as I needed my husband's.
If it were serotonin syndrome with your daughter the way to find out would be to lower the dose of effexor back to 150 a day and see if the outbursts go away in a few days. I think there may be other drugs to use to combat it but none are really proven to help this syndrome that I know of. Instead of adding drugs though I would be lowering them.
Its also possible that it is mostly the overwhelming nature of the hospital experience that has contributed to her having these episodes. A forced environment of tv and therapy with little access to personal space and little outlet for physical energy can be hard on anyone. She was in there a while before it started.
And it is possible, that really she is getting worse. That she would be even worse without xyprexa or a high dose of effexor or the hospital period. To me it seems unlikely. But you never know.
To make a reasonable guess you need to have the opinions of all the professionals she saw before the hospital.
Just ask them what they felt her diagnosis was.
Then ask them what drugs are used on-label to treat those conditions. (All drugs have occasionally been used to treat all conditions but that's not the point, the point is what is usually used and approved to treat what she has.).
When you find out what that is, then call the hospital and demand she not be given drugs off-label. The hospital will have to comply quickly, because to use drugs off-label is experimental and if you know about it and realize you weren't informed about this, then you are free to sue for her emotional damage, or yours, for example. You don't want to, but you want your daughter treated properly. And so does the insurance company. The people who pay, really like drugs used that are FDA approved for her problems. And yes, they are the safest.
Lastly. What does your daughter say? What does she want? Have you been able to visit? What happens during a visit?
What actually is her diagnosis? Anorexia? Anxiety? Depression?
I really feel for both of you. And hope that she feels better very soon.
kate
poster:katekite
thread:102912
URL: http://www.dr-bob.org/babble/20020408/msgs/102969.html