DD has depression and non-epileptic seizures..Need wisdom of the hive

[txmom23]

For over a year DD17 has had depression, anxiety and panic disorders.  We tried very hard to control them with diet and lifestyle changes. We were successful for awhile.  But, she seemed get worse a little at a time.  In late April, she had a well child check up.  She mentioned the issues to the ped.  We decided on 10 mg of Celexa and started seeing a counselor.  It didn't seem to help much and on May 31 she had the first seizure.  Fast forward.  On June 21, she almost collapsed in the shower.  Went to the ER. CT scan was normal.  Followed up with a neuro, he put her on paxil instead.  We had to wait a while but she finally had a video EEG on August 15.  At this point she was having multiple seizures daily.   I asked the drs if the seizures could be caused by the anti depressants?  They said no. Well ,on August 15, she stopped the meds.  She now has a seizure maybe once a week.  We've seen some progress.  She has laughed more over the last month, been more playful, a bit less antagonistic.  But, she is willfully doing things to aren't good for her too.  Like eating whatever she wants, doing whatever she wants, dismissing the coping strategies she's learning from the counselor.

 

Three days ago, she confessed to clipping her thigh with nail clippers (self harm).  I freaked and called the counselor.  They said to take her to the mental hospital for evaluation.  My husband, dd and I discussed this choice.  We decided to wait.  DD has promised to never self harm again.  She says she understands that it's not a solution to the problem.

 

Well, she has an appointment tomorrow with the counselor. The counselor said DD should be medicated.   We don't want her seizures getting worse again.  We don't want her zombiefied again.  It seems as though she acquired the "illness" after beginning the "treatment".  She never had these, more serious issues, before starting ADs and therapy.  She got worse, not better.  That's why we don't want her going to the hospital and getting on the meds again.  We don't want her stuck in-treatment with teens who are worse off than her.  

 

Has anyone been where I am now?  

 

[City Mouse]

I totally would not believe that she is not going to cut herself again. When she promised never to do it again, she most likely meant it at that time, but that is a very difficult thing to stop.

Personally, I think you need to look at inpatient treatment for a time to get the medicine and seizure issue worked out. With such serious symptoms, she needs some kind of medication.

 

I think you have much bigger issues than worrying about being around kids who are "worse off". It is not like severe depression is contagious.

[txmom23]

I'm not totally opposed to meds.  I just want the meds to help not make her worse.  She didn't have seizures or self harm before meds and therapy.

[Corraleno]

Some ADs can initially increase depression and anxiety, and even suicidal thoughts, especially in adolescents. It's a matter of finding the right meds, and making it through the initial adjustment period to the point where the medication has reached a therapeutic level.

 

Self-harm is an extremely serious issue. I would not just withdraw from meds and counseling on the assumption that things were better without them. The meds and counseling may have just brought things to the surface that she was keeping well-hidden before. Once you find the right combination, things will get better.

 

:grouphug: to both you and your daughter.

[Chris in VA]

Been thru the self-harm stuff--it is very, very serious. :grouphug: :grouphug:

Self-harm is an extremely serious issue. I would not just withdraw from meds and counseling on the assumption that things were better without them. The meds and counseling may have just brought things to the surface that she was keeping well-hidden before. Once you find the right combination, things will get better.

 

ITA, esp with what I bolded.

 

I would not jump to residential programs at this point, but I would ABSOLUTELY get her evaluated, then FOLLOW THE ADVICE.

 

I have been there--over and over and over. I know you don't know me or our story, but I beg you to take it very seriously and get help.

[LMV]

 

For over a year DD17 has had depression, anxiety and panic disorders.  We tried very hard to control them with diet and lifestyle changes. We were successful for awhile.  But, she seemed get worse a little at a time.  In late April, she had a well child check up.  She mentioned the issues to the ped.  We decided on 10 mg of Celexa and started seeing a counselor.  It didn't seem to help much and on May 31 she had the first seizure.  Fast forward.  On June 21, she almost collapsed in the shower.  Went to the ER. CT scan was normal.  Followed up with a neuro, he put her on paxil instead.  We had to wait a while but she finally had a video EEG on August 15.  At this point she was having multiple seizures daily.   I asked the drs if the seizures could be caused by the anti depressants?  They said no. Well ,on August 15, she stopped the meds.  She now has a seizure maybe once a week.  We've seen some progress.  She has laughed more over the last month, been more playful, a bit less antagonistic.  But, she is willfully doing things to aren't good for her too.  Like eating whatever she wants, doing whatever she wants, dismissing the coping strategies she's learning from the counselor.

 

Three days ago, she confessed to clipping her thigh with nail clippers (self harm).  I freaked and called the counselor.  They said to take her to the mental hospital for evaluation.  My husband, dd and I discussed this choice.  We decided to wait.  DD has promised to never self harm again.  She says she understands that it's not a solution to the problem.

 

Well, she has an appointment tomorrow with the counselor. The counselor said DD should be medicated.   We don't want her seizures getting worse again.  We don't want her zombiefied again.  It seems as though she acquired the "illness" after beginning the "treatment".  She never had these, more serious issues, before starting ADs and therapy.  She got worse, not better.  That's why we don't want her going to the hospital and getting on the meds again.  We don't want her stuck in-treatment with teens who are worse off than her.  

 

Has anyone been where I am now?  

 

 

Just so I understand, does your daughter have Psychogenic Non-Epileptic Seizures?  

[MedicMom]

Just so I understand, does your daughter have Psychogenic Non-Epileptic Seizures?

This is what I was going to ask as well. My suggestions change based on the answer.

[txmom23]

Just so I understand, does your daughter have Psychogenic Non-Epileptic Seizures?  

Yes.  Diagnosed by the neuro, following a 3 day video eeg.

 

They look like Grand Mal.  She loses the use of her arms and legs, hands and feet curl, jerky movements.  She doesn't lose consciousness. She can hear and slowly respond.  She gets a bit of a warning when they strike.  Triggers are low blood sugar, anger, and sometimes just the thought of people who have hurt her.  The longest one was 13 minutes.  The most she has had in a day was three.

 

Presently, she might have one once a week and it will last less than two minutes.

[txmom23]

I've put her issues on a timeline so to speak.  I do believe there is a reason for this happening.  We just haven't figured it out yet.

 

From age 10 and 12.5 she gained 100 lbs.  No dr could explain it.  She eats like the rest of us.  At the time, it was the standard american diet.  That weight gain led to an eating disorder.  She remembers the doctors telling her to eat less.  She internalized it, thinking...well, if less food is better, than even less food is better.  But, she didn't lose weight despite severe calorie restriction. At the same time she started having trouble sleeping.  We added melatonin, no relief.  So from about 12.5 to 15 these were the main problems (weight gain, insomnia, and eating disorder).  

 

She started Dual credit at the CC at almost 16, got her first job and her first boyfriend all at the same time.  Major stress. Boom...depression, panic and anxiety.  At this time, she and I went grain free/sugar free.  She began to feel much better.  But, never lost weight, just inches.  She was so frustrated with this. So, we saw an endo thinking maybe she had thyroid issues.  All normal on the lab test.  She was so discouraged.  In the spring, before the ADs and seizures, she went strict no more than 50 mg of carbs and high intensive workouts to try to lose weight.  Her friend lost 20 pounds, she lost 3.  But would gain them back at the slightest sugar.  I think that caused the worsening all of this.  Also, she had sex with her bf and it wasn't a good experience.  She broke up with him in June.  This whole thing has snowballed out of control.  Right now, at 17 she doesn't go to CC, no job, no boyfriend and very few friends.  All of her friends engage in self harm to some extent.     

 

My plan (which she has agreed to because she didn't want to go to the hospital either) is to highly structure her life, go back to grain free/sugar free and possibly dairy free.  She has started Vit D, Mag and Omega 3, but she forgets to take them regularly.

A light exercise program that includes all of us together during the day.  She has an appt with our family dr on Wed.  I will ask him to do extensive blood work (auto immune and vit and mineral deficiencies).  What else should I ask for?

[MedicMom]

Gently...from everything you are saying, she needs inpatient, at least until she is stable on meds. These seizures have no physical or chemical basis and are not caused by anti depressants. I know there has been some progress with EMDR treatments for psychogenic seizures but that will probably not be an option until she has attempted inpatient. It depends on her therapy team and the psychologist or therapist who does EMDR.

[LMV]

If she has PNES then anticonvulsants are rarely helpful.  There is some early support in the literature for the benefit of SSRIs in treating PNES but there definitely does need to be more research on this.  I believe Sertraline [aka Zoloft] was used in the studies so that might be an option to try for the PNES and underlying depression.  It may also be helpful to understand/remember that PNES is a form and manifestation of conversion disorder so therapy will be an important piece of treatment.  

 

Since you mentioned an eating disorder, please remember that not all kids with restrictive anorexia are underweight.  If she is still restricting nutrients then that is not going to support or promote good mental health.  Remember that fat is an essential nutrient.  Too much is a bad thing, but too little can be even worse.

 

Good Luck!

[Ottakee]

The more you say, the more I can agree that she needs more intensive help.

 

It can be the chicken/egg thing------did the weight gain, relationship issues, etc. trigger this or was this going on with puberty, etc. and led to the weight gain, relationship issues, etc.

 

I posted on the other thread about using seizure meds to treat the moods, etc. but that might not be the answer if the seizures are more emotionally based rather than a true seizure---although, many of the seizure meds are top line meds for mood issues.

 

The friends thing is so hard as she needs to be out of the environment where her friends are cutting (and who knows what else).

[txmom23]

If she has PNES then anticonvulsants are rarely helpful.  There is some early support in the literature for the benefit of SSRIs in treating PNES but there definitely does need to be more research on this.  I believe Sertraline [aka Zoloft] was used in the studies so that might be an option to try for the PNES and underlying depression.  It may also be helpful to understand/remember that PNES is a form and manifestation of conversion disorder so therapy will be an important piece of treatment.  

 

Since you mentioned an eating disorder, please remember that not all kids with restrictive anorexia are underweight.  If she is still restricting nutrients then that is not going to support or promote good mental health.  Remember that fat is an essential nutrient.  Too much is a bad thing, but too little can be even worse.

 

Good Luck!

She is no longer restricting.  She uses fitness pal and records her meals.  I've read that a ketogenic diet is good for epilepsy, but I don't know about PNES.

 

I'm not as concerned about the seizures, they are getting better.   It would be great to find a med that didn't make the seizures worse and helped the depression.  Maybe Wellbutrin?  

[Starr]

One can't always make a direct correlation between say meds and seizures. Maybe the seizures are better but not because of her stopping the meds? Medications can take a while to sort out and find the best dosage. She sounds like a very sick girl who would benefit from treatment. She isn't going to stay with you forever while you keep her on a *highly structured life schedule*. Once she's 18 you won't have any control in getting her treatment if she decides she doesn't want it.  :grouphug:  :grouphug:  :grouphug:

[wonderchica]

Once she's 18 you won't have any control in getting her treatment if she decides she doesn't want it.  :grouphug:  :grouphug:  :grouphug:

This is an excellent point and one I think should be restated.

[MedicMom]

She is no longer restricting. She uses fitness pal and records her meals. I've read that a ketogenic diet is good for epilepsy, but I don't know about PNES.

 

I'm not as concerned about the seizures, they are getting better. It would be great to find a med that didn't make the seizures worse and helped the depression. Maybe Wellbutrin?

The seizures are caused by a psychological issue. It is completely different from epilepsy or other physically-based seizures(such as a seizure from low blood sugar). Once the psychological issues are under control the seizures will likely disappear. This is why therapy and SSRIs are used to treat psychogenic seizures.

 

Anti depressants will not make psychogenic seizures worse. There are some very good articles on PNES online. (I just taught a class on conversion disorder and psycho-somatic complaints, so I have been researching a bit)

[Cera]

My initial thought is that the issues sound physiological since they correspond with the onset of puberty.  Have they investigated PCOS as a possible mitigating factor for the weight gain at least?

[deannajo]

I'd definitely rule out physical/hormonal (like the previously mentioned PCOS) causes first, and keep up with your nutritional supplementation, dietary changes, structure/routine, and physical activity plan.. Another avenue to consider - before looking towards the super intensive inpatient options, perhaps see if you have a dialectical behavioral therapy (DBT) center or therapist nearby? Depending on how its structured, it can be a pretty intensive, effective outpatient option. A lot of inpatient facilities are set up more for stabilization rather than long-term inpatient treatment, especially depending on insurance, financial means, etc. (sigh) - If you aren't in crisis mode, then I wouldn't go to inpatient as a first course of action - and one incident of self-harm, while certainly scary and not to be ignored, isn't exactly crisis mode. Especially since she is talking to you about it - But DBT is a really great option for complex issues, anxiety, depression, eating disorder, self-harm. And I wouldn't rule out meds completely, but ugh, sometimes finding the right one or the right combination can be so challenging.