Counseling and Psychiatrist questions

[SquirrellyMama]

My dd15 has been seeing a counselor for a few weeks. She said something that concerned the counselor enough to want her to talk to a psychiatrist. 

So, how do these fit together? Does she just see the psychiatrist once for medication amd then the counselor from there? Does she see the psychiatrist every so often to see how the meds work or sould she see our family doc for that?

Also, who has had a teen on anxiety/depression meds? I am concerned but wouldn't rule it out.

Kelly

[Terabith]

Usually you see the psychiatrist once for a longer appointment for diagnosis and initial medication and then monthly ish for short visits for medication maintenance.  At the same time, you see counselor weekly.  Once stable on meds, psychiatrist visits can drop to every 3-4 months.  

[Terabith]

I have both of my teens on medication for anxiety/ depression.  My youngest started meds right after her fifth birthday.  She actually doesn’t do regular counseling because her situation has been so stable for so long.  Meds have been very very important to our family.  Happy to answer any questions.  

Edited December 15, 2020 by Terabith

[OH_Homeschooler]

My daughter (15) sees a counselor on a frequent regular basis (once a week for an hour). She sees her psychiatrist less frequently, depending on what is going on in her life (about once every 3 months for about 15 minutes). It can be more frequent when she is starting a new med or increasing her dosage. I believe I've given both professionals permission to speak to each other, but I'm not sure that they have. 

It has mostly been fine. She started on Prozac, which is considered very safe, but it lost its effectiveness. She is on Lexapro now. It's important to watch them when they are starting or increasing dosage for signs of increased depression and suicidal thoughts. 

Edited December 15, 2020 by OH_Homeschooler

[gardenmom5]

PCPs can't prescribe the psychiatric meds that psychiatrists do - not even for dose adjustments.  

Be really picky about the psychiatrist.  my son saw two - after having been prescribed rx by a pediatric neurologist. (also allowed to prescribe them.) - he was put on an antidepressant, after the first dose increase - he was started increasingly expressing suicidal ideation (a legitimate risk of antidepressants in teens), I couldn't get through to the neuro.  I had to take him to a psychiatrist - the first one said he needed to be on a HIGHER DOSE! (when he was already showing signs of it being the wrong drug) for it to help with anxiety.

  I ended up saying screw this, and took him off.  He immediately went back to his regular  generally happy, but anxious, self.   he wasn't telling me how he was going to kill himself anymore, or was he having the  anxiety attacks/meltdowns that started only after he was put on the rx. - there are those who claim the anti-depressants makes the kid more functional so they will come up with a way to kill themselves.  uh, no, it is what put the idea in his head in the first place because of the effect on his brain chemistry.  I refuse to ever put him on another antidepressant.  I consider them too dangerous for teens.  

2dd is a pharmd - she was expressing her concern about this as soon as she heard he was on one.

one reason why I got him a cat (i'm allergic). - and I am seeing a decrease in his anxiety levels.

Edited December 15, 2020 by gardenmom5

[MoyaPechal]

When I was a teen, I saw a counselor once a week and the psychiatrist I think every 3 months to make sure I didn't need the dose adjusted.

[Ottakee]

In addition to what others said above, I would get her in for a physical and blood work.   Things like thyroid, But D and B levels, blood sugars, etc that are out of whack can cause psychiatric symptoms....treating anything out of whack might eliminate or reduce the needs for meds.    And even if not, the meds will be more effective if everything else looks good.

[historically accurate]

In DD's case, her psychiatrist was a longer appointment the first time and then about every couple of weeks, now every 2-3 months. DD's psychiatrist did do some blood work at the first appointment - vitamins, anemia, food sensitivity, thyroid if I remember correctly. We've had better luck with nurse practitioners as DD has some fear of male doctors. She sees 2 therapists currently weekly. Both a trauma therapist as well as your everyday run of the mill therapist. The two therapists work together, but I don't think they talk much to the psychiatrist unless DD has been hospitalized.

DD started an anti-depressent during an inpatient psych stay when she was 12; she's been a little bit of a conundrum for meds resulting in several more inpatient and partial hospitalizations, but she is stable for the moment at age 15 with an anti-depressant coupled with Lamictal and an anti-anxiety med.  

A different DD's primary care physician put her on an anti-depressant after DD brought up the topic of depression during a physical. The meds have worked so well in her case, we have never taken her to the psychiatrist as her PCP seems on top of it. She does talk to a therapist every so often (she is in college so it's not weekly anymore).

Edit: And big hugs to you, SquirrelyMama; mental health issues can be very hard on a mama-heart!

 

Edited December 15, 2020 by historically accurate

[Katy]

I agree that the psych is for diagnosis & medication. The therapist is for therapy.
 

I just wanted to chime in with my semi-annual board post that if a young woman has anxiety or depression and is on hormonal medication (for any reason), you may want to discontinue the medication before you get her on psychiatric meds. Especially if you changed bcp formulation recently and the symptoms popped up or worsened in the 10-14 days thereafter. 

[Junie]

No advice, @SquirrellyMama, but sending hugs for you and your dd.

[KidsHappen]

4 hours ago, gardenmom5 said:

PCPs can't prescribe the psychiatric meds that psychiatrists do - not even for dose adjustments.  

Be really picky about the psychiatrist.  my son saw two - after having been prescribed rx by a pediatric neurologist. (also allowed to prescribe them.) - he was put on an antidepressant, after the first dose increase - he was started increasingly expressing suicidal ideation (a legitimate risk of antidepressants in teens), I couldn't get through to the neuro.  I had to take him to a psychiatrist - the first one said he needed to be on a HIGHER DOSE! (when he was already showing signs of it being the wrong drug) for it to help with anxiety.

  I ended up saying screw this, and took him off.  He immediately went back to his regular  generally happy, but anxious, self.   he wasn't telling me how he was going to kill himself anymore, or was he having the  anxiety attacks/meltdowns that started only after he was put on the rx. - there are those who claim the anti-depressants makes the kid more functional so they will come up with a way to kill themselves.  uh, no, it is what put the idea in his head in the first place because of the effect on his brain chemistry.  I refuse to ever put him on another antidepressant.  I consider them too dangerous for teens.  

2dd is a pharmd - she was expressing her concern about this as soon as she heard he was on one.

one reason why I got him a cat (i'm allergic). - and I am seeing a decrease in his anxiety levels.

My PCP is the one that originally got me on the right cocktail and he also does my medication maintenance, even though I was originally also seeing a psychiatric nurse practitioner who worked under a psychiatrist until I was stable. I have been seeing solely my PCP for psychiatric management for at least ten years now. I think it really depends on what state/county you live in.