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Experiences with antidepressants pro/con


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(A few additional details provided on p. 2)

After struggling for years (off and on) with major depression and anxiety, one of our dc (now teenage) has started abusing substances and at least one close call with self harm. The therapist has suggested that we look at putting the teen on meds, such as an SSRI. We will probably get the teen evaluated by a psychiatrist rather than going thru our regular family doctor, and when push comes to shove we'll trust the psych's opinion. But this is new territory for us, so I'd appreciate hearing from people who have been here before with their DC. Positive and negative experiences welcome. Hugs also welcome if you don't have experiences to share 🙂 

Edited by egao_gakari
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What would your alternative be if you *didn't*? Obviously you have to do something. You might find something if you ran genetics, sure. (VDR, TPH2 affecting 5HTP levels and hence serotonin and melatonin, MTHFR, etc.) But that would take a while. You start with safety, and then when they're SAFE you work through other options. If you want natural/supplements, you'd want to see indications very quickly that it was working, and it's pretty hard in some situations (not all, some) to get a combo that replaces meds. For some you can. But again, if fast and keeping the kid safe are the goal meds are the way to get there.

Doing nothing definitely would not be a good option. We've done the genetics + supplements thing and we've done the meds thing. The only thing I wouldn't do is nothing.

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And as far as pros and cons, some are obvious. Not treating all the problems, missing underlying problems, compliance, dissatisfaction with how they feel on the meds, etc. 

On the anxiety, sometimes there can be rather uncommon, treatable explanations. I had been taking anxiety meds (finally, after many years of not) and now am off because we identified the underlying cause and are treating it. 

With what you're describing, I'd be wondering about ADHD. Pretty common explanation for that mix. 

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DS22 is on the spectrum and has associated generalized anxiety disorder. Fluoxetine has been absolutely wonderful for him. He started a few months before he turned sixteen, first under guidance from his pediatrician while he was waiting to be seen by a psych. His pediatrician was reluctant to prescribe SSRIs for a teen himself because it was outside his area of expertise, but he felt it was important enough for DS to get started on something immediately that he began the "start low and go slow" process of getting him to a good dosage. There was a several months' long wait to see a psych, and by the time he got to see her the pediatrician had got him to a good dose and things had dramatically improved. But he really likes the psych and so she still does his medication management now.

Hugs.

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My youngest started an SSRI (celexa) just after her fifth birthday for severe anxiety.  It was, by far, the best parenting decision we made.  I was nervous, but it's been nothing but great.  She's now almost 16, on zoloft and buspar, and happy, healthy, functional, does well in school and socially.  When she was a preschooler, her anxiety was so debilitating that we didn't think she would be able to live independently.  It's been fantastic.

My oldest had a nervous breakdown at 15 and is now on zoloft, buspar, and wellbutrin.  They had a rocky year or so, getting significantly better but then worse again when the pandemic hit, but they are doing fine now.  I deeply regret the year we waited between "something is wrong and we need to address it" and actually getting medication, because our pediatrician (who advocated for meds for youngest child at four) strongly disagreed with us about oldest needing meds at 15.  I think if we'd started meds right away, they might not have had to drop out of public high school.

4/4 of us are psych meds for life people.  

Edited by Terabith
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My husband has been taking Celexa for anxiety for several years and as far as I can tell has had good results.  The only thing that might be bad is that he sometimes doesn't worry enough about the consequences of things.

My son took Celexa for anxiety when he was 10yo.  He was on it for 9 months, and it seemed to make him feel better about things.  No more tears during lesson time, for example, and several annoying behaviors--like always diverting attention to himself--evaporated.  Interestingly, when he went off of the medication, the difficult behaviors never returned.  But he also had some troubling behaviors develop while on the medication.  One was that he started lying all the time.  The other was that he started carving up everything in sight--his desk, window sills, boxes, whatever was around (not himself or other people though, thankfully).  The lying greatly reduced and the carving totally stopped after he went off the meds. 

I took Lexapro for anxiety for about a month.  I couldn't sleep while on it, and even when tapering down to a tiny speck (so that I might then taper back up slowly), I still couldn't sleep.  I honestly understood why some people commit suicide on the stuff if that's what it does to them.  Anyway, I decided it wasn't worth it, and stopped taking it.  

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We took one of ours to the psychiatrist during the early teen years for an evaluation, and they suggested Prozac as there is the most information on it since it is a fairly old medicine. It does take 5-6 weeks to see the full effect. It has worked for our child. We were fortunate in that the first thing we tried worked. 

One advantage I didn't originally think about was starting when we did, we had opportunity to slowly adjust the dosage to find the right dose. Child did not really want to be reliant on a med, so at one point we tried (with psychiatrist's approval and oversight) to try to taper off to nothing - this after a couple of higher dosages/lower dosages until we found the right one that worked.  The tapering off/no drug didn't work, but child came to the realization that life wasn't good. We had several discussions about it, how to set an end date when things are going well, try alternate options, but if you are still struggling when you hit that decided end date, then it is time to increase dosage (that made sense in our situation). I was hoping that child would learn and see that the medication does improve life, and that it may be necessary to be on it for life. I did not want my young adult child to just go ahead and stop taking medicine, I wanted child to try to develop some rational/reasoned base for deciding when to adjust dosages/etc. 

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2 minutes ago, Bambam said:

I wanted child to try to develop some rational/reasoned base for deciding when to adjust dosages/etc. 

That has been a piece for us, working on interoception so the person has enough self awareness about how they feel to self advocate. 

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They are already self-medicating, that's what substance abuse becomes for many with mental health issues.  Self-harm won't just resolve and becomes a tight walk with suicidal attempts.  I agree with everything stated above, how can you not?  We have a history of self-medicating in our family, and a child who has a history of self-harm.  My suggestion is to find a very well regarded psychiatrist.  They are not all created equally.  Realize that young adults often take a combination of medications for different symptoms, and it may take a while to find the right medication, or medication combination.

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dudeling was put on zoloft for anxiety by his ped neuro - after several months, the dose was increased. it was a disaster.  She didn't return my attempts to contact her as things were escalating.   I ended up taking him to a child psychiatrist - who wanted to increase the dose, claiming the dose he was on was too small to do anything.  I refused and took him off.  he calmed down within a week - such as that was.  with one new (relatively minor) compulsion that still hasn't gone away.  there are warning labels on SSRIs for teens for a reason.  I refuse to try a different one.  there was a lot of trauma for both of us from that debacle.

he always has refused to cooperate with a therapist of any variety.

we're now trying direct vagus nerve stimulation.  re: polyvagal theory by dr stephan porgas.   (there are many ways to stimulate it, and studies by multiple researchers have demonstrated it can be very helpful for those with low vagal tone. - which can manifest in different ways  - we're using one purchased through our ND from vagus.net.)

Edited by gardenmom5
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I take an SSRI (fluvoxamine or Luvox) for OCD, which is an anxiety disorder. My mom takes the same one for agoraphobia, anxiety, and depression. It's been life-changing for me and has helped my mom tremendously. 

Pros: I can function! I don't obsess over many of the things that used to take up so much time and energy. I'm much more mellow and frankly much easier to get along with. 

Cons: My mom and I have both experienced weight gain. From what I've read, about 15 lbs. in two years is pretty standard. We both had some insomnia at the beginning. That is very typical. We both tinkered with the timing of our dose and that helped. Eventually that side effect went away for me (and now I have hormone-related insomnia, fun!). Another con: Daytime sleepiness. Much less if I get a good night's sleep, but sometimes a nap is necessary. Final con for me relates to Tea. It's not the same and that stinks, but I really don't have a choice. (Don't quote, please!) 

I will probably take an SSRI for life. So, so thankful for my meds, even while I complain about the side effects. 🙂 

If one doesn't work or has intolerable side effects that don't go away, she can try another. It might take a while to find the right one or right combo.

SSRI's take several weeks to work and may need several incremental dose increases. 

Wishing your teen the best. 

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3 hours ago, egao_gakari said:

The therapist has suggested that we look at putting the teen on meds, such as an SSRI. 

I'm coming back to add, do your research, be very aware about what meds you are giving a teen, but realize that you may very well be looking at atypical antipsychotics and mood stabilizers, not just SSRI's, for this combination of symptoms/behavior.

Edited by melmichigan
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Positive results with both teens and adults. One teen had to try several medications before finding a good fit, which seemed take forever but really didn't, and it was absolutely worth switching and switching to find a good fit. It was either the 3rd or 4th medication. 

Edited to add that I would insist on full bloodwork, because you do want to know if something medical is going on. You can go ahead and get the other appointment set up, as it should only take a few days to get the blood drawn and results returned. If they've seen their doctor within the last few months, the doctor should be willing to just write up orders with no visit. If a visit is required, the doctor should still be willing to write up the orders first, and then they have the results for the visit. 

Edited by katilac
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One of my teens has been on Lexapro for about a year. He's had no side effects, and it has really helped him. His constellation of difficulties is different than those mentioned in the OP, so I don't know if Lexapro would be recommended, but I wanted to share our positive result. My son has been on ADHD meds for almost seven years and is poor at discerning for himself what effect they have on him (he is getting a little better at recognizing when they help him focus). But he says he likes the Lexapro and wants to keep taking it. So he feels it is positive, and we see a positive affect on his mood, emotions, and behavior.

Edited by Storygirl
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I asked my DC with the above conditions what advice they would have for you and was told, "find a really good psychiatrist, and be willing to listen to their advice.  Meds can be so important.  They changed my life.  Day-to-day can still be a struggle, but they've improved my quality of life SO much."  DC takes one each of the meds I listed, and it took many attempts (one allergic reaction, and one negative side effect) to find the proper combination.  Feel free to PM.

Edited by melmichigan
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They’ve saved my life.  I was suicidal this winter. Prozac has helped me enormously, though I still have days I’m deeply struggling with suicidal ideation.

also, My 10 year old ASD child is on Abilify. That’s not an antidepressant but it is a mood stabilizer.  We started it when he was 8, after much concern and wavering about medicating my young child with psych meds.  The difference in him is amazing.  

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please remember when evaluating pros/cons of antidepressants for your teen.  adults and teens are NOT medically the same, and the responses between teens and adults can be completely different.

please read up on the warnings of the considered drug and how teens have responded to it.  again - adults and teens have different brains, and the differences in response can be huge.

 

 

eta: I took prozac for a couple years, and it was very effective for the purpose for which it was prescribed.  but I'm an adult and my brain isn't growing.

Edited by gardenmom5
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38 minutes ago, gardenmom5 said:

please remember when evaluating pros/cons of antidepressants for your teen.  adults and teens are NOT medically the same, and the responses between teens and adults can be completely different.

please read up on the warnings of the considered drug and how teens have responded to it.  again - adults and teens have different brains, and the differences in response can be huge.

 

 

eta: I took prozac for a couple years, and it was very effective for the purpose for which it was prescribed.  but I'm an adult and my brain isn't growing.

I think there are differences in the brains for sure, but I also think that there is a tendency for people to shy away from the "heavier" diagnoses for children, and that can end up with kids who are medicated for the wrong thing, and some psychiatric drugs can have very bad side effects if used for the wrong situation. 

I've seen a number of bad reactions, and most of the time they are in a kid who is medicated with either ADHD medications or antidepressants, because of an ADHD or depression diagnosis, when in reality from where I sit as someone who sees a lot of challenging kids but does not do any diagnosing, the kid looks more complicated than that.   I wonder if, as adults, the same kids would get a diagnosis like bipolar, and be put on things like atypical antipsychotics and mood stabilizers.  Those things have more side effects, but they don't tend to cause kids to swing to the opposite extreme.  

This isn't criticism of you.  I think your approach of trying it, watching closely, and then removing quickly was the right thing to do.  I just wonder if some of the difference in frequency in the dramatic poor reactions is not just a difference in child and teenage brain chemistry, but it's that we are less precise in diagnosing children and teenagers.

 

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1 hour ago, gardenmom5 said:

 

please remember when evaluating pros/cons of antidepressants for your teen.  adults and teens are NOT medically the same, and the responses between teens and adults can be completely different.

please read up on the warnings of the considered drug and how teens have responded to it.  again - adults and teens have different brains, and the differences in response can be huge.

 

 

This is all true, but when a kid reaches a point of reaching for illegal substances to medicate and/or self harm, the decision making becomes much different. It’s not a safe option to not do anything when things are already that dangerous. The black box warnings are very scary, IMO, but I don’t know what else someone does for someone who is already in that kind of danger. 

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I have 2 teens on psych meds.

My middle DD was self-harming and attempted suicide at age 12. She has since been diagnosed with depression and PTSD. She was put on Prozac during her first psych in-patient stay. It worked a little; she was still depressed, but not suicidal for much of 2019. During 2020, she self harmed off and on. She went in-patient again in September of last year. The hospital's psychiatrist added lamotragine (Lamictal), a mood stabilizer, to her Prozac and Hydroxyzine (anti-anxiety) in Sept 2020. It has been like night and day. She still has her moments, but she hasn't self-harmed in months, and describes her depression as a 0. We work with a psychiatrist for her, although most of her meds were prescribed during hospital stays. The main con with middle DD's meds is that all of her doctors were hesitant to adjust them at all (other than dosage) as she was not actively suicidal, but she wasn't doing what I would say was well until Lamictal was added (and that was years after she started Prozac).

My oldest is most likely on the autism scale; therefore, her mental health issues are far less dramatic than her sister's. Her neuropsychologist testing in 8th grade did not diagnose her with autism; the neuropsych told us she was anxious but "curiously flat". Anyway, she became fairly depressed as a junior in high school. She decided to do something about it, researched and asked for prozac and an anti-anxiety medicine, and I simply set up the doctor's appointment. She was already on Adderall for ADD. She currently takes prozac and buspirone. Her primary diagnosis is anxiety. We work with DD's PCP for med management; her PCP is very, very knowledgeable about depression and anxiety, and DD is comfortable with her. 

Oldest has been seeing a therapist since 8th grade. She has a therapist who is kind of like a kindly grandmother. Middle has seen both a trauma and a talk therapist as well as doing a few partial hospitalizations for more intense therapy and currently attends a Zoom group. We have had to switch her therapists a couple times due to fit. She currently is doing EMDR for trauma, and she sees a talk therapist as needed (about 1x per month) for further processing and making sure she is handling the EMDR well. 

Both of them have had thyroid, Vitamin D, and iron levels checked multiple times. Both now take Vitamin D supplements, and middle DD takes iron as well. Both have also had extensive allergy testing, with oldest DD having many seasonal allergies. EDS (Ehler Danlos Syndrome) may play a part in my girls' mental health as well; oldest DD will have genetic testing this summer for that. 

Hugs to you, egao_gakari. It is a scary place to be as a parent. I hope your DS responds well to therapy and medication. 

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8 hours ago, BaseballandHockey said:

I've seen a number of bad reactions, and most of the time they are in a kid who is medicated with either ADHD medications or antidepressants, because of an ADHD or depression diagnosis, when in reality from where I sit as someone who sees a lot of challenging kids but does not do any diagnosing, the kid looks more complicated than that.   I wonder if, as adults, the same kids would get a diagnosis like bipolar, and be put on things like atypical antipsychotics and mood stabilizers.  Those things have more side effects, but they don't tend to cause kids to swing to the opposite extreme.  

Bingo, this is exactly what's happening here. We're going around in circles because the pdoc is so insistent starting on prozac is smart and I'm like nope, not happening. He destroys property and is dangerous on Buspar, which has mild dopamine agonist effects and clears the system safely. Why in the WORLD would I let her put him on prozac, which will bump dopamine more and hang in his system longer? Insane. They have their protocol and I have mine. (staying alive)

1 hour ago, historically accurate said:

My oldest is most likely on the autism scale; therefore, her mental health issues are far less dramatic than her sister's. 

That doesn't flow. You can have both be significant together. She just has a slightly different mix of genes and how they present, so her mental health issues are different. 

 

8 hours ago, BaseballandHockey said:

but it's that we are less precise in diagnosing children and teenagers.

That would be a polite way of putting it. I'm still trying to figure out if the pdoc just hasn't seen it yet (because we haven't baselined him completely due to testing) and wold get there if she saw it OR if it's that they stubbornly go through a list of stuff before getting somewhere. I tend to think it's because she's not seeing it yet. But really, I'm not very confident baselining a mix that sorta works if her answer isn't making me confident that we'll choose something that is actually going to hit the bases. I will not administer him something that is highly probable to cause very bad reactions and be a poor fit. That's insane. I will not do something that is likely to land him in our swank new multi-million $$$ children's mental health hospital because she wants to start light. 

I'm just talking it out there. But I'm saying that's where it is and it's literally that insane. But the pdoc is going to talk with me this week and we'll work it out. For me it's very hard because I get knocked for being rigid and hard to work with. But being insistent that the proposed treatment make sense is not a flaw. Just on a personal level I've got knocked with that so much that sometimes I let people bowl over me, and this is time where it could have disastrous consequences. It may be a lot of parents are in that position of getting shafted by the system, looking bad no matter what they do. Doctors have a control dynamic and power and they drop you if you don't do what they want but they take NO RESPONSIBILITY for the consequences if their call is wrong. Zero. If my ds goes off the charts for a week and has to be checked in, is SHE gonna pay for it? Nope, I am. 

That's a rant.

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14 minutes ago, gardenmom5 said:

I'm going to be very blunt. 

And the irony? The pdoc tells us that would be the major side effect she's watching for (I asked, she answered), BUT THEY DO NOT USE GENETICS TO SCREEN FOR IT. I KID YOU NOT. !!!!!!!!!!!!!

And it's right there, in the genetics. It's known, predictable, obvious. THEY ALREADY KNOW THE GENES!!!!!!!!!!!!!

And my ds has them. I dug through his results. Now one source will say suspected, another will state it more strongly. But they already KNOW there are genes that correlate to suicidal ideation. And they still GIVE THE MEDS ANYWAY.

The systems they're using now to correlate genetics and mental health are completely inadequate. I've looked through sample reports from 2 or 3 companies now, and they're invariably crap and to the point of worthless. They go too linearly, wanting a one med one gene correlation, when it doesn't work like that. They want a simple answer to a systemic situation (how the systems work together affects how the med will work). 

So I get why the pdocs aren't using these companies. And that's what you see if you call around. The genetic testing company will have TONS of users listed and those docs are like oh we don't use them anymore, results weren't helpful, over and over. 

But the problem is how stupidly the results are being used, not what *could* be done. 

So yeah, known genes and SNPs connected to or suspected linked to suicidal ideation with antidepressant use. So I'll keep pushing back. Because the pdoc's answer was well we'd start slow and pull it back fast if it happened. With a dc who drops language and only recently started being able to tell us feelings at all?? You really think we'd know what was going on in his head before he started acting it out???

I rant. Not saying any of it applies to op.

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17 hours ago, gardenmom5 said:

claiming the dose he was on was too small to do anything.

Fwiw, I've seen this done with adults too, where they were having negative side effects and the pdocs weren't acknowledging it and said everything would smooth out if they just took it up higher. So it's not like only teens get shafted by a system that doesn't listen. 

17 hours ago, gardenmom5 said:

with one new (relatively minor) compulsion that still hasn't gone away.

I cannot remember what it was, but there was something (a supplement) I came across in my reading that they set could reset your system when coming off an SSRI. You might see if you could find something like that. Maybe if you have genetics you can look at charts and see what got stressed and depleted resulting in the emergence of new symptoms. 

page 3 of this sample report (from one of these genetics for mental health companies) https://s3.amazonaws.com/site-akiajqrf22xmaqzsiz6q/Sample+Reports/NeuroBasic+Sample+Report+(Female).pdf  has an interesting chart showing how things are interconnected. Actually I'm saying genetics, but this company looks at *urine* which is a little different. They'll call it neurotransmitter therapy, and they're looking at byproducts and scraps in the urine to see what might be out of balance. There are various companies doing it and some way alternative docs in my state (well one doc that I know of) are doing it. Not saying it's any good, but I thought the logic was interesting and was exploring it. 

The most interesting thing I saw on that chart was the widespread use of P5P in the neurotransmitter processes. I had no clue, and to me that means you're getting an effect everywhere. Explains why it's so GOOD for me when I take it, just very wow. But I give it to ds (who has his own chemistry, half of mine, not how I experience things) and his reaction is elevated for everything, too much. But the logic is there when you see how the chemicals feed the processes.

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3 minutes ago, PeterPan said:

And the irony? The pdoc tells us that would be the major side effect she's watching for (I asked, she answered), BUT THEY DO NOT USE GENETICS TO SCREEN FOR IT. I KID YOU NOT. !!!!!!!!!!!!!

And it's right there, in the genetics. It's known, predictable, obvious. THEY ALREADY KNOW THE GENES!!!!!!!!!!!!!

 

with insurance changes, I can go back to my ND - the ONLY ONE that has effectively treated him.  she wanted to run the genetics test that  will give that info - is it NOT 23&me!  (pretty sure it's not genesight either.   I dont' think it is available on the open market, but one available to the medical community.)   We would have had to pay out of pocket, and then we couldn't afford it - now we can and may well end up doing that.

right now - we're trying the vagus stimulator.  I has shown promise in other studies.  He's supposed to use it twice a day, but he's not consistent in even using it once a day.   and he has a small tragus, so it doesn't stay on very well.  (I came up with a headband to hold it in place.  it has to be non-metal.)

we know his lithium (human brain has it naturally) is extremely low, but he reacted poorly to attempting to supplement with it when we tried before he ever started with the neurologist.  (litium orotate is available OTC.) - though the reactions were nothing like with the antidepressant, which was prescribed by a ped neuro.

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10 hours ago, gardenmom5 said:

but I'm an adult and my brain isn't growing.

I wondered about this when you initially posted it, now I'm wondering again. I know the data says that it is more likely to have the averse things in teens, but you also just have this maturing of judgment on what you ACT on. (more mature adult looks at that and knows the feeling is separate from their reality and not what they're going to act on) The smaller the sample size (one adult plus one dc) the more I'd be wondering if it's that one was homozygous for a gene connected with s. ideations and the other was only heterozygous, kwim? 

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3 minutes ago, PeterPan said:

 

The most interesting thing I saw on that chart was the widespread use of P5P in the neurotransmitter processes. I had no clue, and to me that means you're getting an effect everywhere. Explains why it's so GOOD for me when I take it, just very wow. But I give it to ds (who has his own chemistry, half of mine, not how I experience things) and his reaction is elevated for everything, too much. But the logic is there when you see how the chemicals feed the processes.

I had a dr who said she was writing me a prescription for P5P . . . .. I get there, and it's a lessor molecular form.  um, hello?  sure they're both a B-vitamin, but they are NOT the same molecular form.  (as both the pharm tech, and later my doc - kept telling me they were the same.)

unhuh.   I've had too much personal experience - molecular forms matter.

I've seen the charts with the methylation process and the way it all feeds into each other.  

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Just now, gardenmom5 said:

she wanted to run the genetics test that  will give that info - is it NOT 23&me!

What company does she use? Almost all these companies provide sample reports, so you can take them and work backwards. No, 23andme does not "give" you the information, lol, and they presumably do not put it in their health reports. However they are RUNNING the genes. Remember, isn't the gig that you sign saying 23andme can do things with your genes? So they're RUNNING a lot that they're not TELLING you. If you look at the raw data file, it's quite large. 

So it's very easy to work backward. I find genes in sample reports for what they look at for this or that and then I search (typically using promethease, because it makes the file easy to search) to see what pops up for that gene. Very seldom do I get nothing. Like I think on the last sample report I worked through (2 weeks ago) I was missing only 2 or 3 SNPs from all the genes the fancy report was taking into consideration. I already had almost all the data and I didn't need to pay another $600 or whatever that company would have wanted.

Or put another way, if the doctors actually knew what they were talking about, they could extra the needed info from the data you already have from 23andme. Instead, we're getting more fast food medicine. 

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Just now, gardenmom5 said:

I had a dr who said she was writing me a prescription for P5P . . . .. I get there, and it's a lessor molecular form.  um, hello?  sure they're both a B-vitamin, but they are NOT the same molecular form.  (as both the pharm tech, and later my doc - kept telling me they were the same.)

unhuh.   I've had too much personal experience - molecular forms matter.

I've seen the charts with the methylation process and the way it all feeds into each other.  

No, this chart I linked was neurotransmitters, not methylation. Might interest you.

P5P is the form the liver converts the b6 into (from what I understand). So I get why you might say well I take methylb6 and don't need that. Fine. I have both MTHFR and COMT defects, so if I take the methyl forms I get really grouchy and if I take the unmethylated forms I get really tired, lol. For real. So P5P skips that problem and gets me right to using it. And it's fast. And it drops my anxiety and even bumps my thyroid slightly. Like I was right on the line between two doses for my thyroid med and the P5P bumped my thyroid *just enough* that I went to the lower dose. 

So it's more just the use of it and why you'd want it. If you want to get straight there and not mess around with the conversion or if you want the effects (on neurotransmitters) directly, it could make sense to take the P5P. But I give it to my ds and it's just a lot directly into the system. I take it and it's really, really good, just astonishing. But he has no MTHFR defect and he can convert and process that b6 and keep the system going. Mine is more cracked so P5P gets me there. And it's stupid cheap and it's quickly obvious if it's good voodoo. 

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14 minutes ago, gardenmom5 said:

(litium orotate is available OTC.)

I know I've seen charts or discussions of what it means is low if you react to lithium. I tried it (before I understood about the methylation stuff) and it was a mixed bag. My thyroid immediately began dropping. I wasn't on meds at that point, so it was extra obvious. So maybe it's b6? (just thinking out loud here, because the P5P form of b6 ups my thyroid and the lithium took it down) If you've run your genetics through knowyourgenetics.com she talks about lithium. 

But yeah, I don't doubt that people would have reactions. It was one of the early things they tried with my dad many years ago, and I'll never forget him sitting at the table like a ZOMBIE. That's what the lithium was doing to me too, making me go totally flat and nonresponsive. And I don't think it was that lithium was so so bad (because as you say it's needed in the body, lol) so much that it was upsetting the apple cart.

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4 minutes ago, PeterPan said:

I wondered about this when you initially posted it, now I'm wondering again. I know the data says that it is more likely to have the averse things in teens, but you also just have this maturing of judgment on what you ACT on. (more mature adult looks at that and knows the feeling is separate from their reality and not what they're going to act on) The smaller the sample size (one adult plus one dc) the more I'd be wondering if it's that one was homozygous for a gene connected with s. ideations and the other was only heterozygous, kwim? 

No - it's not knowing what you act and don't act on.   I was put on prozac because of overwhelming compulsions for self-harm.  Being an adult, and understanding the consequences of the action I was being compelled to do (they would have killed me, or at least gravely injured me.) - kept me from getting help sooner (and a dr that basically made me feel he thought I was a hypochondriac, and I didn't have the mental energy to find another dr.).  however, those compulsions were getting stronger every single time they would happen.  (I did get sent to anther provider, who immediately started me on prozac, and had some samples in his office so I could start them right then and there.)

I remember the first time I had a "compulsion" after I started the prozac.  It felt like I was watching it from a distance- very dissociated, and it didn't have remotely the same effect as when I was unmedicated.  very detached, as though I was reading about it as opposed to experiencing it.  I only had a few more episodes like that afterwards, and each one was milder and milder.  more of a sand in the shoe irritation.  I read people do best if they stay on it for two years, (minimum) so that had been my plan.  I was fine with that - but after a year I started having side effects, (since side effects can also mean you're getting too much.  . ) I lowered my dose and the side effects went away.  For a couple months, then I had them again, so I lowered the dose again.  and did that over six - eight months and I was off before the two years were up.  I have a genetic predisposition to depression (I'm homozygous - dudeling is only heterozygous) - so I now take 5HTP. (combined with a good b-complex).  It works for me.   

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15 minutes ago, gardenmom5 said:

we're trying the vagus stimulator. 

I've seen you mention this in other threads. If he doesn't like it and isn't compliant, maybe another way? TRE, humming, there are other ways. 

Bodywork doesn't change chemistry. My dh will joke that I'm "so normal" after a session with a lot of bodywork. Like I'll spend most of the hour bodyscanning and doing mindfulness when I get cranial sacral. Sometimes I'll call my dad and he'll sound really focused, really good, and he'll say he was just "meditating." 

So there's a point where people have to find how they want to get there. Doesn't help when you really need it to happen, lol. Just saying it might be personal a learned thing.

And, fwiw, I harp on this forever, but INTEROCEPTION is the key to self advocacy. When people are not choosing things, sometimes it's because the self awareness piece isn't there. They don't realize what would make them feel better. So INTEROCEPTION work might be sort of a back door way to get there. Op might look into it @egao_gakari  It sounds like they're saying op's situation is more complex than this thread hints, and I'm just gonna toss out that interoception can be a piece that helps. When we started working on mine, I could finally self advocate and say what I needed for meds, what was working, what wasn't. That self awareness piece is important to mental health and they're working on it. Now we have curriculum to make it EASY.

https://www.kelly-mahler.com/what-is-interoception/

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46 minutes ago, gardenmom5 said:

yeah ---I get that.  I'm going to be very blunt.  please don't quote - i will probably delete this.  

I didn’t quote, but I’m replying about the suicide risk of SSRI’s (that’s what I was talking about when I referred to the black box warnings). What I meant in my post is that that risk is very scary, but when you have a kid with high levels of SI already, they’re already essentially experiencing the effects the black box warns of. They’re already there, so it’s an emergency to do something to address that. 

20 minutes ago, PeterPan said:

And the irony? The pdoc tells us that would be the major side effect she's watching for (I asked, she answered), BUT THEY DO NOT USE GENETICS TO SCREEN FOR IT. I KID YOU NOT. !!!!!!!!!!!!!

And it's right there, in the genetics. It's known, predictable, obvious. THEY ALREADY KNOW THE GENES!!!!!!!!!!!!!

 

I’ve said this before, but it’s unfortunately not yet true that the gene testing can give a clear answer of what medication to use. All the studies so far have shown the testing to not be very helpful. I would do it if a doctor offered, because it seems there’s a chance it could help get to the right medication faster, but it also might totally not. There are lots of articles about how we’re not there yet. Here’s one: https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964

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4 minutes ago, gardenmom5 said:

so I now take 5HTP. (combined with a good b-complex).  It works for me.   

Reading about your experiences, I'm so glad what you did worked and you're safe and feeling well now!

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13 minutes ago, PeterPan said:

What company does she use? Almost all these companies provide sample reports, so you can take them and work backwards. No, 23andme does not "give" you the information, lol, and they presumably do not put it in their health reports. However they are RUNNING the genes. Remember, isn't the gig that you sign saying 23andme can do things with your genes? So they're RUNNING a lot that they're not TELLING you. If you look at the raw data file, it's quite large. 

So it's very easy to work backward. I find genes in sample reports for what they look at for this or that and then I search (typically using promethease, because it makes the file easy to search) to see what pops up for that gene. Very seldom do I get nothing. Like I think on the last sample report I worked through (2 weeks ago) I was missing only 2 or 3 SNPs from all the genes the fancy report was taking into consideration. I already had almost all the data and I didn't need to pay another $600 or whatever that company would have wanted.

Or put another way, if the doctors actually knew what they were talking about, they could extra the needed info from the data you already have from 23andme. Instead, we're getting more fast food medicine. 

I don't remember the name.
I've run both ancestry, and 23&me through promethease.  - they did NOT have the same data!  while there was a lot of overlap on the genes they pulled, (23&me did cover more) - 23&me has holes too.   They have different genes.   I feel like promethease was more "entertainment/curiosity" than a truly serious tool.   My personal ND ran my 23&me data through two different companies that gave better quality reports and information.  But, they're only available to the medical community by subscription.  I'd have to wade through all my stuff to find the names.  I should probably dig them out and take them to my new ND (last one is now doing more admin than clinic.)

If i were to do it myself again, I'd run it through something like genesight.

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5 minutes ago, gardenmom5 said:

  (I did get sent to anther provider, who immediately started me on prozac, and had some samples in his office so I could start them right then and there.)

I remember the first time I had a "compulsion" after I started the prozac.  It felt like I was watching it from a distance- very dissociated, and it didn't have remotely the same effect as when I was unmedicated.  very detached, as though I was reading about it as opposed to experiencing it.  I only had a few more episodes like that afterwards, and each one was milder and milder.  more of a sand in the shoe irritation

Don’t teens experiencing this problem deserve to find the same relief? They need to be carefully watched and meds shouldn’t be given lightly, but for a kid suffering to that degree, they deserve to be helped just as an adult would. 

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2 minutes ago, PeterPan said:

I've seen you mention this in other threads. If he doesn't like it and isn't compliant, maybe another way? TRE, humming, there are other ways. 

Bodywork doesn't change chemistry. My dh will joke that I'm "so normal" after a session with a lot of bodywork. Like I'll spend most of the hour bodyscanning and doing mindfulness when I get cranial sacral. Sometimes I'll call my dad and he'll sound really focused, really good, and he'll say he was just "meditating." 

So there's a point where people have to find how they want to get there. Doesn't help when you really need it to happen, lol. Just saying it might be personal a learned thing.

And, fwiw, I harp on this forever, but INTEROCEPTION is the key to self advocacy. When people are not choosing things, sometimes it's because the self awareness piece isn't there. They don't realize what would make them feel better. So INTEROCEPTION work might be sort of a back door way to get there. Op might look into it @egao_gakari  It sounds like they're saying op's situation is more complex than this thread hints, and I'm just gonna toss out that interoception can be a piece that helps. When we started working on mine, I could finally self advocate and say what I needed for meds, what was working, what wasn't. That self awareness piece is important to mental health and they're working on it. Now we have curriculum to make it EASY.

https://www.kelly-mahler.com/what-is-interoception/

He's mostly fine with it - it's just the doing it.  He has to be relatively still so it doesn't fall off, and he can't wear his headphones at the same time.   (if he could wear his headphones at the same time - there would be zero issue.)  Those are his only issues.  last night, he was reading while he did it.

I do have to remind him, because he does forget.  hm, more alarms for me to set to remind me to remind him . . .   (and the original charging cable got lost!!! and it's a specialized cable so you can't just go buy a 2.5 jack!  bless the company, who sent me a new one when I contacted them.)  But I also have to get him when he's not in the middle of something - so timing is a factor too.

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3 minutes ago, kand said:

Don’t teens experiencing this problem deserve to find the same relief? They need to be carefully watched and meds shouldn’t be given lightly, but for a kid suffering to that degree, they deserve to be helped just as an adult would. 

who said anything about not relieving a teen's distress?  you are seriously misinterpreting what I said.   I'm saying be aware of the risks and watch closely for signs of an adverse response.   You don't want to make things worse. - and for some kids, they make things worse.

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33 minutes ago, kand said:

I’ve said this before, but it’s unfortunately not yet true that the gene testing can give a clear answer of what medication to use. All the studies so far have shown the testing to not be very helpful. I would do it if a doctor offered, because it seems there’s a chance it could help get to the right medication faster, but it also might totally not. There are lots of articles about how we’re not there yet. Here’s one: https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964

I think we're saying the same thing. Every time I find a doctor or pdoc who is using a gene testing service to drive their medication choices, I look up the company, look at the reports, see what they're looking at. And it's not there. The way the docs want the information handed to them and the way the companies are doing it is too fast food, too linear, not respecting the whole system. They have correlations, but it's that saying correlation is not causation. 

So I'm not saying I'm a fanboy (fangirl?) of these testing services, because I don't think they're nailing it. But that doesn't mean the *potential* is not there. It's just the way they're doing it is too simplistic, too linear, and not considering the system and interactions as a whole. It would be hogwash to say genes are not connected to chemistry and behavior at all, mercy. That would have us back at the voodoo "mental health" stuff where we have to "believe" in mental health vs. sin. 

I guess that's what you should know too. The reason I'm always looking for physical explanations is because I'm coming from a religious background that has historically pushed back against the "mental health" community. So if you say it's mental health, they're going to call it SIN. End of discussion, no discussion. Your doctor says you don't have a physical problem, so it's SIN. And then they throw out tropes and stupidity like "we can't measure the serotonin in the brain" (well we can, but it requires metal sensors to be inserted and you wouldn't like it) and ADHD is a sin problem because you're choosing not to pay attention when God says to pay attention and your anxiety is because you won't say enough Bible verses and trust God when the Bible says trust God and your anxiety will go away.

So yeah, you better believe I actually want to SEE the correlation. I'm SO TIRED of the voodoo stuff. When the mental health refuses to deal with physical realities, they play into the idea that it's a will problem, a volition problem, something we can choose to "believe" a different way about. My anxiety was driven by a b6/zinc problem. I take a form of b6, it goes away. It's in my genes, very obvious, and I didn't have a prozac deficiency and didn't have a spiritual problem.

Personally, I find the term mental health and the labels very dark ages. We use them, but I'm just saying they're dark ages. Physical problems, physical causes. But they're lumping together people who have temporary personal challenges with people who have longterm problems due to genetics or whatever, and it's all just "mental health" which takes us back to the discrimination in the church. As soon as they say well you just have a temporary personal problem, you should solve that spiritually, then they feel free to discount people who have longterm, genetically driven problems that aren't going to be temporary, aren't going to improve with a Bible verse or prayer. And I'm not saying people can't make their choices for their temporary problems. (meds, whatever, that's your business)  I'm just saying there's some CONTEXT here.

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23 minutes ago, gardenmom5 said:

I've run both ancestry, and 23&me through promethease.  - they did NOT have the same data!  while there was a lot of overlap on the genes they pulled, (23&me did cover more) - 23&me has holes too.   They have different genes.   I feel like promethease was more "entertainment/curiosity" than a truly serious tool.   My personal ND ran my 23&me data through two different companies that gave better quality reports and information. 

We're talking past each other. I agree the info on the SNPs that promethease kicks out is very brief, and once you run it you don't get it updated without paying again. I agree other sources would crank out fancier reports. I use promethease to make my 23andme data *searchable*. The raw data file from 23andme, if you look at it, lists only SNPs. So if I want to know what *genes* those SNPs correlate to, I need another way to search the information. The promethease html gives me that. 

So I find the gene elsewhere (googling what I'm researching at the moment) and then search my promethease html for that *gene* which then shows me what SNPs I have to look at. Then I use google and websites to look up those SNPs to see what is known about them.

So yes, I'm going through a bunch of steps. The promethease report alone does not do it for me. 

23 minutes ago, gardenmom5 said:

If i were to do it myself again, I'd run it through something like genesight.

You already have almost all that data. They run very few SNPs and if you've done 23andme you have the data.

https://genesight.com/product/psychotropic-report-details/  I know I found a sample report from them, and once you find it (keep clicking links and looking) at the very bottom, in *very small* print they'll show the RS numbers they were looking at for each thing. It's all there and you can work backward from that, looking at those RS numbers in your searchable promethease file or directly searching your 23andme raw data. You will already have almost everything Genesight would have run. 

That's what I find every time I look at these reports. They're drawing HUGE conclusions based on a *slim* number of SNPs, and they don't look at the larger picture (methylation status, which hello predicts a lot of reactions to medications also) at all. 

But yeah, the services crank out great looking reports. It's just their claims are either vague or not adequate. 

But I'm asking really hard questions. Like look at the medications I'm considering (atypical antipsychotics vs. antidepressants, ADHD meds) and then look at the SNPs and what genes they're saying will drive their advice. Even you, not as a phd researcher expert, will know right off the top of your head more genes that are involved! That's how you KNOW their assertions are based on incomplete understanding. 

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33 minutes ago, kand said:

Don’t teens experiencing this problem deserve to find the same relief? They need to be carefully watched and meds shouldn’t be given lightly, but for a kid suffering to that degree, they deserve to be helped just as an adult would. 

I need to smack my sled head here a minute. She said her kid had a reaction and you said you're so glad yours didn't and she's bad? 

The problem is the system takes ZERO ACCOUNTABILITY for what happens. If the kid commits suicide, there's no consequence. If my kid is given prozac by this pdoc and has a largely predictable reaction and ends up needing inpatient care, does the doc pay?

It has nothing to do with saying no to care and everything to do with saying people who have the more complex situations (mine, garden's) are going to have to be extra cautious being more likely to have reactions. Even the really fancy pdoc from the biggest hospital I could find said the same thing. She's like we start uber small and expect unexpected reactions. 

I just find, as someone who has plenty of family using mental health treatment, that the treatment is still too dark ages and that there's more that needs to be done. That's it. And given that they ARE researching (but that it hasn't all come together into actually driving the changes I think we could see one day in practice) I'm not sure why that would be controversial. We need to be respecting how complex these things are and giving doctors ALL the tools. But no, it's still linear. (you're sad, here's prozac) when it's obvious we could predict some of these reactions. They just aren't there yet. The info is sorta there, but it has to pull together at some point into something that hits that evidence based thing the doctors want, where it's in their books and known and congealed. And it's not there yet. It needs to happen.

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1 hour ago, PeterPan said:

I need to smack my sled head here a minute. She said her kid had a reaction and you said you're so glad yours didn't and she's bad? 

What? I never said any of that. I haven’t even mentioned my kid at all. And I haven’t said or implied or even thought that anyone on this thread was bad. I have no idea what you’re talking about. 

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I have taken an antidepressant for years and it has been very helpful.  I am not against antidepressants at all.  However, I am extremely cautious when it is for a child or teenager.  I have had two children who used antidepressants who ended up with suicidal thoughts.  It is something you have to keep a very close eye on.  I don't think they are bad or wrong per se, but they have to be used with caution.

One of my children tried a number of different medications and none of them helped, and some made things much worse.  I think this child was repeatedly misdiagnosed and never needed medications in the first place.

Another child only tried one medication but after attempting suicide was pulled off and never taken anything since.  Things got better with therapy and time.

I think it is great that medications work well for some teens; I just like to urge caution when starting and when changing doses.

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2 minutes ago, Loowit said:

Things got better with therapy and time.

This is one of the things I think about with my ds. Not that it's going to go away, because his issues are pretty permanent. But that maybe we find a mix that is pretty close and then with maturity he works through the rest and deals with himself. 

I don't know, just thinking out loud there. I thought it might be what you're saying sort of. Because so far our options are a mix that is pretty good (not perfect, 60-80% of the way but minimal side effects) or baseline and see if we could do better (more hang time, improved control, but probably significant side effects). And if we stayed, that as we are, that would be the assumption, that we were going really heavy on the cognitive/therapy stuff to keep it in check. 

Like I said, just thinking out loud. It's the tricky stuff, sigh. It's why I'm taking it slowly, so I'll be very sure.

For op, that's something I read in a book on children's mental health meds. It was a book @Ottakee had recommended, something from the library. But it made the comment that if you're asking about the side effects, you're not yet ready for the meds. It's a line I think about a lot and the answer changes for us at times.

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5 minutes ago, Loowit said:

I have taken an antidepressant for years and it has been very helpful.  I am not against antidepressants at all.  However, I am extremely cautious when it is for a child or teenager.  I have had two children who used antidepressants who ended up with suicidal thoughts.  It is something you have to keep a very close eye on.  I don't think they are bad or wrong per se, but they have to be used with caution.

One of my children tried a number of different medications and none of them helped, and some made things much worse.  I think this child was repeatedly misdiagnosed and never needed medications in the first place.

Another child only tried one medication but after attempting suicide was pulled off and never taken anything since.  Things got better with therapy and time.

I think it is great that medications work well for some teens; I just like to urge caution when starting and when changing doses.

I agree with this. Just to be clear what I’ve been trying to say.  I would personally be very hesitant to start a kid on any of these medications. I think they’re often prescribed too casually. Good therapy would always be my first stop (along with vitamin D, bloodwork, etc). But for a kid already suicidal, the decision would be different. I would not even hesitate in that case, even knowing there’s a chance it could make it even worse. 

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My DC had genetic metabolic testing done. Most genetic testing isn't relevant to mental health treatment at this time but the exception can be the few genes that influence drug metabolism.  There are specific tests that are showing promising results, one can search the NEJM for specifics as some new studies have been released since the Harvard Study dated 2019.  I'm sure this field will grow in the future.  The testing didn't really tell us anything we didn't already know, but reinforced it.  

My teen has been in therapy for years, has bloodwork done regularly, and takes a variety of supplement including vitamin D.

I have sat up with a teen with suicidal ideations on the wrong medication.  I have called the psychiatrist in an emergency because my teens attempt at self-harm became a suicide attempt.  Both are equally frightening.  I'm not sure if I'll continue with this thread because it brings me to tears.  A child that struggles with major depressive disorder and who's self harm crosses the line to suicide is in a very dark spot.  I'm sorry, but a child that had a close call with self-harm attempted suicide in the mental health world, so that is where OP's child is at. I would have lost my child, there is absolutely no doubt in my mind, without medications.  They are not a magic cure, they are not to be taken lightly, but they deserve equal consideration in these type of cases.

OP, if you choose meds, make sure you again do your best to screen a very well respected psychiatrist with lots of experience in this age group.  It took us two tries to find the proper person to treat DC.  Make sure you have a list of potential side effects to watch for based on the medication(s) you are working with. Make sure you and your teen are on the same page and realize they may need help with medication management.  Make sure you have a list of when to contact the provider, and how, for 24/7 coverage.  Make sure you know under which circumstances to stop the medication, or how to handle severe side effects. A good psychiatrist will discuss all this with you and is available to their patients.  A good psychiatrist will follow very closely with additions of medications and changes in dose.  When making changes we see the psychiatrist no less than every 28 days, and sometimes every 14.  We sometimes have to call with update reports between visits.  Eyes on the patient is very important when treating mental health in teens.  If your provider is hands-off, find someone else.  

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5 hours ago, PeterPan said:

We're talking past each other. I agree the info on the SNPs that promethease kicks out is very brief, 

I agree, the databases aren't searchable, and promethease tries to do that.  I'm not satisfied with their end product.  I wouldn't use genesight - I said "like" genesight.

the one dudeling's ND uses is much more complex, and as far as I know from previously looking into it - it's not available on the open market, only providers.

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