Update: Summer adjustments – breaks and trials

Summer break is notoriously a time that parents wait to try to add or remove a medication their child is taking.

Starting up and weaning off medications is tough – very tough. The withdrawal can be severe and going slow is just as important when removing a medication as it is adding.

There are several schools of thought regarding summer breaks from medications.

Some psychiatrists believe that during the summer months medications for attention, mostly stimulants, can be given a break especially if weight loss has occurred. Others feel that it is like removing glasses from a child that needs them and feel that the stimulants often help with social interactions as well as academic performance and should therefore remain.

Dr Duncan McKinlay renowned psychologist, author of Nix your Tics and creator of the documentary Lifes’ a Twitch” feels that there is a risk to stopping a medication that is working as the child may not have the same positive reaction once restarted. I have heard this from several other professionals as well as parents who have found that the results once had are much lessened when reinstituted.

In the end, it is a parents choice. Being a parents choice does not mean that a child (if old enough and has the ability to self advocate) should not have some say as well. Before making any changes set up an appointment with your childs prescribing physician and discuss the pro’s and con’s. Let your child talk about how the medication makes him/her feel. What symptoms are the most problematic and if they feel improvement or impairment from the medication. As said, ultimately it is the parents decision but having your child participate and understand the changes will only make the rollercoaster ride easier for all. Another positive in having the child participate is that often times what may appear to be one behavior or emotion is really something else and in discussing the pro’s and con’s and targeting symptoms a clearer picture may emerge.

Once referred to as a “medication holiday” is another of the many stressors a parent medicating their child needs to consider carefully. Starting and stopping medications whether for summer break or any other reason is stressful for the child and the parent. The “Honeymoon” period is another term thrown around for the initial period of time that a medication is new to a child system and showing much improvement only to lessen in effect after a few months and there is a need to be adjusted. Keep in mind that an adjustment does not always mean an increase. For many kids, especially those on the spectrum often less is more. Many of these kids are micro-responders and have better results with an eigth of what other children may be able to tolerate.

Above I am speaking of medications that DO NOT stabilize mood as they should never, I repeat, NEVER be removed if a child is stabilized. I am talking about stimulants and other medications not used for depression or mood stability.

For the child who is not finding stability on their “medication cocktail” summer is often the time of trials. Many parents wait for summer, to try different medications so they can monitor closely and give the child time to adjust and go through the physical side effects. It, if an option, is a great idea.

As any parent who has been through the process of starting a medication knows, there are some rough days even with medications that eventually will help and whose side effects will abate. Nausea, lethargy, headaches, body aches, brain fog, cognitive dulling, agitation are just to name a few of the possible side effects that a child may have therefore not having to “perform” in a school setting during a trial is very advantageous.

If you are considering a medication change for your child, if you have been waiting for summer or any other school break, plan carefully. Consider a shorter summer camp or a later start. Give your child the best possible chance to adjust and function through the trial in hopes of giving them a better quality of life.

The title of this writing – “The Medication Rollercoaster” for the rest of this blog is deceiving.

Alternative approaches need to be planned and considered for summer and school breaks as well. Even natural, homeopathic or holistic approaches have side effects and can be draining on a child.

Many parents wait to try an alternative approach and wean their child off medications during the break. This is a great idea. The ten week period gives you enough time to wean off – incorporate vitamins or other therapeutic trials and have time to reintroduce the medications if it is not successful.

DO NOT UNDER ANY CIRCUMSTANCES add any herbal or homeopathic products to medications without speaking to your prescribing doctor and doing your OWN homework as well. Make sure to check your Drug Interaction Checker and check out all possible drug to herb or homeopathy interactions. They are significant and there are many.

Drug herb interaction checker

http://www.prohealth.com/library/showarticle.cfm?libid=13668

Drug – Vitamin depletion chart

http://www.pharmacistelink.com/naturalmedicine/pdfs/P4880x1204DrugChart.pdf

Wishing you all a safe – happy – healthy summer.

Below you will find the original writing with important information for any parent going for a ride on The Medication Rollercoaster……..

The Medication Rollercoaster – Original article

Let me start by saying I am not a doctor or a medical professional – I am a mom – a mom who has been there.

The decision to medicate your child is a very personal and heart wrenching one for many parents.

Whether the child has a mental illness or a physical one the stress and anxiety is the same.

The difference is in the stigma. Would you give your child insulin if diabetic, chemo for cancer, anticonvulsants for epilepsy?

Of course you would. What many people do not understand is that mental illness can be fatal. It can be severe and debilitating.

Does your child have a physical illness that requires medication? Do you lay awake at night worrying about the side effects?

Medicating a child is tough. It is draining and takes an informed, observant and stable parent to monitor.

I will discuss it all on The Coffee Klatch on Friday 2/26 and will provide resources to help you gain some control over the stress involved with medicating a child.

Here is an outline of the topics we will be discussing in detail on the show:

First thing any parent should do is google a drug interaction checker and bookmark it. I use http://www.drugs.com/drug_interactions.html

Second thing any parent should do – buy a journal – journal every day several times a day if needed

Write down the medication – generic or brand – dosage – dates increased or decreased – reactions and side effects

You are your childs medical historian – be accurate and be consistent – it is amazing what we forget under stress

With possible medication trial and errors it is important to have a record for yourself and the doctor

Do your homework – when discussing medications with your childs doctor ask about all possible side effects

Discuss titrating and weaning. Discuss test dosing. Discuss doctors availability in event of a problem

Discuss blood work prior and during medication use – discuss heart or other pre-required testing

Discuss what is considered an ample period of time to decide if the medication is helping

Discuss your feelings and anxieties about medicating the child – do not be intimidated or pressured

Discuss the fact that you will have to do some research on the medication and make an informed decision.

If your childs doctor is pressured for time let him know that you will come back to discuss the issue

If your childs doctor does not provide you with the time – get a new doctor.

Titrating – when starting a child on a medication here is the golden rule – START LOW AND GO SLOW

Make sure that the pill or capsule that your child is taking is not time released and can be split before breaking

If the pill is time released see if there is a standard form of the drug to use for a day or two as a test

Having a bad reaction to a med is horrible – better it be six hours than 24 or more

Purchase a pill splitter they can be found at any pharmacy

Purchase a weekly pill box – yup like the old ladies have – this will help you remember if you gave it or not

Always keep a few pills in your purse – in the event that you are out at medication time

Although many medications have therapeutic levels there is no harm in starting low and going slow to get there…..

That is of course unless there is an acute life threatening crisis

Weaning off medications – take it even slower especially with antidepressant meds. Never stop antidepressant meds suddenly if they have been on board for a while

Some children especially those with PDD and other autistic features tend to be micro-responders.

I have found many drs tell you to increase the meds during exacerbations, I have found the opposite.

Use your intuition and gut – a moms gut is worth more than people give it credit

During exacerbations Temple Grandin had observed that she needed to lower her medications instead of increase them

All meds are not made the same – be careful of switching to generics or even the other way around

Take note when you switch brands of meds for changes in your child.

Over the counter meds MUST be checked on the interaction checker – MUST – I have provided a resource on FB

Herbs MUST be checked with the interactions checker – also provided resource on FB (including teas)

Many drugs cause vitamin deficiencies – especially stimulants – do your homework

Even if a medication cocktail is inevitable always insist on starting one at a time to not confuse the issue

If your child is on a medication requiring blood level tests – GET THERE – do not say tomorrow

Blood level tests are required for a reason – to check organ functions or to ensure safe levels – GET THERE

Be careful not to let the child get dehydrated as the concentration of the drug can increase

Be careful of grapefruit and other known foods that interact with many drugs also resource provided on FB

If you have a spouse or a partner – get on the same page – if you cannot agree seek consultation.

Always start a new medication on a Saturday if possible so that you can observe the child

If the child needs to take medications at school make an appt with the school nurse – discuss your child

Ensure that the child will be in a comfortable environment and not be embarrassed or stigmatized.

Are the drugs unaffordable for your family – there are programs that can help with providing medications

Call the pharmaceutical company manufacturing the drug to ask for assistance to see if they have a program

Be very very careful with clinical trials – parents get desperate to help their children- remember they are trials.

Don’t be afraid or embarrassed to ask for help yourself. If you are feeling overwhelmed say so.

Seek out a support group – check out online forums – read parent reviews such as remedyfind.com or healthrevolution.com

Give yourself a break – this is not easy – be pro-active and you will have a lot less to lose sleep over.

And remember, we are always here for you on our private

accounts on Twitter

Marianne @childanxiety

Elise @aspergers2mom

Pierrette @padentremont

Jane @jhotvedt2

So welcome to the medication rollercoaster – it’s gonna be a wild ride. ~Marianne

2 Responses to The Medication Rollercoaster – updated Summer Version

  1. Thanks Marianne for outlining so well the pros and cons on this subject and listing resources parents can go to for more information. You are a mom – a mom who has been there and that is why you connect so well with all these parents who are following The Coffee Klatch. Lorna

  2. Sally

    Another great resource is the psychotropic drug database that lists all side effects. It's wise to get all the information before you make a decision on how to adjust medications.
    http://www.cchrint.org/2010/07/20/psychiatric-meds-101-a-surprising-discovery/

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