To Med or Not to Med

The term “self-medicate” has a negative connotation.  It makes me think of alcoholics or drug addicts, both prescription and illegal. Yet, taken literally, the two words simply mean to administer medicine to oneself. Or to want to.

Nigel and I saw his doctor – his psychiatrist – today. He goes in every couple of months for his “med-management” appointment. He doesn’t like these appointments because he doesn’t like answering questions about himself (really, he only likes answering questions about Indiana Jones, or Lego, or the JFK assassination, or either of the World Wars). And even though I prepared him ahead of time, reminding him that the doctor is required to ask these questions and that he could write the answers down if he didn’t want to say them (“Why would I want to write anything, which would cause pain to my hand?!!”), he still got impatient with the questions and often sneered his answers. Or instead of actual answers, he would sneer – in reply to “How would you rate your mood today?” – “Same as it was last time!!

This level of verbal hostility probably encouraged the doctor to nod in agreement when I indicated to her Nigel’s desire for some medication that would help him to not blow up at certain peers of his who think that it’s fun to antagonize him. He wants something to control his tendency to respond in anger because he wants to go back to being mainstreamed. And he knows that that is his most difficult hurdle. Not because anyone told him, but because he actually has the self-awareness to see it. Yet, he does not have the ability to control his reactions to people when they upset him. So, he wants medication. He knows that medication helped him to stop habitually pulling out his hair and eating it, so he figures that medication can help with his behavioral issues. He wants to self-medicate.

And I had done my research and knew what the doctor would suggest: antipsychotics. There’s another negative connotation. Is that really what he needs? Are the occasional times that he blows up worth putting him on a daily medication with significant side effects? I asked him, there in the doctor’s office, gently, “I know that some of the kids bothered you every day, but did you respond with anger every day?”

“Yes. Every day.”

I took a deep breath and tried to let what he’d said sink in. It was too difficult to imagine, again, what he went through at school, day after day, and to think that in spite of that, he still wants to go back. He wants to be like everybody else.  It means that much to him. But I still wasn’t ready to say yes to antipsychotics. So I suggested that he try behavioral therapy to learn different responses when his peers anger him.

“I don’t want to see more psychiatrists,” he said, right there in the doctor’s office. “They’ll do the same kind of treatment!”

His psychiatrist smirked as she wrote that down. I asked, “What kind of treatment are you expecting from the psychiatrists?”

“Asking me questions!” And, of course, the psychiatrist politely laughed.

But the issue was still hanging over my head. He wants to change his behavior but he can’t handle therapy sessions. So, the doctor went and got several pages’ worth of printed material for me on the two medications she suggested as possibilities (Risperdal and Abilify). She gave me her cell number if I wanted to discuss anything with her. And I left feeling just as unsure and melancholic as when I’d arrived.

Right now Nigel is sitting on the couch in the living room, watching The Never-Ending Story III, which he was excited to rent tonight. Most of the time, I hear the faint sounds of the TV, which he keeps at a low volume, but once in a while he makes stim-type sounds or repeats one of the lines of the movie. He is happy; he is doing his thing. And he is not on antipsychotics. I wish it could always be that way.

10 thoughts on “To Med or Not to Med

  1. Kate

    Hmm. Well, that is certainly a difficult question. I would tend to say that if Nigel actually wants the meds, then he should probably be allowed to give them a try. They don’t usually have permanent side effects – you can always stop them.
    Personally I am so paranoid about side effects I won’t even try most things. But if Nigel’s willing to try, really, what do you have to lose?
    I speak from experience, though, in that my parents forced me, yes, forced me to go on Abilify a few years ago.
    Personally, I had horrible side effects, and couldn’t stand it, but they did go away when I got off. They made me wait 2 weeks and then I begged them to let me get off and they finally did and THANK GOD for that because it was the most uncomfortable, intolerable two weeks of my life.

    But the point is not everyone reacts that way and he would have the choice about if he wanted to stop them or not, much sooner than I did, if he wanted to.

    And I have heard it helps some people, and I have also heard a LOT of parents with autistic kids with anger problems use risperdal with good results.

    So just my two cents.
    Free choice is a good thing. 🙂
    And if someone chooses something they are much more motivated to seeing it through and trying to make it work.

    Kate

  2. Fearless Females

    I wish I could help. I really do. But you and Nigel are the only two who can decide. I wasn’t sure from the post but does the doctor believe he should go on meds? If so, then maybe you could try them. I had the same hesitations about having Nick go on meds, but after he started he told me he was feeling better and did better in school, so my doubts disappeared pretty quickly.

    Also, is there a social skills class that can work on teaching him techniques on how to handle kids who upset him?

  3. Em

    Oh Tanya, I feel your pain. Like Nigel, Son18 is very aware of the social rules and wants to fit in, but he just can not self-regulate his behaviors well enough to make it happen.

    Son18 has been on medications for a number of years. We used to feel badly about it. Now we think, gee, if his eyes gave him trouble we would get him glasses. So if his behavior gives him trouble, why not give him what he needs to behave better? So we do.

    For us, Risperdal has been a total life saver. It takes the edge off the anxiety, the anger, and the impulsiveness. But I’m not saying you should try it…cause every kid responds differently. Just sharing that we’ve had a very good experience with it.

    Don’t let the label “antipsychotic” break your heart on this one. We both know our kids aren’t psychotic. It just happens to be that class of meds that help the right part of the neurological system.

    You have to do what you think is best…and no one can judge you for that. And as a parent who has struggled with these same issues, I, for one, will understand and support any choice you make!

  4. Casdok

    Antipsychotic is such a horrible term. Like you it put me off for years. Until C got to crisis point and i gave into Risperdal. And couldnt believe the difference it made. He was on it for 2 years, and in that time he learnt to manage some of his own behaviour enough to come off it.
    I wish you well in your ponderings!

  5. Tanya Savko Post author

    Everyone, I can’t thank you enough for your words of encouragement.

    Kate and Casdok, thank you for reminding me that he doesn’t have to be on it forever. For some reason I was losing sight of that.

    Holly and Em, I appreciate your empathy and advice. I really do feel better now! It’s a hard decision, but I’m realizing that it doesn’t have to be a permanent one.

  6. Bonnie Sayers (autismfamily)

    The Pharmacist told me that Risperdal and Geodon are in the same class of antipsychotics. Abilify is in a different one. Mathew started about five years ago on Risperdal. A google on side effects should bring my article on BellaOnline. It was great for Matt, he stopped the PICA, had a solid bowel movement first day and sleep was so much more organized, same time each nite.

    When dosage was upped we got the side effects and had to explain to teacher and aide, they thought mimicking autism behaviors, big difference between hand flapping and hand shaking from tremors, same with leg movements and lip smacking.

    Geodon has no weight gain side effect, that is the big difference and he could use it, but dont want a huger kid attacking me. We did the liquid Risperdal and Geodon is a capsule that I open up andput in his rice drink. Takes it in AM smaller dosage and at 5PM ish takes other dosage with a pinch or two more and is asleep by 7:15, works great for our needs.

    my ex is paranoid schizophrenic. He was on Risperdal and I saw how he did on it and that helped me decide. He went off and was homeless, now back on and more focused. I was thinking of changing to abilify and had talk a week ago with pharmacist and decided Geodon is better than abilify. Never see commercials on tv for Geodon. That says something. Good luck

  7. angharad

    we had the same dilemma about prozac. my son was having suicidal thoughts from when he was 10 and as there is a history of attempted suicide with my father i didn’t want to take any chances. people can be very damning of parents who medicate their kids – for us it was a real benefit but its really for each family to make these choices- good luck with coming to a conclusion!

  8. mama mara

    Silly me. I assumed Nigel was already on meds, and you were wrestling with adding more. I used to resist meds, but now I see them as chemical correctors for my boys’ unbalanced systems. I’ll never forget when Taz, inpatient in a child psychiatric hospital, started Abilify. The very next day, he grinned at me and crowed in amazement, “Mom, I don’t want to hit you!” It changed his (and our) life. Over time, he’s needed more meds, had to change meds, had some godawful reactions to other meds, but overall I do not for a minute regret finding the right psychotropic treatments for him. Ditto for Rocky, who takes Geodon and Guanfacine and is much less likely to explode in rage at school.

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