Advise for Bipolar Child


To Whom It May Concern:

You didn’t ask or inquire or request my advise.    I’m almost sure you don’t really want to know what I’m going to say.   But since you’re reading it someone who cares about you must have advised you to read it.    You might not recognize it but in one way or another this letter is about you or someone who wants to be closer to you and wants to see you happier.

This letter is is directed to those people who are struggling with the problems of bipolar disorder and the use of psychiatric medications.    You have decided your child can be treated for this disorder without the use of conventional drugs.   “Drugs.”  Sounds terrible and I don’t blame you.   You have heard so many horror stories about psych meds you really believe you’re protecting your child from something dreadful.   Maybe he or she has been given these drugs and got worse or sick from them…and when they were stopped improved?   It could have been someone close who took the meds and deteriorated or had terrible side effects?   There’s plenty of literature written or media coverage by groups with extremely convincing arguments against psych drugs and you have no reason not to believe them.   Why trust psychiatrists, the pill pushers?   They “probably cause brain damage.”   They change the person so much you can hardly recognize them.   There must be a better way like naturopathic or vitamins or special diets.   Maybe biofeedback or hypnosis?  They’re at least not so “invasive.”  There’s got to be a better way and you’re going to try to find it.

Well, maybe you’re right!   Certainly your intentions are right and your desire to save your child of needless suffering.   It’s not irrational to see things like that and if you’ve got others on your side it’s easy to be convinced you’re right.   If your child agrees or asks for your help to stay off the doctor’s drugs there’s even more reason to keep up the fight.  And a fight it is.   You’ve had to argue with all sorts of people and conclude that “perhaps they’re not on your side?”   You’ve become stronger in your position rather than to give in because you really believe you are right.    You have plenty of excellent arguments and “proofs” to show your decision to refuse the drugs is right.   Anyone who opposes you has some hidden agenda or just doesn’t”t know what you know.

If most of the above is true for you I must tell you  few things.   If you really want to help you child please read on.  You have nothing to lose except conflict and frustration while gaining clarity.

The first thing I want to tell you is this, “if your child has a diagnosis of Bipolar I that has led to arrests and/or hospitalization and if this diagnosis is correct” you are exactly who needs to know the following information.    The second thing you must know is you can’t help your child by preventing the use of meds.    In fact you can’t hep him by going against conventional psychiatry if the major consensus is that meds are needed.    The third thing is you can do irreparable harm to your child by striking out on your own against the advise of two or more psychiatrists or clinical experts.   It’s true, occasionally you find a doctor who is simply wrong.   Wrong in the diagnosis and the treatment.   Perhaps that’s why you’ve taken the position you now hold?   But if several clinicians in different locations and at different times have told you medications are necessary, believe them.

There’s more you must take into consideration.    Your child’s condition can be helped through numerous approaches in addition to the medications.    Perhaps some of these can reduce the need for medications.    In fact let’s be very clear,  medications are only the beginning of the road to recovery.    Bipolar Disorder clouds judgment especially when untreated and requires a lot of education and training for the afflicted person to improve his judgment.   Medications and “psycho-education” are the main tools for recovery.

It may take some time to find the doctor who can hep your child.   But, before you can do that you have to be ready to move over to the doctors side and relinquish control of your child’s treatment.    While you are in control of the care you will suffer greatly and unnecessarily.   You may see brief improvements but a slowly deteriorating course will occur over years as long as you are at odds with the doctors.   If you want to help, both yourself and your child, relieve yourself of a false responsibility.    You aren’t prepared to provide the kind of help you really want to.   Even if you yourself are a psychiatrist.

The successful treatment at this stage of history is with the careful and judicious use of medications and appropriate guidance.    In my experience over the last 25 years with thousands of patients with Bipolar Disorder I have seen a large number of families like yours who are trying to protect their child by running interference to the doctor’s advise.  That’s why I am writing this letter now, since a case of this kind has presented itself to me very recently.   I wish what I am saying was not so.   I have great pleasure removing or lowering medication doses or telling someone they don’t need them.  I wish there were better ways but at this time, in 2011, there are none.   I pray to the Kodesh Barchu improved, non-medical treatments will soon become available, but meanwhile we are left with the difficult problem of finding the right combination of medications.

I believe there are two requisites for successful treatment with medications: they must be comfortable and effective.  Often they both come gradually according to the length of time the person has shown symptoms of the disorder without taking the proper medications.   The longer the treatment is delayed, the longer it takes to find the right treatment.

The first requisite is comfort.   This is often the determining factor in holding off the meds.   This is what you need to know about medications.   ALL medications have side effects, both psychiatric and non-psychiatric.   The idea is to reduce those side affects as much as possible.   Very often, once one starts seeing benefit and good results with them finds the side effects are minor and comparatively unimportant.   Most side effects are uncomfortable and scary but not harmful.   There are ways to reduce them by starting at low doses and going slow.   Medications in psychiatry are the most interchangeable chemicals of all medicine.    The art of psychiatry to a large degree is with what is called medication adjustment or management.   Once the correct diagnosis is reached the phase of treatment the dominates the work of the psychiatrist is “Medication Management.” The comfort of the patient is the good doctors first major concern.

Effective medication treatment means symptoms of unstable moods, irritability, agitation, grandiosity or euphoria or depression or a mixture of these are reduced.   Any auditory hallucinations or paranoid ideas should be at a minimum or completely absent. The person should be able to function at a higher level then before the medications were started for longer periods of time.   This can be a long and difficult process but at least recovery will be possible.   I treated a bright 19 year old bipolar girl who came to me after a single encounter with a psychiatric hospitalization.   She was resistant to treatment but gradually began following my advise throughout one year before she had reached a degree of recovery enabling her to begin college and move forward with her life.   Others had such chronic conditions improvements were extremely limited.   As I mentioned the longer they go without medications the more difficult they are to achieve success.

Another thing well known to the field of psychiatry is each time the person stops the medication, the more difficult achieving the same level of function or better.   Most of the time they require increased doses of the medications and/or addition of other medications.   This is well documented across all psychiatric literature in Bipolar Disorder.

I speak directly from my heart and soul imploring you to give it a try.   Every day you resist worsens your child’s chances of recovery.

Gershon Freedman, M.D.

This entry was posted in Advice on psychiatry, Medications, Mental Health advice. Bookmark the permalink.

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