Expert: Libby Bonner - 11/5/2006

Question

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The text above is a follow-up to ...

-----Question-----
I have a 30 year old son who has had suicidal thoughts since he was about 13 years old. He has been given sample anti-depressants in the past 2 years, due to not having insurance.  Within the past couple of months he has deteriorated to the point where he is now seeing a psychiatrist, privately paid for by family.  He has not had any in depth counseling sessions to date, rather, brief visits to start him on EFFEXOR.  At first, they seemed to at least clear his thinking abilities but last week, the doctor increased his dosage and gave him even more samples of the product to take along with his prescription.  He was also given sleeping pills to try.  His behavior has changed so dramatically since then, we have had to call 911 three times in the past week alone because he was so suicidal.  The doctor has not returned our calls and my son will not go to a hospital.  I have read the latest news on the dangers associated with Effexor but I can not find a comparison of side effects with this drug and others, such as Prozac, which he took briefly and didn't have a care in the world while on it.  I am more than concerned, as is the rest of my family.  I have been sleeping only a few hours a night, with several nights of no sleep at all because of my concerns.  Is there any advice or help you could give me?
-----Answer-----
Wish I could help more.  He is apparently at home?  The latest samples are the same med as that whose dose was increased?  And then there are the sleeping meds.

I suspect he is taking his meds incorrectly, because of the different ways they have come to him -- some w/ clear directions, others w/ oral directions, if any.

A doc who doesn't return calls is not a doc you need.  And 3 911 calls and no one took him, the last time, to an emergency room?

I hope you can perhaps get control of the meds and dole them out as it seems they outght to be....son may not let you do this.  --And I hope you can get somone to share suicide watches w/ you.

Meanwhile, call the country sherrif to see what he might suggest, and please see an atty right away about getting guardianship of your son and/or getting him committed.  Not as easy as it sounds.  Get a copy of the book I am not sick, I don't need help.  Share w/ atty.  It has material on hosptializing resistant patients.  [Be sure the atty knows the result of the 911 calls: nothing.  Maybe he can put the fear of god into someone.]

Your ultimate goal is to get him hospitalized, then maybe into residential care til stable....and to begin the application process for Soc Sec Disability - SSDI.  I would also like to see him hooked up w/ the nearest/best community mental health center, w/ the hope that he will be assigned a case worker, social worker, enrolled in helpful life-skills classes...

Also contact a local or state NAMI office to see what they can suggest.  www.nami.org  This is one of your best on-going sources of help.

These are just the worst situations on earth, and I am so terribly sorry.  Do enlist every single person you can think of to be a support to you and to help w/ your son.

Thank you so much for your concern and for your suggestions as to getting help for my son.  He lives by himself and all of his relatives live in other states; I am the closest to him but I don't drive and getting to him is difficult.  We all call him several times a day; if he doesn't answer because he's sleeping again or just doesn't feel like talking, we all panic.  He and I live in Florida and the Police have told me repeatedly they can not "Baker Act" ( involuntary intervention) unless he shows signs of slurring his words or harming himself.  I have explained his history in depth and have even begged them to at least take him for ER evaluation at the very least but they will not do so.  They tell me I must go and petition the courts for an exparte order to have him locked up.  We all believe that if we were to do this, he would never forgive us and would harm himself out of anger at having had this done to him. I want to do what is best for him but as his mother, I can't have him admitted unless he is okay with it.  That might not make a lot of sense to you, but I would lose him if I did this and losing him is what I'm trying to prevent.  He wants help,but he is terrified of being locked up. before he moved to Florida, his Dad took him to a crisis center in another state for help, which he willingly agreed to do.  However, they tried to lock him up and he escaped from the center out of fear of the place.  We did hire an attorney at that time who advised that once the person is in the system, trying to get him out of the system would be an ongoing process for the rest of his life and we couldn't do that to him.
I will check into the places you suggested and I can't tell you how nice it was to finally find someone who truly understands his condition; most people think he's capable of "snapping out of this" by himself and they give him no understanding of his disease.  They might make an attempt to help but then they wash their hands of it.  I am tired of it, too, but I can not, nor will I ever, give up on him.  
If you have any more advice to offer, I would appreciate it immensely. Thank you so much for your help.  

Answer
Follow-up.  Is son bipolar?  Only given anti-depressants?  I just now caught this.  If bipolar, he should be on a mood stabilizer like lithium or lamicatl + carefully chosen and monitored  chosen anti-depressanats.  MIght also be given one or more atypical antipsychotics.  Still could be a candidate for ECT.


I spent last evening reading the 2d edtion of Amador's I am not sick; I don't need help.  It is helpful beyond belief - GET A COPY.  It deals, among other things, w/ maintaining communication and relationship w/ the loved one even while doing "unforgivable things" like having him hospitalized.  Get it, get it, get it....and see what parts apply to your situation, and then USE IT.

It's likely he will be in a locked ward initially; everyone is.  Don't recall if Amador covers this or not.  Do your best to let admitting personnel know of past problem.  Also, figure our how you will get transport to any places you may need to be on his behalf.  If money is a problem, beg, borrow, or steal!

I would also add that you/doc might want to condider ECT....IF he has been compliant w/ taking meds but gets no better.  If he is just non-compliant and stays un-well, that's another story.