05
Feb 25

Caring for Your Depressed Teen

Dad and daughter hug“It can be useful to have your teen rate her depression each day…  It’s important for her to visually see that it is improving.”

If your teen is severely depressed, they may not want to do anything besides lie in bed and stare at the wall. It is ironic that the things that will most help us are often the things we least want to do. Exercise is a wonderful antidote for depression, as is sunshine, but the depressed person wants nothing to do with either. Negotiate with your teen. Say that if they’ll go for a twenty-minute walk in the morning and a brief outing in the afternoon,they can lie in bed for an hour each morning and afternoon. When they return from these walks, simply say, “You did well to get out there and walk.” It takes a long time for exercise to produce benefits.Your teen will need a tremendous amount of encouragement during these early days of recovery.

Afternoon outings may be equally difficult for the depressed patient, so take it easy. A visit to the psychiatrist suffices, as does a visit to the therapist.The therapist may keep your teen for only 30 minutes or so. Now is not the time to worry about getting your money’s worth.Therapy can be exhausting for the severely depressed person and it does no good to push them past a tolerable limit. You may need to go into the therapy session with your teen for the first few minutes to get the discussion started since they may not be able to start on their own.

If your teen does not want to go out of the house, offer three choices. Give them some time to think about it. They are not good at making decisions right now. Keep the outing brief and close to home since they will tire easily. Remember, too, that if they’re getting used to new medicine, they will not have their usual stamina. They may also get dehydrated or overheated, or they may experience minor side effects they do not think to mention such as constipation or dry mouth.

Do not bring up any stressful subjects, such as upcoming exams. Dole out their homework in small chunks. Avoid topics about the future that may overwhelm them. The phrase “one day at a time” will come in handy here.

While you’re waiting for your child to respond to treatment, observe their carriage. Do they walk with a slump? Do their eyes look hollow? Do they seem confused? Write your observations down in their medicine log. After they are well, you may forget these important physical characteristics, and they are important forecasts of relapse.

I once heard a psychiatrist say that he often noticed his patients begin to look better two weeks before they begin to feel better. He didn’t tell them this, but he did make note of it when they looked improved. One day, about three weeks after my son had started on a new medicine, I noticed that his face seemed brighter and his eyes looked less strained. I followed the doctor’s lead and kept my observations to myself, not wanting to irritate him when I knew he didn’t feel any better. But my pulse quickened with hope. Sure enough, two weeks later, he admitted that he was feeling better. The week after that, he was even better, and the week after that, better yet. It continued until he was well. It will happen for your child too. So keep watching and encouraging.

Meanwhile, it can be useful to have your teen rate their depression each day. I can almost promise you that they will not want to do this, but you can do it for them. At the end of each day, ask them to rate their depression on a scale of 0 to 5. Record the number. The reason for this is that depression is insidious. It creeps up slowly and retreats just as slowly. Often, the patient insists that they are still depressed when the illness has actually subsided.

Sometimes the news of recovery isn’t welcome. Many people come to identify with the illness if they’ve been depressed for a long stretch of time. They may hate it, but they may also feel that once it is gone, nothing of themselves will be left. As paradoxical as it may sound, recovery can be the hardest part of the healing process. For more on this, see Factors That Can Delay a Teen’s Emotional Recovery.


04
Feb 25

Antipsychotic Weight Gain and Teens

Teenager“The routine helped her to get through the days, and the activity improved her mood.”

It can be heartbreaking to watch your teen put on unwanted pounds after starting a new medicine. My daughter once gained twenty pounds in one month on a new antipsychotic. It was as though her brain was no longer getting the message that she was full after eating. She would eat a meal and half an hour later be starving. This is a positive story about how a psychiatrist and his patient worked together to get her through it.

While my daughter’s psychiatrist set to work adjusting her medication, she and I began focusing on exercise. She was barely out of psychosis and had been sedentary for some months. Her psychiatrist wanted her to walk for an hour and twenty minutes a day, but the extra weight made her feel exhausted and winded.  He told us to break it into four 20-minute segments per day. Somehow, this seemed manageable to my daughter and we were able to get in a total of 80 minutes of daily walking. The routine helped her to get through the days, and the activity improved her mood.

I removed every scrap of sugar from the kitchen and replaced it with fruit, cut vegetables, and whole grain breads for when she was desperate. I reasoned that if she was going to overeat, at least it would not be calorie-rich food with no nutrition. This limited the weight gain. The psychiatrist also urged me to push high-protein, fiber-rich foods, which satisfy the appetite longer. I tried not to let her eat after dinner. Fortunately, she only had to make it to bedtime because her medicine made her fall asleep ten minutes after she took it.

Fortunately, her doctor had the problem resolved within a month. He slowly cut her offending antipsychotic with a smaller amount of the antipsychotic Geodon. The Geodon counteracted the hunger issue. The nightmare was over, but she was up twenty pounds. We continued with the walks. I took her to the Lily Pulitzer store, and I saw what a difference a well-cut garment can make in terms of flattering a heavy figure. Patterns hide a paunch better than a solid color. The tops I bought her were designed to be worn out, not tucked in, and they were sewn to glide over her hips so that it slimmed her and made it look like she had a waistline. She wore jeggings with boots and that was slimming too. I’ll never forget the day I saw her look in the mirror and smile at herself.

She lost the twenty pounds in two months. Geodon requires food to work. In fact, a couple of clinical trials suggest that 500 calories is the magic number. So I fed her a 500-calorie breakfast and dinner with her medicine, which is taken twice a day. Once we became rigorous about getting her calorie count up with each dose, the appetite-suppressing effect kicked in. Now she wasn’t hungry. She ate a light lunch, usually some low-fat cheese or turkey and a piece of fruit, along with a bottle of water. After the weight came off, it was easier for her to walk and we condensed our walking times. She began running ten minutes a day before our morning walk. When her psychiatrist ran blood work again, we held our breaths, but her cholesterol levels were the best they had been. Then something completely unexpected happened. My blood work was better than it had ever been too!