08
Apr 24

Caring for Your Mentally Ill Teen

Mom shows confidence in daughter“The teen who is going through a difficult time emotionally may tire easily, become confused, or get frustrated. You can help by maintaining an air of quiet encouragement.”

If only mental illness were like strep throat: you feel terrible for a few days, you take medicine, and a week later you’re back in shape. Recovery from mental illnesses is slow, measured more in months than in days. Fortunately, there are many things you can do to hasten your teen’s recovery.

Show Some Confidence

At this early point, it is easy to feel like things are out of control, but try to show your teen that you are confident about their recovery. Save the tears, anger, and self-flagellation for the therapist or for private moments with your spouse. On the other hand, it is okay to admit to your child that you’re worried. If they say they’re angry about it all, you can confide that you too feel angry that this is happening to them. Here is an example of what I mean:

Her: Why is this happening to me, Mom?

You: I don’t know why, honey. I honestly never expected something like this. I admit that I’m very worried. But I have a lot of confidence in the people who are helping us. We’ll get through this.

Her: I saw you crying last night. Admit it, you think I’m losing my mind.

You: I’m sorry you saw that. I have had some tough moments. It’s hard for a parent to see her child suffering.  But I don’t believe for a minute that you’re losing your mind. I want you to know that Dad and I are working together to get you the care you need. We’ll get through this.

Note the repetition of, “We’ll get through this.” Sometimes there is nothing more to say. Don’t feel that you have to have all the answers.

Managing Your Home Environment

Now for the good part: the things you can do to promote your teen’s recovery. The brain heals and becomes regulated by routine. Get your teen to wake up and go to bed at the same time each day. Establish a routine and have them stick to it, eating meals, exercising, and doing schoolwork at the same time each day. They will rely upon your encouragement in the early days of treatment. It can be a slow and discouraging process, particularly when a medicine trial does not go well. Reassure your teen that you intend to do everything you can to help them get well.

Meanwhile, keep the household calm and quiet. Try to serve dinner at the same time each day. Cut everything out of your schedule that you possibly can so that there is less irregular activity (besides, you need to trim your own obligations in order to take care of yourself). If you are in the habit of shouting questions to your kids, try to stop. Instead, go to them directly and speak in a normal tone of voice. If conflict is a regular part of life in your household, you may want to address it now while you have the benefit of a family therapist involved. Many families find that they become stronger when a crisis such as this occurs.

Avoid Teasing and Sarcasm

Emotionally ill teens do not perceive sarcasm or teasing the same way that we do. Their pain is always at the forefront, and everything you say to them gets filtered through that tender layer. When my teens were depressed I was astonished to find them taking what I had said literally. When I tried to explain that I was joking, they became confused and hurt. Having a teen with a mental illness can make you a better communicator.

Get Your Teen Talking

The most powerful thing you can do during this time is listen. If you are in the habit of lecturing or criticizing, your child’s recovery will be considerably delayed. I don’t mean to sound sanctimonious. After years of knowing better, I still have to work to keep the negative tone out of my voice and to avoid lecturing. There is no such thing as a perfect parent, and your child is still expecting you to be you. But why not go for an even better you? I recommend that you allow yourself to do ten percent of the talking and let your child take the other ninety percent. Maybe you’re thinking that your house will be awfully quiet with a ratio like that. But think about it: the more you talk, the less they have to speak, and you need to know what their symptoms, fears, and needs are if you are to help. One of the best ways to get your teen to talk is to reflect back what they say.  If they say, “I’m sick of hearing you and dad fight,” you can say, “It sounds like our arguing is causing you a lot of stress.” It might encourage them to further explain how they feel.

If your teen does open up and start talking, congratulations! Keep it up by saying things like, “I’d like to hear more about that.” They may very well oblige you. Don’t be afraid of long pauses. If you speak too soon, you cut off the possibility of hearing what else they have to say, and this is where the good stuff often lurks. If they finish a heated explanation and you’re quiet, you leave the door open for more. You’ll be amazed at what else you can get from your teen by just patiently waiting for more.

One thing I’ve learned about talking to kids is that they often hear the first sentence and then tune the rest out. So make that first sentence count.  Better yet, make it your only sentence. Then they’ll really remember it.

Consider Your Teen’s State of Mind

The teen who is going through a difficult time emotionally may tire easily, become confused, or get frustrated. You can help by maintaining an air of quiet encouragement. You may need to write things down for them each day. If their confusion is severe, help them prepare an index card each night, listing everything they have to do the following day. It is also wise to help them organize the books and assignments they’ll need the following day. A little planning on your part will help your teen have a better day. Eventually, they’ll be able to handle this themselves.


03
Apr 24

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!