Q:  Adult Son Overmedicated?

My son (20 yrs old) was diagnosed with BiPolar II, and ADHD, about a 1 1/2 yrs ago, it was his 1st year of college. He had to leave school. Started seeing a psychologist, who sent him to a psychiatrist. He was on wellbutrin 300XL and 300mg neutotin 3X a day. The psychiatrist also put him on Celexa 80mg a day plus concerta 54mg a day. It seems my son kept saying he didn't feel any different. I noticed a difference with the wellbutrin & neurotin he seemed calmer, more social. After he started taking all the other medications he seemed agitated, started hangin out with bad kids, the Dr then added stratera80 mg a day with all this other medications. I fell he was being OVER medicated, but tried to get the Dr. to call me, since my son kept telling him he didn't feel any difference being on all this medication, I didn't hear anything from him till it was too late. Do you think this was too much medication for him. He had never been in any trouble all through his life , now he is in trouble with the law.
 

Dear Shelley -- 
Parents are in a difficult position when they have a 18-yr-old or older who's not doing well.  Psychiatrists often feel they have to avoid dealing directly with the parents lest they endanger their relationship with the patient they see themselves as responsible for treating.  I hope we're all moving in the direction of routinely bringing in family members who want to know what's going on, want to participate in the discussion of options, and want to be in a position to inform the psychiatrist about what they see.  

As parents do this, they'll have to watch out for their obvious intense "investment" in their child which can cloud their point of view regarding what's happening, and why, and what might best be done about it.  In some cases the psychiatrist really may be in a better position to make judgments about these things, because of a position of greater objectivity.  However, I fear that in many cases the psychiatrist is the one who's relatively "blind" because of having primarily just the patient's history and point of view on what's going on to rely upon; and in some cases also a relative bias against the parents' point of view, which can be transferred from the patient's own anti-parent sentiments straight into the psychiatrist if the doctor is not careful about this. I think I've made that mistake at least several times myself.  

Thus, as you can see, if everyone comes to the process recognizing they may have some bias against seeing clearly, and that they thus all need one another's point of view to see well -- at least considering all points of view, though not necessarily weighting them equally, then that theoretically should lead to the best possible outcomes.  Everyone also needs to remember that getting a good outcome is not guaranteed even with the best efforts and process, so when things are going badly, it isn't necessarily anyone's fault -- unfortunately. 

There, with that little sermon behind us, what about your son's medications.  Well, based only on the information you have provided (and therefore recognizing that I might get biased by listening only to you -- you see?), it does look like a strong emphasis on treating the ADHD rather than the bipolar disorder first.  Most mood experts I read recommend doing it the other way around.  And it also looks like a strong reliance on antidepressants, where an even larger majority of mood experts agree that having a solid mood stabilizer in place is a good idea before using an antidepressant.  If you're in a position to seek a second opinion, you might be able to get some thoughts based directly on your son's symptoms and history and response to medications, instead of this "theoretical" way of looking at it.  I always welcome my patients getting a second opinion:  it's an opportunity to make sure I'm not missing something; and if I'm on the right track the next doc' may well agree with me and second what I'm doing; and if they don't, and the patient/family want to go with that doc' for a while and see how things go, that's a good way to make sure my approaches are not too atypical or ineffective.  I hope your son's doc' might share that point of view, if you suggest the second-opinion approach.  Good luck with that. 

Dr. Phelps


Published December, 2004