Keeping them med compliant

[PaulaJeanne]

Things are going really well for my dd(20), but I know she's going to be out of meds within the next five days & she won't see the psychiatrist who prescribed them. She's upset with him because he didn't listen to her last visit (almost 90 days ago). She had gone through a really bad disregulation and walked out on a job she loved for about a year. I went into the session with her at her request, and I was disturbed by how he wanted to keep her meds exactly the same, and told her she needs to talk to a therapist. We both felt she was dismissed.

I looked up some other options in our insurance plan & gave her two names & phone numbers, but she hasn't called. She just started a new job which she loves. I know she's feeling so good (and busy) right now, she probably doesn't think she needs the meds.

I've called her & sent two text messages about this today... . no response. I'm starting to panic. When I get home from work today, if she hasn't called anyone, I feel like I should make some calls with her. No one will be available tonight, so how do I make sure she gets an appointment with someone? It's not like she can get an appointment same day with anyone either... . some of them may not be available for a while. And of course, she works retail & her shifts are all over the place. There's no way she'll turn down a shift so she can keep a psychiatrist appointment. Yikes!

I feel guilty and angry with myself. I should have been all over this.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Verbena]

I understand your panic that your DD will be out of medication.  At least she has been willing to take medication.  Does she see/feel that it helps her? 

I have been in your shoes.  I tried for YEARS to get/make my DD take her medication.  I was the only who was always concerned about it, I was the one who bought it, I was the one who counted the pills.  My husband didn't "believe in it" which is quite ironic because I have always thought he could benefit from medication, assuming there's anything out there that can help with a miserable, negative attitude.  DD knew her father was against it, so I was fighting a losing battle.

For a few short months, though, DD did take her medication (Prozac I think it was) on her own without my insistence.  The difference in her was enormous.  We actually went that whole time without any major meltdowns or blow-ups, and the chaos was significantly less.  Of course, DD has no memory of the medicine helping and neither does her father.  Once she stopped, things got worse and the battle between her and me over medication really began.  It was a battle I never won. 

All this to say that your DD has to want the medication and be responsible for seeing that she has it--even if you are the one paying for it.  Ideally, she will see the difference once she stops taking it (if you're not able to get her more), put two and two together, and do what she has to so she can always have it available.  But, it doesn't work that way with pwBPD, at least not in my experience. 

[Rapt Reader]

Hi, PaulaJeanne... . I do know how you feel; before my son (who is 36 now) got his BPD diagnosis and then the treatment for his ongoing recovery, he was just like your daughter. He would take his meds fairly regularly, and when things were going well for him, he figured he didn't need the meds and go off of them. The resulting downturn would always happen eventually, sometimes tragically, but getting him to consider the meds again was like pulling teeth.

Like you, I took it upon myself to be his "med minder," always on guard that every med was refilled on time and available for him. And I'd encourage him to take them, and be stressed out and frantic if he didn't. It was quite the full-time job for me (besides my real full-time job!) and if I forgot that a med needed refilling or forgot to fill up his weekly pillbox container, I felt guilty... . if he didn't take his meds because of my "egregious failure" I then felt even more guilty.

This is what I've learned now that he's been diagnosed and in recovery, and I've become active on this site learning all I can: It was helpful to him that I kept up with his prescriptions, and made sure they were refilled or reauthorized & then refilled, and then picked up. But, I should have made it more of his responsibility so that he wasn't so dependent on me. He should have been part of the process, not the unwilling party being "forced" to take his meds. I should not have harped on him to take them, causing him to be angry and defiant, and me to be fretful and upset and stressed to the max.

Now that he's in recovery and not belligerent about taking his meds, I still help with the logistics of them (he doesn't have a car and is still in his self-imposed staying at home mode; his recovery is the better for this), but he is a big part of remembering to have them refilled and reauthorized. I do not need to tell him to take them; he does it on his own without prompting every day, realizing that the meds are a big part of the success of this recovery. No anger, no false thoughts that he doesn't need them anymore, no annoyance on his part at all. It's just what he needs to do and he does it.

Verbena is right: she needs to want to take her meds. I don't think that there would've been anything I could have done to make my son take his, prior to his recovery process. The tension, the fights, the yelling on his part and the crying on my part--nothing ever changed the fact that he took his meds when he wanted to, and didn't when he didn't want to. End of story. All of my stress, pleading, fretting, guilt, getting sick-to-my-stomach and weight-loss didn't change that fact.

All you can do is be supportive in helping her stay on top of the logistics of them, as a helper, not the one doing all the work. I hate to say it, but you need to let go of the rest of it... . I'm not saying it will be easy, and not even saying that I could've done it during those terrible, stressful days with my son. But, things are looking up for your daughter with her new job and her boyfriend, and she's not in some free-fall right now.

Maybe she will realize on her own that the meds have helped her get to this place, maybe not. But you are there for her as a support system, and if you aren't too stressed out about this you will be available to maybe have a friendly conversation with her, adult to adult. Maybe some situation will show up where she will surprise you and be agreeable to the idea of getting the medications worked out. But she's got to want to do it, and nothing positive will happen if you stress out or pressure her. I'm hoping that she comes around and does the right thing, and that you are somehow able to let this guilt and stress go, so that you can relax. I know what you have been going through... . here's a 

[qcarolr]

This seems to be a really common issue - and one that really has to become the responsibility of our 'child'. I even played this game with my bipolar for the first 10 years after my dx when DD27 was about 3 years old. Sometimes it just feels so 'fake' to have to rely on meds. to balance our my brain. I never mixed in any street drugs or non-rx meds. My DD has most likely used substances along with various meds since high school. I was in such denial.

Another difficulty is the dad. My dh grew up in a household in total denial that psych pain was real or needed outside help to resolve. He has accepted that things can get better with therapy and meds. in the past couple years.

Don't mean to be discouraging - this is my experience. DD has gone on her own to restart meds several times in past years, and has done better for a time. Her toxic friends and the draw of the quick fix when the distressing times come has gotten in her way.

Encourage her that things are going better for her right now, and that at the first signs of any trouble to let you know if she needs any help with her refilling the meds. or making appointments. The more you can accept letting her carry the responsibility, the better compliance she may have. I think this goes along with what Rapt Reader has shared.

Hang in there. It is hard to let go of being the 'mom' and let our young adult kids flounder more and more on their own.

qcr

[PaulaJeanne]

On Saturday she asked me for my credit card so she could order a uniform for work on line. I told her I'd give her the credit card if she made calls to the two psychiatrists I found in our insurance plan. I scripted out exactly what message to leave (I didn't expect anyone to actually answer the phone, particularly on a weekend). She did it without any argument. Hoping someone will call her back & she'll get an appointment this week.

I know she's 20 years old & I do have to let her be an adult. But the downside is so devastating. I'll be a little more laid back if she has a 90-day prescription for Lamictal in hand.

Thank you all for your support. I'm keeping my fingers crossed... .

[PaulaJeanne]

Grrr, I don't know whether to post this here or on the staying/improving board. This morning I finally got my dd an appointment at 5:30... . that's in a half hour from now. She was at work at 4:30 this morning & is pretty tired. She asked me if I could take her, but I'm at work & I'm an hour & half away. So I ask my udh to take her & he says okay. She was cool with that.

She called me a few minutes ago to tell me Daddy's sleeping and doesn't want to get up. He's retired, and he sleeps until noon almost every day, gets up, maybe does one chore, then needs a nap! So she asks me for the address and she's driving herself.

Damn it, he knows how important this is! She is out of her meds as of today. We've been through that nightmare before. Why doesn't he get it?

[Eclaire5]

I really hope she made it. I know medication is absolutely necessary in my daughter's case. When she is compliant her mood is so much more even and it's much easier for us to deal with her. Good luck!

[PaulaJeanne]

Okay, she made it to the appointment. This is a psychiatrist I've known for 17 years. He's been really responsive to my family whenever we've been in desparate need, but he takes no insurance and yesterday's visit cost $275. He hasn't seen my dd20 in quite a few years, but he's been working with my oldest daughter (non). Just wondering what she might have shared with him about her little sister.

When she got out of the appointment she had the prescription for lamictal, but he was really tough on her & he wants to see me and my dd's bf. He also wrote her a lab test order for cannibas, benzo's, opoids, amphetamines... . the works. She lied to him about smoking weed, and he told her he won't work with her if she's not clean. He also told her he wants ME to hold on to her meds & give them to her daily because she's been noncompliant in the past... . that part she told the truth about.

At the moment she doesn't care... . she has 90 days of lamictal--she'll let me worry about it tomorrow. I'm waiting for him to call me back. He's probably aggravated because he knows exactly how manipulative the pwBPD is. I told her that I'm telling him the truth about her smoking weed. She says, "yeah, so what. I got what I needed & I have 90 days. I'll find someone else."

She's been so good lately. I totally forgot how manipulative she can be. It's like I get lulled into thinking life is normal, and then all of a sudden the truth comes back to bite me. I know lamictal can be dangerous... . it's that rash thing... . Stevens-Johnson syndrome. She's never gotten a rash from it, I'm wondering if I can taper her over the next month & see if she stays even. I'll ask him when I speak to him.

Who knows if its really doing any good. I've heard BPD is really untreatable, but the last time she went off meds (which was sudden, not tapered), she spun out of control.

[Eclaire5]

For what I know, latest research debunks prior belief that BPD cannot be treated with meds. There seems to be more and more evidence that the disorder is not just related to "poor parenting", trauma or abandonment issues. I read somewhere that actually a larger percentage of diagnosed BPD cases have fairly normal childhoods and have had "good-enough" parenting. There is also more research showing that their brain works differently, and I think that's why the mood stabilizers, anti-depressants and atypical anti-psychotics help so much in many cases. We can tell right away when our daughter is not taking her meds because she gets really moody, angry and disheveled. When she was first diagnosed and I looked for information on BPD, it was so discouraging to read that it is caused by abuse, neglect, traumatic experiences, and so forth. I felt that I must have been a horrible parent for my daughter to have such devastating disorder. Didn’t even consider that my ex-husband (her biological father) was a raging BPD, Bipolar, Anti-social, ADHD type of person (he was actually diagnosed with all of that; I am not just trying to insult him  ). Unfortunately she inherited a lot of her problems from him and she now struggles a lot, but thank God the medications help!

So, for now just try to encourage your daughter to take her Lamictal and maybe you can convince her to see her old psychiatrist who takes your insurance. I think that patients need to like their therapist for treatment to be effective, but they don’t have to like their psychiatrist. They are just there to provide the prescriptions, and as long as they know what they are doing, it’s all right to deal with their arrogance or craziness.

[peaceplease]

the psychiatrists just mange the medication end of it.  They are not into psychotherapy.  Appointments can be as quick as five minutes. Many psychiatrists are dismissive.  As Eclaire5 mentioned it is more important for them to like their therapist. 

A person should never just abruptly stop their psychiatric meds.  The withdrawal can be quite severe and serious.   And, I would only do a taper with the help of a doctor.

Too bad, the doctor is putting the responsibility on you to take her meds.  That is not fair to you!  I believe that it has to be their responsibility to take their own meds.  I used to give my daughter her Adderall when she first got them, so she would not be tempted to take more.  Then, I gave up when she was hounding me for more, and said they were hers.  My dh was angry with me, but I told him that I was tired of playing med cop.  And, I told my dd that I would no longer be holding onto meds for her.  She is trying to get a benzo from dr., and wanted to tell them, I will give them to her. BS!  I refuse to ever be bothered with her meds, and she is an addict.  No doctor should give her a benzo, as she is on methadone and she is an addict.

I hope that you can find another dr. that takes your insurance.  That is great that your dd likes her new job!

peaceplease

[PaulaJeanne]

Eclaire 5 and Peaceplease, I can't tell you how much your posts mean to me. Thank you so much for really listening to me & responding. Sometimes, that's more than anyone can hope for!

You are both absolutely right... . I will and have been encouraging her to see the old psychiatrist who takes her insurance. Right now in her splitting mind he's black, not white. She used to like him.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders