Josh took his first dose of Adderall yesterday and went to bed just after 11 PM, waking up this morning on his own at 9 AM.
Let's hope this continues.
Thursday, October 21, 2010
Wednesday, October 20, 2010
Maybe Since SHE Said it He'll Listen?
Josh went to see the Nurse Practitioner yesterday and allowed me to go with him. He told her that he thought he needed to get back on Adderall, but gave her no other information about 'the state of affairs'.
So I did.
"Josh went off his Bipolar medication this summer and quickly returned to 'normal', but slowly he's begun to slide into the same patterns he was in last fall when he began slipping towards suicide and failed his classes. He sleeps all day and is up all night, as a result, he's missing classes and close to failing this semester. Basically, he's not functioning well at all, but I'm kind of concerned that taking Adderall might cause further sleep problems."
"Well actually, it might have the opposite effect, people generally sleep BETTER when on this type of medication. But Josh, you have GOT to force yourself back onto a normal sleep schedule. There are all kinds of ramifications to what you're doing. Our bodies respond to the light during the daytime hours and you're missing out on that. This throws off your circadian rhythms and actually effects your immune system and tons of other stuff. You need to establish a sleep routine where you go to bed each night at, say, 11, and then you get up everyday at 9 and the first thing you do is take your Adderall, that will jump start you.
You need to do what we call 'sleep hygiene', you monitor your caffeine intake, make sure you have nothing distracting you when you go to sleep, even the light emitted by your phone or an alarm clock can disturb your ability to get to sleep. You want total dark and quiet, nothing but maybe some white noise.
You've told me before that you don't want to be on 'brain meds', but if you're serious about that you need to get the sleep under control and also work on taking in a very healthy diet, and supplement that with vitamins just to be on the safe side, and exercise, I can't tell you how important daily exercise is for you if you want to avoid brain meds.
I have a friend who was terribly depressed and on medication and she became an avid runner and no longer needs any depression medication, exercise is THAT good."
"So," I said, "let me make sure I understand what you're saying here. You're basically saying that Josh needs to make important LIFE changes."
"Yes, and he's the only one who can do this. You can't do it for him, I can't do it for him. Josh, this is YOUR life and nothing that I'm talking about here is anything more than what we ALL should do to be healthy. Our bodies cannot function normally when we're not taking care of them."
She suggested that for the first few weeks, he take a dose of melatonin before bed, "It's something you can take forever, but I think it will be especially helpful during the first few weeks."
She wants to see him back in one month.
When we left, Josh said that while he was at work that night, he'd think about the best way to reset his clock. The NP had suggested that it might be easiest if he missed one night's sleep, so Josh was going to try to figure out how to work that into his work/school schedule.
We discussed the addition of Wellbutrin to his meds, but Josh would like to avoid that if possible. The NP told him that she felt if he REALLY addressed the things she'd discussed, he could probably avoid additional medications.
Now we'll see what the man/boy does.
So I did.
"Josh went off his Bipolar medication this summer and quickly returned to 'normal', but slowly he's begun to slide into the same patterns he was in last fall when he began slipping towards suicide and failed his classes. He sleeps all day and is up all night, as a result, he's missing classes and close to failing this semester. Basically, he's not functioning well at all, but I'm kind of concerned that taking Adderall might cause further sleep problems."
"Well actually, it might have the opposite effect, people generally sleep BETTER when on this type of medication. But Josh, you have GOT to force yourself back onto a normal sleep schedule. There are all kinds of ramifications to what you're doing. Our bodies respond to the light during the daytime hours and you're missing out on that. This throws off your circadian rhythms and actually effects your immune system and tons of other stuff. You need to establish a sleep routine where you go to bed each night at, say, 11, and then you get up everyday at 9 and the first thing you do is take your Adderall, that will jump start you.
You need to do what we call 'sleep hygiene', you monitor your caffeine intake, make sure you have nothing distracting you when you go to sleep, even the light emitted by your phone or an alarm clock can disturb your ability to get to sleep. You want total dark and quiet, nothing but maybe some white noise.
You've told me before that you don't want to be on 'brain meds', but if you're serious about that you need to get the sleep under control and also work on taking in a very healthy diet, and supplement that with vitamins just to be on the safe side, and exercise, I can't tell you how important daily exercise is for you if you want to avoid brain meds.
I have a friend who was terribly depressed and on medication and she became an avid runner and no longer needs any depression medication, exercise is THAT good."
"So," I said, "let me make sure I understand what you're saying here. You're basically saying that Josh needs to make important LIFE changes."
"Yes, and he's the only one who can do this. You can't do it for him, I can't do it for him. Josh, this is YOUR life and nothing that I'm talking about here is anything more than what we ALL should do to be healthy. Our bodies cannot function normally when we're not taking care of them."
She suggested that for the first few weeks, he take a dose of melatonin before bed, "It's something you can take forever, but I think it will be especially helpful during the first few weeks."
She wants to see him back in one month.
When we left, Josh said that while he was at work that night, he'd think about the best way to reset his clock. The NP had suggested that it might be easiest if he missed one night's sleep, so Josh was going to try to figure out how to work that into his work/school schedule.
We discussed the addition of Wellbutrin to his meds, but Josh would like to avoid that if possible. The NP told him that she felt if he REALLY addressed the things she'd discussed, he could probably avoid additional medications.
Now we'll see what the man/boy does.
Tuesday, October 12, 2010
History Repeats Itself
Josh is not doing well at all with this school thing. He has missed more classes than he's attended.
HE is very disappointed.....and yet.....he wants to make excuses.
Everytime I have tried to talk to him about this his attitude is that *I* don't understand. Every discussion ends with him leaving the room in anger, only to return fifteen minutes later to repeat the entire exercise.
No matter how gently I try to couch my comments, they offend him.
He feels overwhelmed and I point out that HE keeps backing himself into a corner. I point out that all along I have been encouraging him to GET ON A NORMAL SLEEP SCHEDULE and be militant about maintaining it.
"Yea, but last night I had all that homework to do so I had to stay up and then I slept through my alarm."
"OK, but Josh, you left campus on Thursday knowing what homework you had to have done for Tuesday. You knew you had to work all day Saturday, which means you had all day Sunday and Monday to get it done. But you slept all day Sunday and Monday. This is a time management/sleep schedule problem and the 'answer' to it is really very simple and totally up to you. Sleep everyday from Midnight to 9AM and do your homework in your next available time slot. You act like you're being asked to climb Mt. Everest. Honey, there are lots of people who take 5 or 6 classes and work full or part time. You are taking THREE classes and working about 15 hours a week."
"It isn't just that though Mom. I sat up all night TRYING to do my homework, but basically just spinning my wheels."
"Yes, and you don't want to hear this, you get mad when I even approach the subject, but I think ALL of this is Bipolar related."
"How? How is this Bipolar related?!"
"Josh, if you were sliding toward the manic end of the pole, none of this would be a problem. You'd be buzzing around, busy as a bee and creative as hell. You still wouldn't be sleeping worth a damn, but you'd be productive. You are sliding toward the depressive end and in THAT mode, nothing is easy. It isn't easy to motivate yourself or stay on task. You sleep too much, and everything seems overwhelming. I hate to point this out to you honey, but one year ago TODAY? You were right in this same spot, functioning the same way. I BEGGED you to address this over the summer BEFORE school started and you promised me Josh, you PROMISED me that if you went off your medication and you began to struggle, you would get to the doctor and begin the process of finding the right medication for you. You are about one month away from sitting in the bathtub again with razor blades honey and you are deep in denial."
"Well, I told you I think I need to get back on Adderall."
"Yes, and I told you to try that....I encouraged you to get to the doctor and get a prescription for it, because if that's ALL you need, you'll know it really quickly. And if it makes no improvement, than I would think you'd have to consider Bipolar medication."
"Well, you never made the appointment!"
"You are NOT a child Josh, I asked you several times to call and make the appointment, so don't blame me. Pick up the phone and do it."
So he has an appointment Tuesday afternoon, but I'm pretty sure Adderall isn't the answer.
"Josh, a year ago I told you that it wasn't too late to salvage the semester, and I'll say the same to you today, BUT, you have GOT to act. Get the adderall, give it a couple of days, that's all it will take to see if it helps, and if it doesn't, you need to get back to the doctor and get on something for Bipolar."
"God Mom, remember what that medicine DID to me? I'll definitely fail if something like that happens again."
"I know honey, and maybe if the Adderall doesn't work, you need to consider biting the bullet and dropping out. Yes, you'll have to repay your grant, but that isn't the end of the world. Maybe you need to drop out and address medication and get stable on it and give yourself a year of just working full time, you can live here as long as you're working full time and doing the things you need to do. Pay off the grant and a year from now reapply for school and try again. This isn't a matter of you failing because you're stupid, you are failing because you're not functioning well. And you never know, the first Bipolar medicine you try, could be the right one."
Josh had to go to work, and he has to work till 2 am on inventory and he has to work tomorrow night, which means he really will not have the time required to get his assignments done. So yes, he has created a terrible set of circumstances for himself AGAIN. And he seems to want me to produce some magical answer to solve all his problems.
And I think I HAVE the magical answer, he just doesn't want to hear it.
This is a post I wrote on my private blog October 15, 2009...almost exactly a year ago.....
I am very concerned about Josh....about this depression which manifests itself as sadness, inability to sleep at night, inability to get up as necessary in the morning for class and basically not functioning well with his responsibilities.
I've cried a small river (does that mean I cried a creek?) of tears this afternoon. I talked with his brother, my sister and various friends in the blogosphere about this situation.
We all agree that medication is called for, but Josh is an adult and after meeting with his doctor several months ago, he refused the medication that the doctor suggested.
At 3:oo, before I left to go to the gym, I woke Josh up (well, he was awake, but still laying in bed buried under the covers). I was crying, and I told him that I'm very concerned about him, about the fact that he missed class again; that he isn't functioning well. I told him that I'm sure that he is as upset as I am that he overslept again. He agreed. I told him that I would be home by 4:15 and that I wanted him here when I returned so that we could talk.
And this is basically what I said to him:
First of all, I want you to know that I'm not mad at you; I'm concerned about you. I know that when you wake up, long after class is over, you are upset with yourself. I can see it in your eyes and your demeanor. And that's the whole point Josh...I know you WANT to do better, your intention is not to blow off your classes, but you are unable to DO better. (this is where he started crying)
I love you and I care about you....I want you to be successful, so we need to find a solution to this problem. You have all the symptoms of true clinical depression Josh (which I listed for him) and when you saw Dr P and discussed this with him, he felt that medication could help you.
I know you're opposed to medication, you don't want to be a "zombie", unable to "feel anything". But I have to tell you that your perceptions of what this type of medication does to a person is not really valid. I'm not a doctor, I can't begin to explain to you how it works or why it works or even what it might make you "feel like", but I can tell you that the people I know who take medication for depression swear that it changed their lives. There are people out there who suffered, as you are, for years, and I hear them say that their only regret is that they didn't take medication sooner.
This is what I know for sure. Dr. P is the first human being to ever touch you, and he has been your doctor ever since. He has always shown such caring and concern for the three of us. I trust him....literally....with our lives and I always have.
I trust him in this too. If he feels medication is called for, I trust that he is making that recommendation out of a desire to help you.
Add in to all that, the fact that *I* care about you. I know you better than any other person on this Earth, and *I* think that medication could be the answer to what you are struggling through. Let's face it, you have knuckled down over the last couple of weeks, determined to do better....but you're not. Doesn't that illustrate to you that possibly this is out of your control? If you don't trust Dr. P as much as I do, don't you at least trust me?
If you don't want to consider medication, than let's talk about other possible solutions together because, bottom line, I can't stand to sit by and watch your future go up in smoke.
He and I then talked about medication a bit more and I ended the discussion by saying that perhaps he shouldn't make a decision about the medication right now, but should agree to go talk to Dr P about it again...express his concerns about medication, have Dr. P explain how the medicine works, why it works, what he might experience were he to take it.
In the end he agreed to do that...to go see Dr. P again and discuss the options. He does not want me to go with him.
He left to go see his brother, and as he was leaving, I walked to the door with him and gave him a huge, gigantic hug and told him that I love him.
"I love you too, Mom."
And he was gone.
I'm still crying...I can't seem to stop.
The difference between last year and this year is that I'm not sitting here crying. I'm upset, but not consumed with worry. Because one thing has changed during the last year. I've realized that nothing is going to get better or easier for Josh until he gets a clue. My role in this is limited. I can talk. I can point out this and that. I can encourage. But I can't really own the problem.
I've made some progress since last year. Let's hope that Josh will do some growing too.
HE is very disappointed.....and yet.....he wants to make excuses.
Everytime I have tried to talk to him about this his attitude is that *I* don't understand. Every discussion ends with him leaving the room in anger, only to return fifteen minutes later to repeat the entire exercise.
No matter how gently I try to couch my comments, they offend him.
He feels overwhelmed and I point out that HE keeps backing himself into a corner. I point out that all along I have been encouraging him to GET ON A NORMAL SLEEP SCHEDULE and be militant about maintaining it.
"Yea, but last night I had all that homework to do so I had to stay up and then I slept through my alarm."
"OK, but Josh, you left campus on Thursday knowing what homework you had to have done for Tuesday. You knew you had to work all day Saturday, which means you had all day Sunday and Monday to get it done. But you slept all day Sunday and Monday. This is a time management/sleep schedule problem and the 'answer' to it is really very simple and totally up to you. Sleep everyday from Midnight to 9AM and do your homework in your next available time slot. You act like you're being asked to climb Mt. Everest. Honey, there are lots of people who take 5 or 6 classes and work full or part time. You are taking THREE classes and working about 15 hours a week."
"It isn't just that though Mom. I sat up all night TRYING to do my homework, but basically just spinning my wheels."
"Yes, and you don't want to hear this, you get mad when I even approach the subject, but I think ALL of this is Bipolar related."
"How? How is this Bipolar related?!"
"Josh, if you were sliding toward the manic end of the pole, none of this would be a problem. You'd be buzzing around, busy as a bee and creative as hell. You still wouldn't be sleeping worth a damn, but you'd be productive. You are sliding toward the depressive end and in THAT mode, nothing is easy. It isn't easy to motivate yourself or stay on task. You sleep too much, and everything seems overwhelming. I hate to point this out to you honey, but one year ago TODAY? You were right in this same spot, functioning the same way. I BEGGED you to address this over the summer BEFORE school started and you promised me Josh, you PROMISED me that if you went off your medication and you began to struggle, you would get to the doctor and begin the process of finding the right medication for you. You are about one month away from sitting in the bathtub again with razor blades honey and you are deep in denial."
"Well, I told you I think I need to get back on Adderall."
"Yes, and I told you to try that....I encouraged you to get to the doctor and get a prescription for it, because if that's ALL you need, you'll know it really quickly. And if it makes no improvement, than I would think you'd have to consider Bipolar medication."
"Well, you never made the appointment!"
"You are NOT a child Josh, I asked you several times to call and make the appointment, so don't blame me. Pick up the phone and do it."
So he has an appointment Tuesday afternoon, but I'm pretty sure Adderall isn't the answer.
"Josh, a year ago I told you that it wasn't too late to salvage the semester, and I'll say the same to you today, BUT, you have GOT to act. Get the adderall, give it a couple of days, that's all it will take to see if it helps, and if it doesn't, you need to get back to the doctor and get on something for Bipolar."
"God Mom, remember what that medicine DID to me? I'll definitely fail if something like that happens again."
"I know honey, and maybe if the Adderall doesn't work, you need to consider biting the bullet and dropping out. Yes, you'll have to repay your grant, but that isn't the end of the world. Maybe you need to drop out and address medication and get stable on it and give yourself a year of just working full time, you can live here as long as you're working full time and doing the things you need to do. Pay off the grant and a year from now reapply for school and try again. This isn't a matter of you failing because you're stupid, you are failing because you're not functioning well. And you never know, the first Bipolar medicine you try, could be the right one."
Josh had to go to work, and he has to work till 2 am on inventory and he has to work tomorrow night, which means he really will not have the time required to get his assignments done. So yes, he has created a terrible set of circumstances for himself AGAIN. And he seems to want me to produce some magical answer to solve all his problems.
And I think I HAVE the magical answer, he just doesn't want to hear it.
This is a post I wrote on my private blog October 15, 2009...almost exactly a year ago.....
I am very concerned about Josh....about this depression which manifests itself as sadness, inability to sleep at night, inability to get up as necessary in the morning for class and basically not functioning well with his responsibilities.
I've cried a small river (does that mean I cried a creek?) of tears this afternoon. I talked with his brother, my sister and various friends in the blogosphere about this situation.
We all agree that medication is called for, but Josh is an adult and after meeting with his doctor several months ago, he refused the medication that the doctor suggested.
At 3:oo, before I left to go to the gym, I woke Josh up (well, he was awake, but still laying in bed buried under the covers). I was crying, and I told him that I'm very concerned about him, about the fact that he missed class again; that he isn't functioning well. I told him that I'm sure that he is as upset as I am that he overslept again. He agreed. I told him that I would be home by 4:15 and that I wanted him here when I returned so that we could talk.
And this is basically what I said to him:
First of all, I want you to know that I'm not mad at you; I'm concerned about you. I know that when you wake up, long after class is over, you are upset with yourself. I can see it in your eyes and your demeanor. And that's the whole point Josh...I know you WANT to do better, your intention is not to blow off your classes, but you are unable to DO better. (this is where he started crying)
I love you and I care about you....I want you to be successful, so we need to find a solution to this problem. You have all the symptoms of true clinical depression Josh (which I listed for him) and when you saw Dr P and discussed this with him, he felt that medication could help you.
I know you're opposed to medication, you don't want to be a "zombie", unable to "feel anything". But I have to tell you that your perceptions of what this type of medication does to a person is not really valid. I'm not a doctor, I can't begin to explain to you how it works or why it works or even what it might make you "feel like", but I can tell you that the people I know who take medication for depression swear that it changed their lives. There are people out there who suffered, as you are, for years, and I hear them say that their only regret is that they didn't take medication sooner.
This is what I know for sure. Dr. P is the first human being to ever touch you, and he has been your doctor ever since. He has always shown such caring and concern for the three of us. I trust him....literally....with our lives and I always have.
I trust him in this too. If he feels medication is called for, I trust that he is making that recommendation out of a desire to help you.
Add in to all that, the fact that *I* care about you. I know you better than any other person on this Earth, and *I* think that medication could be the answer to what you are struggling through. Let's face it, you have knuckled down over the last couple of weeks, determined to do better....but you're not. Doesn't that illustrate to you that possibly this is out of your control? If you don't trust Dr. P as much as I do, don't you at least trust me?
If you don't want to consider medication, than let's talk about other possible solutions together because, bottom line, I can't stand to sit by and watch your future go up in smoke.
He and I then talked about medication a bit more and I ended the discussion by saying that perhaps he shouldn't make a decision about the medication right now, but should agree to go talk to Dr P about it again...express his concerns about medication, have Dr. P explain how the medicine works, why it works, what he might experience were he to take it.
In the end he agreed to do that...to go see Dr. P again and discuss the options. He does not want me to go with him.
He left to go see his brother, and as he was leaving, I walked to the door with him and gave him a huge, gigantic hug and told him that I love him.
"I love you too, Mom."
And he was gone.
I'm still crying...I can't seem to stop.
The difference between last year and this year is that I'm not sitting here crying. I'm upset, but not consumed with worry. Because one thing has changed during the last year. I've realized that nothing is going to get better or easier for Josh until he gets a clue. My role in this is limited. I can talk. I can point out this and that. I can encourage. But I can't really own the problem.
I've made some progress since last year. Let's hope that Josh will do some growing too.
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