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Your son has trouble trusting therapists because the first one misdiagnosed him and gave him a medication that threw him into manic attacks.
It is well known that that giving a bipolar patient an antidepressant, including Lexapro, can bring out the mania much more strongly.
Bipolar, like MDD, is a mood disorder with elements of depression AND mania. The depression looks the same and the first therapist did not thoroughly assess your son for mania.
You said that he had rages. That implies out of control anger. The symptoms of mania are as follows. If your son does not have the symptoms then he does not have bipolar disorder:
A) A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)
B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1) inflated self-esteem or grandiosity
2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3) more talkative than usual or pressure to keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C) The symptoms do not meet criteria for a Mixed Episode
D) The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
E) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
If he does have bipolar then notice item # XXXXX distractability. This can sometimes be confused with ADHD. The medicine Concerta (methylphenidate) is very similar to cocaine, and if he does not have it then it will be doing him more harm then good. That diagnosis should be given a second opinion to make sure he is not given this form of "speed" that will only help him focus if he indeed has ADHD.
Marijuana helps some and hurts others. If he is seeking it, then it may be helping him to feel better. Most children when asked by their parents if they are taking an illegal substance will deny it, and this is normal behavior even if it is not up to standards and is disappointing.
Talk to him about the misdiagnosis by the first doctor and he will feel that you are more on his side.
If he will not follow the drugs of the second doctor then you can try one more doctor to check his diagnosis and if the second one agrees then you will have to apply leverage on him to take his medications, in front of you if necessary. If he won't comply then you can consider sanctions.
You can also see how he is doing without taking the meds. If he is not showing signs of bipolar, then perhaps he does not need these medications. You will have to monitor him carefully. Sometimes medications help and sometimes they are harmful (as was the Lexapro).
You can not go only by what the psychiatrist says but what your son says, and more important by his actions. If he is out of control then he needs help. You as parent will have to be making the decisions for him based on your keenest observations, and with professional guidance.
I wish you great wisdom and perseverance.
Elliott, MAE, LPCC, NCC, CCMHC
I did not tell you previously that his father is also taking Abilify and a myriad of other meds. He went through a job loss and health issues and it has not been easy for my son to deal this with during such a formative period of his life. After reading your post, I'm not sure if he has adhd. He definitely had an episode of depression earlier this year and problems at school handling his anger. to my knowledge, he has been smoking pot perioically for one year. It scares me that he is bipolar. How will his self-medicating with marijuana affect his future mental health if he is indeed bipolar?