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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5453
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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My 43 year old single mom of two recently stopped taking all

Resolved Question:

My 43 year old single mom of two recently stopped taking all medications for her major depressive disorder. She has been very lethargic and depressed. Prior to stopping the meds, she started an on-line relationship with a man and then found out the man is barely 18, does not work and does not have a car and she has never actually met him.

The biggest problem today is that she intends this person to move in with her and the children and take care of her. She is very upset that I told her that would not happen and she sees nothing wrong with this.

What should I do?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

Dr. Z. :

Hello I believe I can help you with your concern

Dr. Z. :

I am so sorry that your mother is exhibiting this type of behavior, I can imagine how this distresses you.

Dr. Z. :

First off, I would like to say that you can tell the psychiatrist anything on a phone call or an email, and you do not need your mother's permission. Now the psychiatrist cannot discuss your mother's case with you per medical privacy laws, but medical privacy laws do not prevent the psychiatrist from listening to you

Dr. Z. :

Has your mother ever had a history of unstable relationships or impulsive relationships before?

Customer:

The person to whom I am referring is my daughter, a single mom of two children.

Customer:

Yes, she has had many unstable relationships and has impulsive relationships lately.

Dr. Z. :

I am sorry in your question it says "My 43 year old single mom of two recently stopped taking all medications" that is where I got confused

Customer:

ok

Dr. Z. :

In addition to seeing a psychiatrist for medication management, does your daughter see a therapist or psychologist at all for counseling?

Customer:

She will not see a psychologist any more because she says it costs too much and doesn't do any good. That they don't tell her what she does not already know.

Dr. Z. :

And just a few more questions, does your daughter ever exhibit mood swings and intense outbursts of anger?

Customer:

Yes, that is a part of her behavior. She has taken many antidepressant medications since she was around 28 and three years ago she received ECT treatments.

Dr. Z. :

Okay so the antidepressants may not have been working well for her and that is why ECT is used for resistant depression. I think your daughter also may have a diagnosis of Borderline Personality Disorder (BPD) this can account for other aspects of her behavior as well. Here is a link describing it in more detail for you

Dr. Z. :

And actually medications have not been proven to cure BPD, only a certain type of therapy called Dialectical Behavioral Therapy (DBT) has been considered effective for treating BPD.

Customer:

So the most immediate problem is that she intends for the 18 year old whom she had never met, except online, to move into the home with her 15 year old daughter and 12 year old son. I am most concerned about the fact she thinks this is okay.

Dr. Z. :

Now although she is an adult and she can make a decision for some 18 year old young child to live with her, even though it is not a wise decision, it is not illegal. But is there anyway you can compromise with her to at least see him in person and go on dates with this man for a few months to get to know him or possibly ask her to wait for the new medications to kick in before he moves in, this can at least delay it for a while

Dr. Z. :

I understand and it is definitely not okay, but individuals with BPD have these unstable relationships, attachment issues, and are very impulsive. Another compromise you can ask is she can tell her new psychiatrist and get an objective opinion on the matter, but you would like to be there too

Dr. Z. :

You can also call CPS if you feel that her mental health condition was causing her to be an unfit mother, but I would consider that a last resort.

Customer:

We own the home they live in because she is on disability for her mental illness. I have tried to reason with her and she gets very volatile and threatens to leave the house with the children and live on the streets. While I don't believe she will do that, she is not speaking to her children, has not prepared a meal for them or cleaned the kitchen of the messes she has made fixing food for herself.

Dr. Z. :

Well that can constitute neglect by not providing food or cleaning the kitchen for the children. Since you own the home, you can legally prevent this young man from moving in and demand that she at least go on dates with him for a sustained period of time to get to know him in person before she can even think about allowing him to move in. I think you are right, she will not move out live on the streets and if that happens then you can gain custody of the children if you are concerned about the children's welfare.

Dr. Z. :

Try not to make demands to your daughter as this will cause her to resist, but give her options that are reasonable, so she can make the decisions for herself. She will respond better when it is presented in this way.

Customer:

I hope she will respond positively and will continue to try to help her. If she will not respond accordingly, what do you suggest we do? Try to get custody of the children? There are two fathers involved.

Dr. Z. :

You can try to get custody of the children, call CPS, or at least tell her about these plans to give her a chance to get help and the right treatment. Also I want to recommend this book that will give you some good insight on your daughter's behavior and tips on how to react to it.

Dr. Z. :

Also here is a look at the best therapy modality to treat BPD for your daughter.

Customer:

The other side is when she is taking her meds properly, she is good and acts pretty well. Her children are good students and participate in plays, bank chorus, etc. She cooks well-balanced meals and keeps things nice. However, for the last four-five months, she gone spiraled downward. She says she has to have someone take care of her because she is no longer capable of caring for anyone and she stays in her bedroom almost all the time and texts the 18 year old.

Customer:

Thanks for the suggestions, I have read "I hate you don't leave" but will reread it.

Dr. Z. :

Oh that is good that read that, I can recommend other books to if you like. Well then make that compromise with her that when the new medications kick in and she is feeling better, then she can go out on dates with this man because she has never met him and then decide later if moving in is a good idea. She does not have to rush this. Also you can tell her she may be feeling desperate because she is a low state right now and she may change her mind when the medication works and she feels better.

Dr. Z. :

Help her to think about it objectively would be a goal, and like I said if you present compromises to her, she will respond better usually.

Customer:

I did tell her that if he "loves" her as he professes, he should get a job, a car, an apartment, take her on dates and treat like she should be treated. She says they need to help each other and don't want to wait and go through all that garbage.

Dr. Z. :

Well since she believes strongly in the medications, she should respond to the rational reasoning to wait for the medications have set it in until making a decision on this because she is not in the right state of mind. Also, she may listen to the opinion of the psychiatrist, so pushing her to ask the psychiatrist for their advice would be good too.

Customer:

On the top of my list of concerns is the example that would set for her impressionable children if he were to move in, and an 18 year old male moving in with at beautiful 15 year old girl in the house can only cause friction and trouble. If he moved in, the children's fathers will try to intervene and the fathers are not dependable.

Customer:

The children are very stressed and are now having problems in school with concentration and other emotions.

Dr. Z. :

It will definitely cause issues and I agree having an 18 year old in the house living with their mother, would have a terrible psychological/emotional impact of the children, but to my knowledge that is not illegal or considered a danger to the welfare of children. This is why you will have to be firm, since you own the house, to not let him live in that house with her children.

Dr. Z. :

Here are some other books I think would be helpful too.

Dr. Z. :

I have read these and they are all very good

Customer:

Thank you. You are very helpful. As you can tell, I have been dealing with various aspects of her illness for almost twenty years. She seems however to be getting worse. Also, can you recommend medications that could help?

Customer:

She is also a great reader -- an you recommend books for her?

Dr. Z. :

Well I am sure she has tried a slew of antidepressants, but Lexapro and Viibryd seem to be two good antidepressants with strong efficacy. Also a mood stabilizer like Depakote and Lamictal are good. Also antipsychotic medications like Abilify, Zypreza, and Risperidone have shown good results in helping individuals with this behavior.

Dr. Z. :

The I'm not Sick I don't need help book is very good. Also this book is good as well

Customer:

You are the first person who has suggestion BPD and she has in Charter Lake Hospital for two months one time and a few short stays after that. The diagnoses have always been in the bi-polar, manic-depressive realm.

Dr. Z. :

Bipolar and BPD are very commonly misdiagnosed with each other, but this is because a lot of people do not understand BPD as well.

Customer:

She has taken all of those as well as Lithium and others. I don't mean that they won't work. She is also part of a case study/book written by her psychiatrist, Sonny Joseph, who is a Harvard trained doctor.

Dr. Z. :

So I know she has tried ECT, has she ever tried Transcranial Magnetic Stimulation (TMS)?

Customer:

Can I copy or print out this conversation so I can remember the suggestions and especially the books?

Dr. Z. :

Transcranial Magnetic Stimulation (TMS). This is very similar to the Electroconvulsive Therapy that you mentioned you have tried, except this used magnetic stimulation instead of electrical and is considered safer with less side effects. Also this modality is relatively new (FDA approved since 2008) and has been considered a last resort for patients when other conventional treatments of depression/guilt have been unsuccessful. This novel method for treatment of depression has been very successful for resistant depression and I think it is something that you should consider based on your symptoms and the other unsuccessful treatment approaches. Here is one links describing it in more detail for you and another link of a study in praising its effectiveness and minimal side effects.

Customer:

I asked Dr. Joseph about TMS and he said it was very expensive and he knows we are retired and on limited income. Do you know if a Mayo or other clinic that will accept Medicaid?

Dr. Z. :

Actually this chat will always be saved for you, here is a link for you and you can bookmark this chat. Also an email with a link to this chat will be sent to you, so you can always have it as well.

Dr. Z. :

I can check to see if a Mayo or other clinic may accept Medicaid.

Dr. Z. :

What city and state do you live in?

Customer:

We are in Orlando, FL

Dr. Z. :

Okay give me a few minutes to look for you

Dr. Z. :

So this psychiatrist does not say if they accept medicaid or not, but he does provide TMS here is his website advertisement and his homepage as well.

Dr. Z. :

It says the fees for TMS are $200-275 too

Customer:

What are the fees for? Each treatment?

Dr. Z. :

I am not sure, I am assuming each treatment, but their website does not explain it very well to me. I would normally call and ask, but it is past their operating hours.

Customer:

I will certainly check into TMS.

Customer:

I know you are ecstatic because I can't think of any other questions right now.

Dr. Z. :

It is an option for her at least that hopefully will help.

Customer:

You have been so helpful!

Dr. Z. :

I am just happy to help. I want to wish you and your daughter the best of luck. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

I certainly will. Your rating will be the highest possible.

Dr. Z. :

Thank you very much, I truly appreciate it

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5453
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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