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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Laney on December 11, 2011, at 14:19:21
likely is an AD going to work for him while he is self medicating numerous times per day and getting worse with increased dose of citalopram.
Thanks!
Laney
Posted by bleauberry on December 11, 2011, at 14:40:52
In reply to 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 11, 2011, at 14:19:21
Just my view, I think when someone finds marijuana hard to avoid it means they need some help in the dopamine/norepinephrine department, maybe the opioids, and of course serotonin is always involved to some degree. So I doubt most people would find serotonin based meds helpful and maybe even hurtful since they will further worsen any dopamine/ne shortfall.
Anyway the best medication I am aware of for a situation like this is actually an over the counter herb called rhodiola rosea. Other than that you could probably be looking at things like wellbutrin, low dose ssri with ritalin, zoloft with nortriptyline. Any combo that allows the flexibility to get a 50/50 approach on serotonin and ne. Any ssri should probably be prozac or zoloft.
But you never know. Anything is possible.
His environment needs to be looked at. Does he have a reason to be depressed? Has life been unusually harsh recently to maybe slowly bring this on?
I know a guy who failed so many meds and also failed ECT I see him once in a while and he is functioning perfectly with just marijuana as an antidepressant which works great for him where nothing else did. In your case it looks like it is not being helpful because if it was then he wouldn't be so depressed. Whether to quit or not, well, that's a different issue. For now if the treatment is going to include antidepressant choices then the ones above are the ones I would look at.
Posted by Laney on December 11, 2011, at 14:47:48
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by bleauberry on December 11, 2011, at 14:40:52
He won't quit the pot. Can't pot be a depressant? How can an AD work if your constantly putting something into your brain that has a counter affect? So is what your saying drop the citalopram and add a NE/dopamine drug combo to the current addiction?
Thanks!
Laney
Posted by Laney on December 11, 2011, at 14:50:04
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 11, 2011, at 14:47:48
His moods are all over the place right now. Sometimes crying, sometimes angry and completely disrespectful, most of the time in his room and oversleeping and shut off from everyone.
Laney
Posted by ed_uk2010 on December 11, 2011, at 15:02:24
In reply to 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 11, 2011, at 14:19:21
> likely is an AD going to work for him while he is self medicating numerous times per day and getting worse with increased dose of citalopram.
>
> Thanks!
>
> LaneyTo be honest, it is not very likely.
The efficacy of antidepressants in the <16 age group is normally poor. Fluoxetine and escitalopram have shown marginally better activity than placebo in some, but not all trials. Other ADs have not shown efficacy, and psychiatric adverse effects such as aggression, agitation, aggravation of depression, impulsive behaviour, suicidal thoughts and hypomania appear to be a lot more common in children than in adults. If the citalopram is making him feel worse, it will need to be tapered off.
This is not to say that he cannot be treated, it's just that the focus at this stage should not be too centered on medication. In order to get better, he will most likely need a support program which involves a combination of psychological therapy and help to reduce his drug usage. He may benefit from additional support at school, if this is possible.
Also, severe depression in young people is sometimes the presenting symptom of bipolar disorder, especially if there is a family history. This is just one thing to consider.
Hope this helps.
Posted by ed_uk2010 on December 11, 2011, at 15:19:28
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 11, 2011, at 14:47:48
> He won't quit the pot. Can't pot be a depressant? How can an AD work if your constantly putting something into your brain that has a counter affect? So is what your saying drop the citalopram and add a NE/dopamine drug combo to the current addiction?
There are no NE or dopamine drugs which have been shown to be useful for depression in adolescents. Fluoxetine is the best studied AD in children but hostility and anger can occur, as is the case with other SSRIs. Trials show that only a minority of adolescents clearly do better on SSRIs than placebo. Some do much worse. All ADs needs to be very closely supervised in children and young people. If distressing psychiatric reactions occur, the drug should be tapered off. A common clinical error in these circumstances is to increase the dose and compound the problem.
>He won't quit the pot. Can't pot be a depressant?
He is going to need help here. I would recommend seeing a psychiatrist who has a particular interest in drug misuse. Pot can cause a variety of psychological reactions. It may induce paranoia in those who are susceptible. At the moment, stopping or reducing the pot and finding him a therapist who he respects are the main things you need to do. ADs are not likely to play a major role at this stage. Reponse to ADs is normally better in those 20 yrs +, once the brain has developed. There have been so many attempts by different companies to show that their ADs work in children.... and so many failures. Even in the few 'successful' trials, the differences between active drug and placebo were marginal, and significant adverse effects were always reported.
Posted by JohnLA on December 11, 2011, at 15:40:15
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by bleauberry on December 11, 2011, at 14:40:52
I know a guy who failed so many meds and also failed ECT I see him once in a while and he is functioning perfectly with just marijuana as an antidepressant which works great for him where nothing else did.
not trying to hijack this thread, but bleauberry; do you know what strain of marijuana this person is using and his dosing? i have failed several meds and ect. i'm considering trying a trial of marijuana, legal here in california, for my depression.
thanks for any help on this.
john
Posted by Laney on December 11, 2011, at 17:29:29
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by JohnLA on December 11, 2011, at 15:40:15
John,
He's 15. He's getting it from wherever he can.?? His brain is still forming. I would say that this is him self-medicating his depression. He's worse now on citalopram. He says he's not giving up the pot. He's rebellious though they can reluctantly get him to go to the doc for help.
Laney
Posted by Laney on December 11, 2011, at 17:38:00
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by ed_uk2010 on December 11, 2011, at 15:19:28
Do you think this site is a good one? One I can recommend to them?
Thanks - Laney
http://www.theantidrug.com/drug-information/marijuana-facts/marijuana-mental-health.aspx
Posted by emmanuel98 on December 11, 2011, at 19:13:25
In reply to Re: 15 yr. old nephew pot addict and depressed. How » ed_uk2010, posted by Laney on December 11, 2011, at 17:38:00
My 23 year old nephew is addicted to pot. Yesterday, my brother drove up to where he lives to hospitalize him. He is hearing voices telling him to kill himself. His mother (my brother's ex) is psychotic and I have had psychotic depression, so his genes aren't great. Also he suffered a traumatic brain injury when his mother was driving drunk in the wrong lane and nearly killed him. But the pot can't be making things better.
Posted by Laney on December 11, 2011, at 19:41:32
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by emmanuel98 on December 11, 2011, at 19:13:25
Wow - now that's scary. No history of mental health problems in the family except my depression dx but lots of addiction on his side of the family. Father, brother, uncles, grandfather, etc. etc. Mostly alcohol related but other drugs off and on over the years!
Posted by Phillipa on December 11, 2011, at 20:34:27
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 11, 2011, at 19:41:32
Hi Laney just on the site. I know the frustration went through it with own Son. I seriously didn't know it at the time but he quit high school age l6 went from being a to being a top athlete to no sports. I wanted him committed to a drug rehab place but in the state lived in then they said age l5 and they could refuse. I recommend an intervention like on TV. Today as you know things are different for my Son. Write can disclose more. Love Phillipa
Posted by Christ_empowered on December 12, 2011, at 0:45:40
In reply to Re: 15 yr. old nephew pot addict and depressed. How » Laney, posted by Phillipa on December 11, 2011, at 20:34:27
I'd personally drop the celexa. When I was that age, everybody was on an AD and it didn't work. One of my friends was on celexa (I think it was new then), and he'd just save them up and snort them or pop them when he got stoned. I have no idea if it did anything or not, but that's about how useful my friends and I found AD drugs at that age.
I think maybe some counseling, family counseling, that kind of thing, to get him to get out of his room and maybe reduce or give up marijuana on his own, instead of making the marijuana use the central issue. You could also see about doing things in church, if this kid's family is religious. That often helps.
Posted by Laney on December 12, 2011, at 0:47:25
In reply to Re: 15 yr. old nephew pot addict and depressed. How » Laney, posted by Phillipa on December 11, 2011, at 20:34:27
Phillipa,
How is your son now?
I think he absolutely has to get off the drug. I can't imagine getting better in any way while still being stoned all the time.
So yes, I agree. Something like an intervention but without him agreeing to it. It would most likely have to be forced as he is so adamant that he isn't going to ever quit.
Posted by Zyprexa on December 12, 2011, at 2:45:41
In reply to 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 11, 2011, at 14:19:21
When I was younger I found a decreased want or need for pot when I started meds like zyprexa and depakote. Regular ADs didn't do it alone.
Posted by europerep on December 12, 2011, at 7:55:43
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by JohnLA on December 11, 2011, at 15:40:15
> not trying to hijack this thread, but bleauberry; do you know what strain of marijuana this person is using and his dosing? i have failed several meds and ect. i'm considering trying a trial of marijuana, legal here in california, for my depression.
>I would suggest you open a new thread for this. It might actually be an interesting question to talk about, but it would be off-topic in this thread I think.
Posted by Phillipa on December 12, 2011, at 18:15:57
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 12, 2011, at 0:47:25
Laney who is prescribing the meds for your nephew? Does this doc know about the pot useage?
If he can't help could you call AA or NA? Maybe they can help?
Once your kids are grown and gone no idea what he does or does not do. Know he doesn't like meds. Does drink? Phillipa
Posted by JohnLA on December 13, 2011, at 15:09:36
In reply to Re: 15 yr. old nephew pot addict and depressed. How, posted by Laney on December 11, 2011, at 17:29:29
laney-
sorry for the confusion. i meant my question for bleauberry about the marijuana/etc. i should have not asked that within this thread. again, my apologies.
sorry too, for what your nephew is going thru. i taught highschool for 26 years. can i make a suggestion? is there any adult that your nephew respects/trusts? family, teacher, etc. i always found that no matter how pissed-off at the world a teenager could be there was usually at least 1 positive role model adult in that kids life. my suggestion is to start there. recruit/enlist that person in getting your nephew the professional help he needs.
teenagers, under the right circumstances, can make amazing positive life changes with just a little guidance from the right source. i've seen it happen in my career numerous times.
hoping your family finds some peace.
john
This is the end of the thread.
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