[Bat Mom]

Hi All. This is the first online 'forum' I have ever joined so please bear with me, I will try to write appropriately. My daughter (21 years old) was diagnosed Bipolar I last year. She went through lots of meds and is 'rapid cycling'. She is a senior in college that is 6 hours from home. 10 days ago she checked herself into a hospital for suicidal thoughts. Long story shorter, she is in a severe depression. Doctor is a travelling doctor and is not in the hospital every day. Over a week ago the doc said she was going to try Lithium again but wanted blood work first as when my daughter tried Lithium before, made her thirsty ALL the time and constantly peeing. She is now in day 10 of inpatient 6 hours away and still not started on Lithium. She says the depression has gotten slightly better but still has thoughts. No word on blood work.

Here is my question, we have an excellent psych hospital 20 minutes away in RI (she is in NY). She spoke to nurse to see if she could transfer but hospital is saying that no one gets released while having these thoughts. I am thinking of speaking to the social worker to see if she could be released to my custody to check her into the local hospital.

I could really use some advice. Not sure where to turn. I would think it would be important to have her on mood stabilizers but she isn't. She is on Klonopin and Adavan and Lexapro (? 20-mg---she was on 200mg earlier in the year) and something else that I can't remember.

I want to help in any way I can but not sure what I should do.

[spiritual_emergency]

What I suggest is that you investigate the laws regarding involuntary treatment in both RI and NY. You need to know what the legalities are because these are what willingly or unwillingly bind the hands of those who provide her current treatment. I suggest you also contact the hospital and ask them, specifically, what they would need from you before they would be willing to release her into your care. I suspect they would be more likely to do so if you can present them with the following details...

- The name of a psychiatrist who is willing to take over her care;
- The name of the local hospital she could be transferred/admitted to;
- A therapist / counselor / psychologist who is willing to take over her care;
- Your insuring agent, if applicable.

You might need to do the groundwork to ensure all those details are in place before you present a formal case to the hospital administrator or possibly, a tribunal. Ideally, you will be able to initiate the change with some phone calls but it's possible you might need to negotiate some legal channels. This might take some time to do so and with Christmas just around the corner, it might not be possible to have her back in your home state before Christmas. On the other hand, if you can make things come together quickly, you might be able to use that detail to your advantage.

What might also be helpful is to seek out some local mental health support groups or mental health advocates in both RI and NY who might be able to provide you with additional insights for working within the mental health legal system so you can get your daughter transferred closer to her personal support network as quickly as possible. These links may be helpful:

- New York State Office of Mental Health
- Rhode Island Mental Health Laws

Best of luck to you and your daughter.

~ Namaste

[Bat Mom]

Thank you so much so much for your reply. It means such a great deal to me. We are moving to NY tomorrow and I am sure I will spend the entire time on the cell phone trying to do just as you recommend. The hospital did switch her doctor today, actually they switched all patients of her old doctor today, I guess that says something about the doctor. Day 11 now and still not on Lithium which I really don't understand but I am hopeful that answers may start to come now.

[spiritual_emergency]

Hello Batmom,
It's so terribly worrisome when they're far away and you know they're in trouble. I would expect your own stress levels will subside a bit once you can actually see your daughter, be with her, offer up some hugs and then, start getting a grip on what is happening for her in terms of treatment and her response to it. The situation with her past doctor does sound confusing but hopefully, with you there and her being assigned a new doctor, the situation will start to improve.

Something I have found helpful for myself is to learn about the various medications that can be used in treatment. You'd noted earlier that your daughter was previously prescribed: Klonopin (Clonazepam), Ativan and Lexapro.

Klonopin is an anti-convulsant / mood stabilizer and was likely introduced as an alternative treatment to Lithium. As I understand it, Lithium is considered to be more effective against mania than depression and this, coupled with any negative effects your daughter experienced previously, may be why the doctor has been slow to prescribe it. Ativan is an anti-anxiety agent and Lexapro is an anti-depressant. Anti-depressants are used selectively for those with bipolar disorder as it's been found they can trigger manic episodes in some people. Anti-psychotics are also being increasingly used as a treatment for individuals with bipolar disorder. It would not surprise me if they have since been or will soon be introduced to her treatment protocol.

Two sites I've found very helpful when researching medications have been askapatient.com and rxlist.com. The latter is medically oriented but provides reliable information on par with a drug insert while the former offers consumer reports and ratings from people who have personal experience with that specific medication. Reviewing both seems to offer a more rounded perspective on what the medication is and how it actually impacts people taking it.

Meantime, depending on the individual doctor or hospital you may find they are extremely reluctant to share any details related to your (adult) daughter's treatment with you (i.e. the medications she is currently being prescribed). If your daughter is in the frame of mind where she can reliably share that information herself it might not be a problem; if she's incapable of doing so at this time, try to secure her verbal/written consent to release that information so the hospital will share those details with you.

Please do let us know how it's going, and good luck.

~ Namaste