Had to take my DS to ER for suicidal thoughts

amother

Papaya

Sun, Oct 29 2017, 9:29 am

Yesterday, on Shabbos, I took my DS to the ER for the first time for suicidal thoughts. He's 11. He got in a fight with his friends and was extremely upset. He couldn't calm himself down and kept yelling he wanted to die or wanted someone to just kill him or put him out of his misery.

I was terrified he would end up admitted and put on a "thorazine drip"...I knew that wasn't going to happen but that was my vision as we drove to the hospital.

By the time we got there, he had calmed down and the ER experience was then a diversion.

My DS is in psychotherapy and he is on meds for anxiety and depression. he says it doesn't help much. I think it does some but when there are moments like he had yesterday, there is not much we can do.

I think his suicidal thoughts weren't legitimate and just an expression of his pain but I fear one day if he has another episode of being so low and feeling so hopeless, out of desperation, chas v'shalom, he'll do something rash and irrevocable.

This child has been our extreme challenge. I feel like we are going to end up in heartache one day and there is a slim chance he will be okay.

Boca00

Sun, Oct 29 2017, 9:44 am

I am so so sorry for your pain. No advice, but sending lots of hugs and I hope you are getting the support you need for yourself to help you through this challenge.

amother

Jetblack

Sun, Oct 29 2017, 10:13 am

Is he on a mood stabilizer?
When my child went onto antidepressants this Psychiatrist first put child on a mood stabilizer. The doctor claims that antidepressants make children suicidal. If you put them on a mood stabilizer first and then add the antidepressant, you avoid that.
I can't thank this Doctor enough.

amother

Amber

Sun, Oct 29 2017, 10:14 am

I'm so sorry, extending my empathy as another mom of an extremely challenging child.
What modality is the therapist using with your child? It sounds like he could benefit from DBT, and you should be trained as well, to help him access emotional regulation skills when these situations come up again. And hopefully preempt these extreme emotional swings.

amother

Seafoam

Sun, Oct 29 2017, 10:43 am

amother wrote:

I have a relative that could have written this post word for word a few years ago. They had him admitted a few times for suicidal thoughts. Just to give you chizzuk- he is now doing so well. He’s older, went to a very good school and just matured. I used to think he would never be able to get married and now I think he’ll be a great husband. He’s off all meds and is a different child. There is hope!

amother

Aqua

Sun, Oct 29 2017, 11:00 am

amother wrote:

Yes. Many antidpressents cause suicidal thoughts (paradoxically). Look online at the drug warning labels of every drug he's on. Take it to the doctor and ask to switch. Don't let them be dismissive of this. If it's on the label, it happens to some people.

amother

Papaya

Sun, Oct 29 2017, 11:59 am

On his medication, he is much much better than before. But he probably would benefit from a mood stabilizer.

Yesterday, was unusual because it's been a while since he has had such a complete melt down.

I will say, he is often the target of being bullied because kids like to push his buttons and see him melt down. My DS just doesn't have the coping mechanisms or social skills. He perceives off hand comments or mild slights as grave injustices. Sometimes he is capable of just shrugging it off but most of the time not.

amother

Jetblack

Sun, Oct 29 2017, 12:05 pm

amother wrote:

Believe me my child was the same! Said kid was in a fight with just about everyone. No skills could be taught because this child was so sensitive.
Now, after a few years on Depakote, child is so much more normal. Decent social skills. Excellent relationship with us and therapist.

amother

Pumpkin

Sun, Oct 29 2017, 4:59 pm

amother wrote:

This child has been our extreme challenge. I feel like we are going to end up in heartache one day and there is a slim chance he will be okay.

I know the feeling. Hugs.

Our ds had a near-successful episode of suicide attempt (not the first one) and I invested every ounce of energy into changing the tankwater. B''H there hasn't been any attempt in a few years, but I still live with the shadow of it. Never know when it will strike again.
BTW, we chose to remove the meds. Based on numerous conversations with Peter Breggin. But mostly because of our ds saying he felt it was not helping him. We took him seriously.
When he was a teen our ds was out of school/yeshiva, hanging around....etc. Now he's thick in the midst of college, and busy with things that give his life meaning. It has not always been this way. Nobody predicted it would ever be this way. He was doomed to a life of depression and not-up-to-any-good. B''H changing the tank water has had an impact.

What's not working for your ds now? what would he like to see happen in his life? he may not know. If I've never tasted ice cream, I couldn't tell you that having ice cream would make my life bearable/liveable.

amother

Mint

Sun, Oct 29 2017, 5:14 pm

I was the kid my parents worried about in much the same way you are worrying about your son. I had severe emotional problems from a very young age. I responded to my first medications (antidepressants) in a negative way too, and was hospitalized for self-harm and suicidal thoughts shortly after starting the meds. It was difficult for several years but I did eventually find the right help and become healthier. I still have to take meds and manage my mental health condition but nowadays my life is completely normal and if I didn’t tell you my history, you’d never guess it. I’m married with a family, I’ve completed advanced degrees, held jobs and accomplished a lot at them, and I have a healthy social life and good relationships with my family.

I just wanted to share that it’s very possible for even the most troubled kids to get better with the right help and support. And this is coming from someone raised in the 1990’s. The awareness and help available these days is much better.

Refuah shelayma to your son.

amother

Wine

Sun, Oct 29 2017, 5:33 pm

amother wrote:

I was also this child. I was suicidal from a young age, but Baruch Hashem as I grew I grew out of it. I'm now in my early twenties, I do have suicial thoughts here and there, but not to the point where I ever dream of doing anything.

I was neglected, abused and I have anxiety.

amother

Papaya

Sun, Oct 29 2017, 6:56 pm

Thank you all for your responses. I do feel hope.

Jstar

Mon, Oct 30 2017, 3:20 pm

I have access to a Psychiatrist very familiar with kids, emergencies, and suicide. I showed him your question and he wrote up what his response would be if he had seen your son at the ER. Hatzlacha raba.

MODERATOR - Any chance you can send a private message to the OP letting her know about this response so that it doesnt go unnoticed? Thanks.

Response:

When DS expresses that he is suicidal, he is experiencing his pain as overwhelming/intolerable emotional pain. It’s hard for anyone, especially a child to express this kind of pain. They feel alone, helpless and are scared. When he’s very upset, he needs validation of his pain. A statement like “What your friends did stinks!” is a real way to “meet him where he’s at,” helping him feel understood and not alone. You can help him understand that he is entitled to be upset and to have scary thoughts. It is his job to make sure that he shares with you or if it's in school, a guidance counselor when he has these thoughts to make sure that he can be safe. You should explore with him how he perceives his impact on you regarding his suicidal thoughts. Does he perceive himself as a burden? Then I would let him know that while you are sad that he has these thoughts, you are not upset at him for sharing with you and you want to know. As his parent it's your responsibility that Hashem chose you to take, to care for your neshama during the harder times. Parents want and hope to be there for their children when they really need them but children need to hear that because they believe that it is better not to hurt you with there bad feelings.

Acute suicidal crises are scary but time-limited experiences. According to Rudd in the Fluid Vulnerability Model of suicidality, acute high-risk suicidal episodes have a beginning, middle, and end. The focus is keeping a person safe during the time when they are above the threshold of potentially acting out on the SI. Thomas Joiner is his Interpersonal-Psychological Theory of Suicide focuses on three aspects that increase the risk of suicide: thwarted belongingness, perceived burdensomeness and acquired capability of suicide. Validation/meeting your son where he’s at during the time when he is in his acute suicidal desire helps to mitigate this thwarted belongingness.

Baruch HaShem suicide in this age group is super rare. In 2015, there were 27 suicide death of 11 yo, a rate of 0.67 per 100,000 as opposed to ages 20-85+ were the rate is 17.5 per 100k (25x higher than 11-year-olds). Among High School kids that rate of suicide completion to attempts is 1/1100. Baruch HaShem, kids are unsuccessful at killing themselves. At this point, you need to make sure that your home is a safe environment. It is impossible to make a house 100% safe. The focus is potentially lethal objects in the house, specifically pills, guns, and sharps objects. ALL sharp objects (sharp knives, shaving razors, scissors etc) should be locked up. ALL prescription pills and Tylenol should be locked up. Guns should be removed from the house. Other pills can be left in the accessible places for older children in small quants ie around 2-3 doses worth that if taken as an overdose would not be lethal/harmful. The point is to make sure that there is supervision/knowledge of the use of the shapes objects. I imagine that he would use a steak knife when eating a steak/shabbos table and scissors for projects. Impulsively, he might try to hurt himself, but hopefully, without a potential lethal means, he’ll survive the attempt to live to be in a non-suicidal state of mind.

Help him write a safety plan. The therapist or psychiatrist can work with him on it. It should be written or when he’s older and has a smartphone, there are safety apps, like MoodTools app. The safety plan includes signs that he is having trouble, coping skills, reasons to live, emergency contacts, places for distraction.

If he needs to come to the ED for a safety assessment or a psychiatric urgent care that's OK. In the ED, we access where the pt is at in their acute suicidal crisis. As long as the pt is not actively wanting to die and the environment is able to keep the patient safe, then the psychiatrist will try to discharge the patient. Like any medical decision, there are risks and benefits to hospitalization, and we try to avoid exposing children to the risk of hospitalization as long as they can be safe. After discharge, in the immediate aftermath of an acute suicidal crisis, adult supervision of a child should be increased, you can check in with your child asking if they are having any suicidal thoughts and there should be close followup with the therapist and psychiatrist. Parenting, limiting setting and consequences need to be continued to avoid reinforcing the use of suicidal statements as a manipulative tool. If a child needs to be admitted, you will work with the inpatient psychiatrist about the right medication for your son. As the legal guardian of your child, the psychiatrist cannot start your child on a medication without your consent.

Hope this helps,
---MD
Child, Adolescent, and Adult Emergency Room Psychiatrist at ---

amother

Papaya

Mon, Oct 30 2017, 5:25 pm

Thank you!

amother

Papaya

Sun, Nov 05 2017, 1:33 am

What are some mood stabilizes that are given to kids these days? I really wish my DS didn't need something like this.

amother

Jetblack

Sun, Nov 05 2017, 2:27 am

amother wrote:

What are some mood stabilizes that are given to kids these days? I really wish my DS didn't need something like this.

I also wish. Crying

Depakote
Lithium
Lamictol

amother

Hotpink

Sun, Nov 05 2017, 12:48 pm

I'm so sorry to hear that your son and family are going through this. It is so important and great that you are taking it seriously etc. Refuah sheleimah.

I recently learned that Ohel has a mental health department/division. Unfortunately, I became aware of this due to some tragedies in our community. Perhaps it could help to contact them. They may be able to help connect you with more help for your son and support for you. http://www.ohelfamily.org