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KOK Edit: your favorite copyeditor since 1984(SM) KOK Edit: your favorite copyeditor since 1984(SM) Katharine O'Moore Klopf
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Monday, May 12, 2008

Miracles Do Happen

This weekend, I have seen a miracle unfold, and it has filled my heart so much that I am overwhelmed with relief, happiness, and gratitude.

I've written here about my very bright 13-year-old son Neil, who has severe attention-deficit hyperactivity disorder (AD/HD) and depression. I've also written that mine is the House of AD/HD, because I am now officially the sole person in this household with a current population of 6 people, 3 cats, and 1 dog who does not have AD/HD. (And we're not too sure about one of the cats.) AD/HD (not severe but the mild inattentive type) has recently been diagnosed in my 6-year-old, Jared.

The family joke has always been that Neil was born a cranky little old man. He's always been way too serious and very crabby and has never seemed to find much joy in life. Even the staff psychiatrists, in meeting with my husband Ed and me about Neil during Neil's hospitalization in the children's psychiatric unit of a local teaching hospital back when Neil was 8 years old for a reassessment of his diagnoses and medications, said, without being privy to our family joke, "Well, it's not psychiatric terminology, but Neil ... Neil was born a little old man." It's always been thought that his depression stems in part from anxiety. When he was in first grade years ago, his very experienced teacher told us that she thought that Neil would be the first first-grader she'd ever see have a heart attack, because he was extremely anxious when he and his classmates were asked, at the beginning of that school year, to walk over to a classmate and introduce themselves.

Late last week, Neil and I got into a ripsnorting argument. And in his anger and his upset, he finally blurted out what he's been holding in all of these years: Besides being depressed, he has always been anxious about just about everything. He constantly worried that "something bad" would happen to Ed or me or Jared or all three of us. He worried about his interactions with other students. He worried about his homework. The poor child was anxious about absolutely everything. And despite living in a family in which everyone talks about feelings in an effort to understand them, Neil has always kept his feelings inside. He thought that he was abnormal, he told us after the fight; he thought that not very many people have depression and that not many are anxious all the time. We were floored, because we're always talking about depression, for which I take medication, and other mental health disorders and their effects on people's lives. He apparently just couldn't get past his own feelings of shame and differentness to really have taken in what we'd always been saying. (Yes, Neil knows that I talk here about his achievements and his difficulties, and he says that that's okay with him.)

We got him in to see his therapist (the one who also monitors Ed's, Neil's, and Jared's AD/HD meds and my depression meds) on Friday after leaving a frantic call on her answering machine. Neil had come across to us as being so depressed that we were scared for his safety. (That poor boy, thinking that he had to handle this all by himself! Imagine how much worse it would be for him if he had parents who ridicule psychology and deny that there are such things as mental health problems.)

The therapist revised his diagnosis to generalized anxiety disorder and major depression (in addition, of course, to the AD/HD) and prescribed Lexapro, a selective serotonin reuptake inhibitor (SSRI). He started taking it this weekend and will be gradually increasing his dose of that and weaning himself off of the Wellbutrin that he's taken for a few years for his depression.

Lexapro is prescribed both for generalized anxiety disorder and depression, whereas Wellbutrin treats only depression. That the Lexapro works for Neil makes sense logically, because one of the reasons those with AD/HD can't control what they focus on is that their bodies don't use the natural neurotransmitter dopamine efficiently, so they don't get a reward of mildly good feelings for focusing and completing tasks, something that those of us without AD/HD do get. Though there is no antidepressant yet that works directly on helping the body handle its own dopamine better—and research has shown that a low level of dopamine is a big contributor to major depression—Lexapro (and some other SSRIs) help the body use its own serotonin, another neurotransmitter, better. And when the serotonin system is working well, that helps improve the function of the dopamine system.

Just since Saturday, since Neil began taking the lowest beginning dose of Lexapro, we have seen a huge change in him. The one of our sons who pretty much never smiles is smiling frequently—and genuinely, not just molding his face into a position that he knows it's supposed to be in occasionally to allow him pass as "normal."

What broke my heart is that this boy, whom I've wanted his whole life to hug much more often than he permits, sat down on my lap tonight and hugged me and let me hug him—for a good 15 minutes! He must have needed so much more touch from us for years than he ever got before now. It wasn't that we didn't offer it to him; he just couldn't bring himself to seek it out or to sit still for very long when it was offered. This boy is the little engine that could, continuing to chug along despite such a painful emotional life and despite all he's had to go through as we tried to find the ideal educational situation to accommodate his AD/HD.

I cried when I held him, both with joy and with a desire to go back in time and take away all of the pain that he has had to live through. That there is a medication out there—and someone who knows to prescribe it—that can allow my child to experience "everyday" happiness that the rest of us take for granted is truly a miracle. Parents aren't supposed to have favorites, but I know that in a way, I admire Neil's accomplishments more than his sister's or his brother's because he has always had to work so much harder for them. Neil has the intelligence and the potential to make some great contribution to the world as an adult. I have always felt that in my very body. When the obstetrician held baby Neil up so that I could see him right after he was born, I truly felt the earth shift on its axis, something that I did not experience with either his older sister's birth or his younger brother's birth. Now it is possible that he may actually enjoy it when he makes that contribution. And it is possible that he may also have a significant other and several friends around to share that enjoyment, because he will be a pleasure to be with.

God, I love that child!



6 comments:

Karoli said...

What a wonderful story! I'm so glad you were able to break through and help him with this, because anxiety is completely debilitating.

Hugs to both of you!

Stephanie said...

How absolutely wonderful that this change is happening. Reading this left me choked up. I'm so happy for Neil (and you).

Julie Cancio Harper said...

Katharine, Happy Mother's Day! What a gift!

I'm so happy for you and for Neil and I'm crying all over my laptop. Depression and anxiety run in my family and I'm so glad to hear that Neil's breakthrough did not wait another day. Think of all the happiness in front of him!

Thanks for sharing your miracle with us.

Katharine O'Moore-Klopf said...

Thank you, everybody. I couldn't wait for Neil to come home from school today to see if he was still cheerful. He was, and I got to grab a few hugs and kisses. :-)

Heidi W. said...

What a relief it must have been to finally get a good diagnosis of the GAD. My son was diagnosed with GAD when he was barely 7, and he just turned 8. We use "self-calming" techniques from his behaviorist to control the physiological symptoms when he's keyed up, and a lot of organizational controls with his homework to prevent him from getting anxious when doing schoolwork.

Katharine O'Moore-Klopf said...

Heidi, I'd be very interested in a description of the self-calming techniques that you use with your son. We've developed some with our son over the years just by learning the hard way.

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