<p>My 17 year old son with Asperger’s was talking to me Friday night about having depression. It’s not constant-it comes over him periodically. </p>
<p>He’s always gotten his Concerta prescription from his pediatrician who has told him that after he turns 18, he won’t see him any more.</p>
<p>These two things together make me think it’s time to find a psychiatrist. I’m going to be asking for referrals but I wonder if anyone knows of some good questions I can ask.</p>
<p>I have a nephew who sees a psychiatrist; the kid is so heavily medicated that it’s eerie to be around him. Of course, no psychiatrist we interview is going to say that he overmedicates his patients. </p>
<p>Is this for just prescribing drugs or for actual therapy? For prescribing drugs, I think it’s very important to get a doctor who prescribes a lot of drugs, has a lot of direct clinical experience with that. Someone who mainly does therapy is not going to treat enough patients with drugs to know first-hand their positives and negatives</p>
<p>As far as picking a therapist, I recommend going to “sample” sessions with several and finding someone you really can connect with AND RESPECT. It’s important to respect your therapist so you can trust them.</p>
<p>What about checking with some of the resources for autism/asperger’s in your state? It may be more beneficial to find someone to treat his depression that also understands autism/asperger’s.</p>
<p>I would start by asking for info from people whom you know who are seeing psychiatrists.</p>
<p>Also, typically psychiatrists only give meds, not therapy. They see several people in an hour so don’t have time to give therapy. I think it’s best to see a social worker or clinical psychologist for therapy and a psychiatrist for medication. Speaking from personal experience as a patient and as a former clinical psycholologist.</p>
<p>missypie, contact your pediatrician for a referral, talk to a school counselor if you can, contact Asperger’s support group websites, contact a local children’s hospital, use google – and you’ll find lots of people to talk to. Psychiatrists are like shoes: it can be a totally individual fit, so you screen them first. Ask questions. Be specific. Once you find someone you feel you can trust, introduce your son to him/her. I can’t tell you how many teens I know see a psychiatrist. I personally think that many teens are slightly nuts (recent brain studies seem to confirm this somewhat - they have different though pattersn & reactions from adults) and a trained, neutral person they can talk to honestly is something many of them will benefit from. Good luck. Information is out there, as are effective therapists.</p>
<p>You clearly run in very different circles than I do.</p>
<p>Anyway…an important thing to remember is that different people have different needs, and different doctors specialize in different needs. Some people really want or need medication, and don’t want therapy. Some doctors will treat their patients that way. Other people don’t want meds, they want talk therapy, or more behavioral therapy, or what have you. As a general rule, psychiatrists are more likely to fall into the first general category, psychologists into the second. But the point is that it’s a terrible fit if a patient wants meds and gets a doctor who does talk therapy and doesn’t know much about meds, or a patient who <em>doesn’t</em> want meds gets a doctor whose solution to everything is to suggest medication.</p>
<p>And of course, it’s not as simple as a binary. There are professionals who do both medication and therapy. And there are many different schools of therapy. A behavioralist therapist is not going to be quite the same as an expressive therapist, or a cognitive-behavioral therapist.</p>
<p>So before you begin your search, sit down with your son and figure out what his needs are. Then you can get referrals. And go to “sample” sessions, as kenf1234 suggested, so that if someone is not to your liking, you can switch.</p>
<p>If your son is going to college, the college may have a mental health service, and the other students may know which doctors are good for what sort of needs, and be able to provide referrals.</p>
<p>Call one of the Dallas private schools (hurry they are about to get out) and ask them who they suggest. Or, call SMU health services. The HS’s and SMU will know people who work with youths.</p>
<p>Or, talk to someone who does extensive DR work in North Texas. Very occasionally they come across someone who they think can actually help kids. FWIW–I’d try the schools first.</p>
<p>Missypie- I would start with the pediatrician. I am also surprised his present Dr will not see him past age 18. He will also need to find another general MD. Depending on the size of your town your choices may be limited. In many places there is a shortage of psychiatrists and many will not be taking patients. (at least that is the case where I live and in several of the college communities my son looked at). Also you might check if your insurance has a list of providers. The school psychologist might also have some recommendations.
My son with LD and ADD used to get his meds from his pediatrician. He also began to have depression and anxiety on his meds. We were referred to a psychiatrist who had much more experience with medication. They tried many different combinations of ADD drugs till they found what worked. The Dr we saw did both med management and talk therapy. He was also licensed as a pyschologist in addition to being a psychiatrist. I had expected to go once and get an prescription. This was not the case. The Dr spent several hour sessions talking with my son and then proceeded to try some different options.
I have another family member with mental illness and in that case she presently see’s 1 person for talk therapy and the psychiatrist just for medication.
In our town for some reason it is not uncommon for teens to see either a MFT or psychologist or psychiatrist.
My son’s psychiatrist specializes in children.
Most college health centers will not write a prescription for ADD drugs. Your son will need you to either send him the prescription or find a local Dr at his college to write it for him.</p>
<p>Thanks everyone for your suggestions. I have several sources of referrals. What I really was asking is that once I’ve got a doc in mind, what do I ask him? Are you a Freudian? A behaviorlist? Etc.</p>
<p>Yeah, when he goes away to college (he’s only a Jr.), I guess he’ll need a local doc. Concerta is a controlled substance, so we can only get a 30 day RX at a time-have to go in for the RX once a month.</p>
<p>All you have to do is ask the psychiatrist if he’s had experience treating young men with Asperger’s. Depression is very common with Asperger’s. You sound like a great Mom and on top of all of your son’s needs.</p>
<p>(My good friend has a 17 year old Asperger son. I’ve watched him mature from a hyper/very difficult 5 year old into a very polite capable young man. He’ll be graduating high school in the June and then off to a 2 year program for Asperger students which combines life skills, job training and internships, and for those capable–college classes.)</p>
<p>When you call make sure you tell the intake person that your son has vocalized feelings of depression. That will get him in earlier. Getting appts for a new patient can take up to 8 weeks if there is not a ongoing crisis. And a psychiatrist will write 3 separate Rxs for controlled substances, they want to see new patients every month for a few times, but then only a 15 minute med appt is needed every 3 months.</p>
<p>You could also get a ped psychiatrist - most of those work with students until they leave for college.</p>
<p>^^great advice, cmbmom–especially the part about mentioning to the intake person that her son has vocalized feelings of depression. It should speed up the appointment somewhat.</p>
<p>If there is a teaching hospital in your area, it can be a source of referrals.</p>
<p>Interviewing the psychiatrist is important. Not all are created equal. You want your inner voice to say, I trust this person, he/she gets it, and I believe he/she will help.</p>
<p>We’ve been dealing with the same med management for our 17-year-old aspie son (not the goalie) including the depression for a number of years.</p>
<p>First thing, is this covered by your employer’s medical or separate mental health benefit? In our case we have a separate managed mental health care insurance. With this provider, I called their 800 number and asked to talk at length to a case manager. Now Asperger’s is not considered a “mental health” issue that is covered, but the depression, and obsessive compulsive behavior as well as any ADD type behavior is. However, I did ask to find both a counselor (psychologist) and psychiatrist (MD) who both dealt with autistic patients. And in our medium sized city, surprisingly enough we have a couple of each in network. </p>
<p>And I’ll tell you from our experience, the medication management - trying to manage several different issues is trial and error and mostly about managing the side affects of the various pharmaceuticals. And over time, some antidepressants seem to become less effective, so occasional (every 2 or 3 years or so) medication changes have been necessary. Not sure if that is about the changing chemistry of an adolescent’s mind or what.</p>
<p>You can PM me if you’d like for more specific recommendations.</p>
<p>I would ask your family doctor for help, or other doctors you may know. Also check your area online, then check out those that seem appropriate. Then go check out the individual and see if he/she seems ok. Find out if they are just pushing drugs or use other approaches. Ask a lot of questions.</p>
<p>“typically psychiatrists only give meds, not therapy”</p>
<p>What? Maybe if you’re in an HMO, or in prison. If you have quality coverage, or you can pay out of pocket, you can and should find a psychiatrist to prescribe AND spend significant time with the patient in order to closely track his progress.</p>