If at first you don't succeed?

I'd be lying if I said that life the last two weeks - especially last week - was anything nicer than rough. It seems that either Ella's issues suddenly escalated beyond the point of anyone's control or the Prozac was in her system long enough (we bumped up to 10mg three weeks and 3 days ago) that it was having its full effect and it was the opposite of helpful. 

Virtual school work became impossible most days and bedtime was a disaster. She would get so amped up and frantic that she could not bring herself back down which turned into a meltdown. 

We discussed with our CBT therapist and decided with her that her services were not being received well and that we are not making progress. She recommended that we consider an IOP - Intensive Outpatient Program - a day-treatment program that we could be in for 4-6 weeks. The sad part about pediatric mental health is that there are precious few resources for children under 10 (the same song I've been singing for 6 years). We have 3-4 places in our area that see children her age for IOPs. Our top two choices have a 3-4 week waitlist. One is out of the question (we've interviewed with them before and were very unhappy with the experience). The other is iffy as to whether or not they really treat children her age with her issues. 

Two days after that recommendation, Ella had what our therapist said she would call a "psychotic break" if Ella was an adult. She had a meltdown that had zero triggers and did not follow any of the regular patterns that we see in her typical meltdowns. She refused to put clothes on for bed. She was laughing hysterically (between screaming at us) with a laugh that I've never heard before - it didn't even sound like her. She would go from running from us to literally bouncing off the walls and on the beds. She finally ended up jabbing at us with clothes hangers, hissing at us, and throwing anything she could get her hands on. It's probably the scariest thing I've ever witnessed as a mom (and we've had tons of ER visits and even an ambulance ride for croup and asthma). We made the decision to take her to Children's Medical Center in Dallas and had to force-dress her to get her in the car. Brandon stayed back with William and I drove with Ella. 

I was hoping and praying all the way there that she would calm down enough for us to be able to u-turn and head home (thinking maybe just driving would soothe her like an overtired infant). She stopped screaming and fighting, but her body was so tense it was clear this was beyond her control. She had her hands and arms drawn up like someone whose muscles had atrophied. I could see the tense muscles in her arms, neck, and face. At times she would talk to herself and say, "I want to relax and I. JUST. CAN'T!" In quieter moments over the 40 minute drive I would ask her if she thought she could relax enough to sleep in her own bed and she would say that she didn't want to go to the hospital, but that she just couldn't calm down enough to go home. She even knew this was more than she could handle. 

We spent the night in the ER with very little interaction from the staff other than initial vital signs (which she fought and earned us a med-tech stationed outside our door). She eventually fell asleep and was calm enough after that for us to go home with no actual medical intervention. The mental health social worker that evaluated us agreed that an IOP was our best option (Ella didn't meet the criteria for inpatient treatment) and that we should revisit the psychiatrist about changing meds.

Our psychiatrist had us stop the Prozac immediately (it was a small enough dosage with a long enough half life that it naturally tapers off without having to "step down") and start Clonidine, which is typically an adult blood pressure medication but is sometimes used for ADHD, ODD, Intermittent Explosive Disorder, and other issues in children. They told us to expect the Prozac to slowly work its way out of her system and that we should start seeing an improvement if that was the cause in a week and a half to two weeks.

The first week off Prozac was, I think, the hardest week of our lives (on top of having to be constantly vigilant and insanely calm with Ella, we were dealing with setting up Hospice care for Brandon's step dad and Home Health care for his mother). Ella was a completely different person than I've ever seen - angry, hateful, vengeful, constantly on edge, ready to snap and cause emotional and even physical harm to anyone around her. I MISSED MY DAUGHTER. It was AWFUL.

At one week off the Prozac we started noticing a few small differences. She was less tense and less on-edge. We went the entire day without a meltdown, had a small one at bedtime and was able to calm down relatively quickly. Tomorrow will be 2 weeks off the Prozac. We have had 3-4 meltdowns in the last week - one relatively large and violent one but a car ride induced nap took care of it. It seems pretty clear with the timeline of the Prozac reaching full effect and now tapering off that the worst of the behaviors we were seeing were likely a product of the medication. 

We are now almost back to the point from a month ago where we were discussing with the therapist how thankful we were that we were not a severe enough case to warrant an IOP. Which is relieving on our end and great because THERE ARE NO AVAILABLE IOPS FOR 8 YEAR OLDS IN NORTH DALLAS. Those resources are precious few during regular times, but with Covid distancing and crowd restrictions it is literally impossible to get in anywhere that we trust. Children's Medical Center in Dallas even told us yesterday that their waitlist is so long they cannot even add anyone to it. 

So what do we do now? After much discussion with our counselor and psychiatrist, plus waiting out the Prozac taper and seeing positive results, we have decided to hold off on IOP treatment and seek some face to face therapy (rather than telehealth that was not getting results). There is an outdoor, equine assisted therapy farm only 10 minutes from our house with counselors (who are highly recommended by our therapist) who are trained in Cognitive Behavioral Therapy. We are planning to see them for Ella AND for William and I have an intake appointment with them tomorrow afternoon. I'm excited about this new possibility - I'm still have a bit of farm girl in me - and relieved that this in-person option seems to be the safest possible scenario (in Covid terms) since it will be outside and very "socially distanced" from any other clients. 

There are so many times I've felt hopeful that we've found a solution only to have those hopes dashed (sometimes in scary ways). I can't say that I'm actually hopeful that this therapy will work, but I am at least relieved to be seeing an improvement from the Prozac and to have a plan moving forward. So, if at first, or second, or third, or 15th, you don't succeed . . . try, try again?