A few weeks ago I was having a normal conversation with my 16-year-old daughter about her latest breakup with her boyfriend, when she said, “Well, after I go on Prozac tomorrow hopefully I will feel better.”
Wait, what?!? I must have heard her wrong.
“Honey, did you just say you are going on Prozac? Why would you need to take Prozac?”
“Well, the doctor says I have anxiety and it will help.”
I am not going to lie; I have only been this upset a handful of times in my entire life. My ex-wife and I have joint legal custody, and I had no idea that drugs were even being considered let alone that a decision had been made.
For the most part, my ex-wife and I have co-parented very well. What made this a particularly surprising turn of events was that while our daughter was growing up, my ex-wife treated our daughter’s body like a temple. She was the only kid among her friends not allowed to drink soda or cow’s milk as they might negatively affect her health. But Prozac for mild anxiety? Sure, no problem. I was honestly and genuinely shocked.
My daughter had been struggling with the breakup with her first-ever boyfriend, and was also having some big fights with her mom about everything from her mom’s new boyfriend to whether she had cleaned the kitty litter box well enough. I have had many tearful conversations with my daughter on these and other topics, and while she was having some understandable struggles, they all seemed pretty normal to me and by her own account she was coping with them well. She was still getting As and Bs in school, never missed a practice or game with her competitive field hockey team, and was very active socially and otherwise.
I asked my daughter to hold off on taking the medication, and explained to her that Prozac was a very serious drug and that she was not to take it until I had spoken with her therapist and the prescribing doctor. My daughter promised me that she wouldn’t.
My ex-wife was furious at me for intervening.
I tried to reason with my ex-wife. “Our daughter has always been a person who cares a lot about what people think, and like many kids is insecure about people liking her and doing well in school and sports. That is not a mental illness. That is our daughter’s personality. As she grows up and becomes more confident, this will change. Allowing her to take a pill to ‘fix’ her personality is not a great lesson to teach her. Please reconsider pushing for this. Let’s get her back into therapy and keep an eye on things.”
She responded, “You don’t understand. She is struggling and needs help. I am on Prozac. I don’t see what the big deal is.”
I was only able to get my ex-wife to back down when I reminded her that we have joint legal custody and legally she was not allowed to put our daughter on Prozac without my consent.
From my daughter’s perspective it is totally understandable. One of her parents and her doctor had both told her it was completely fine to take this “medicine” and that it would make her feel better. Since she totally trusted these authority figures, it never occurred to her to question them.
My ex-wife even went so far as to ask my daughter to take the Prozac anyway and not tell me. Fortunately, my daughter is a smart kid and realized at this point that the drugs were far more dangerous than she was originally led to believe.
I asked to speak to the physician that had interviewed my daughter, diagnosed her and prescribed the Prozac. I called the number for my daughter’s pediatric practice and was told the doctor would call me back.
What I understood to be the background was that my daughter had seen her pediatrician in late spring of 2016 for her normal wellness visit, and then again a few months later. At this second visit, the decision was made to put my daughter on Prozac. But the original understanding between the pediatrician and my daughter last spring was that my daughter would first do weekly Cognitive Behavior Therapy (CBT), and if that proved ineffective, other treatment options would be considered.
I received a call back from the person I thought was my daughter’s doctor a short while later, and asked her to walk me through my daughter’s assessment and diagnosis. As she did so and I asked a few basic questions, it became clear that the doctor was very inexperienced and not very knowledgeable, particularly about the diagnosis and treatment of anxiety in teenagers. It turned out that the doctor wasn’t a doctor at all. She was a nurse, and an extremely inexperienced one at that. I had no idea that a nurse could prescribe medication like this.
As I probed further, I asked if my daughter had reported self-harming or suicidal ideation, and the nurse confirmed that my daughter had not. The diagnosis was mild to moderate anxiety. I asked the nurse why she was comfortable prescribing Prozac “off label” for anxiety when it was only FDA approved for treating depression in teenagers, and has a black box warning even for a depression diagnosis. She responded that it was not at all uncommon for her practice to prescribe psychotropic drugs “off label” for kids.
I then mentioned to her that the black box warning for Prozac warned of serious side effects including suicidal ideation at the beginning of a course of treatment or when dosage was modified. I asked her whether, in her experience, she had ever seen those side effects in her patients. The nurse said she had never seen those side effects. That seemed odd if she was an experienced nurse, so I asked her how long she had been a nurse that could prescribe Prozac, and she responded, “Only a year.”
I just couldn’t believe that a nurse with barely a year’s worth of experience had prescribed my daughter a mind-altering drug with a terrible side effect profile, without my daughter ever being interviewed by her pediatrician let alone a psychiatrist.
I asked the nurse if other treatment options were considered and exhausted before medication was decided on, and she said that therapy had been considered and exhausted. The nurse told me she had spoken with my daughter’s therapist and believed my daughter had been seeing a therapist weekly for several months. This was incorrect, and I explained that my daughter had only had a few sessions over the past several months and only one session in the last month.
I asked the nurse if she still thought the CBT option had been exhausted, given the fact that my daughter had received much less CBT than she realized. Instead of admitting her mistake, the nurse doubled down and said that the handful of therapy sessions was adequate and she stood by prescribing Prozac. I figured that as an inexperienced nurse she simply felt embarrassed about not being more careful in her conversation with my daughter’s therapist and didn’t want to acknowledge her slip-up. I thought I would just speak with the supervising physician and get things cleared up.
When I talked to the supervising physician (who had spoken with the nurse but had not interviewed my daughter), I started off by saying that I wanted to have my daughter’s records updated so that she could not be prescribed psychotropic drugs without my knowledge and consent. The doctor said that was my problem to work out out with my ex-wife, and that they couldn’t help me and would not amend my daughter’s records as I had requested.
I explained that the nurse had not been careful in her conversation with my daughter’s therapist, and had mistakenly understood that my daughter had received 4x more therapy than she had actually received. I asked the doctor if knowing that this information had been misunderstood would change her level of comfort with the drug being prescribed so quickly. The doctor said it didn’t change her opinion at all, and that she was completely comfortable with what had been decided.
She went on to tell me how there simply aren’t enough pediatric psychiatrists to serve the huge increase in demand, so pediatricians and even nurses have to fill the void. I informed the doctor that I would be removing my daughter from her practice — she responded by telling me that my daughter would be banned from the hospital she worked at. She then sent a letter to my daughter’s home, indicating that she was being banned from her practice and the local hospital due to me being out of control and inappropriate. Sort of like when you breakup with a girlfriend and she responds, “No, I am breaking up with you.” It would have been funny if it weren’t so tragic. It all still seems so surreal.
The reality of the situation is that drugs like Prozac are being given out like candy. Have a broken heart over breaking up with a boyfriend or girlfriend? Take a pill. Trouble getting into a good college? Take a pill. Nervous about a big test? Take a pill. Super sad when your grandmother passes away? Take a pill.
But my fight wasn’t quite over yet. My ex-wife, probably in an effort to save face, was insisting that a psychiatrist evaluate our daughter before she would let it go. I let my ex-wife select the psychiatrist (I reserved the right to have my daughter reevaluated by a psychiatrist of my choice if I didn’t like the results), and I got lucky — this psychiatrist agreed that drug intervention wasn’t warranted, given my daughter’s symptoms and diagnosis. The psychiatrist even went so far as to say that my daughter’s therapist hadn’t done her job by not insisting on seeing my daughter before agreeing with Prozac being prescribed for her.
The medical profession has failed us. The pharmaceutical companies have failed us. The government and the FDA have failed us. As parents, we really are the last line of defense in protecting our children. I am a very involved father, and yet a panicked mom, an inexperienced nurse and a careless doctor almost put my daughter on a drug that could have permanently and negatively altered her life. And I almost didn’t realize it until it was too late.
We trust the medical profession far too much. We think they know way more than they do. In a weekend of research, I became more knowledgeable than my daughter’s therapist, psychiatrist and pediatrician combined; at least with regards to SSRIs, their efficacy and adverse side effects. These professionals are human and fallible like the rest of us. The key is to educate yourself and your children. Make sure your kids understand what the real risks are, and be armed to push back when mostly well-intentioned but overworked medical professionals simply take the path of least resistance.
And never, ever miss a wellness visit for your kids.