Fluoxetine/Prozac question

Discussion in 'General Parenting' started by ksm, Sep 2, 2011.

  1. ksm

    ksm Well-Known Member

    difficult child was on Strattera all summer and was always having rages - like a volcano ready to explode over a" look" or even just a request to do something. So it was stopped a little over two weeks ago and the generic Prozac was started (10 mg - she weighs 98#). The explosions have slowed down to about once a week, and she gets over them quicker. But yesterday she told me she thought the Prozac was making her hyper and talking all the time at school and it was irritating her friends. I have left a message for the prescribing office as we don't have a recheck for 10 more days. Has any one else had this problem? She has only been diagnosis as ADD and some behavior problems in the past. But her bio mom is bipolar. I am really worried that she will be diagnosed bipolar too - as she reminds me of her mom so much - as she always has an excuse for everything, can be down and up in the same day, etc. I know a lot can just be normal teenage girl drama - but I am worried. And our insurance is denying any further testing as unnecessary.

    Today, the drama was she tried to wear just a camisole to school, underneath a zippered hoodie. She walks the 4 blocks to 8th grade, so after I dropped off her little sister at school, I came by her school and intercepted her about a block before the school. She had her hoodie zipped up tight to her neck and she had been acting odd all morning. So I asked her to unzip her hoodie and saw it was the black camisole she slept in. The thing is - today is going to be 103+ degrees. No one needs a hoodie. And all tank tops are not allowed - and sleeveless tops have to have 3" of fabric at the shoulder. Now I knew she was going to be unzipping her long sleeve hoodie during the school day... So I had her get in the car, drove her home, change in to a tshirt and took her back to school. She wasn't late. And at least we didn't have the explosion of rage that we would have had a couple weeks ago. She wasn't happy.

    I am just so tired of the crap. KSM
  2. keista

    keista New Member

    Prozac is very helpful to many ppl, but certainly not for everyone. It worked for DD1 for a few weeks, and then her symptoms got worse. Dosage was increased several times, and each time symptoms got better and then worse, so I took her off it. She was 8 at the time.

    As it turns out, if there is even a suspicion of bipolar, SSRIs are NOT recommended unless mood has been stabilized with a mood stabilizer. That "hyper" feeling your difficult child is reporting, may be mania/hypomania as opposed to the "hyper" in ADHD. And while it may seem benign and just annoying, if it is mania/hypomania, it can end up "ugly" if not controlled.
  3. ksm

    ksm Well-Known Member

    Thanks Keista... But if therapists/psychs won't diagnose bipolar until 18, and insurance won't authorize further mental health testing, what is a mom to do? By 18, I am not even sure if she will have health insurance... The state one we have now currently goes to either 18 or 19.

    The other night, her sister wanted to sleep (past bedtime) and J was just laughing and giggling and wouldn't be quiet. When I asked her what was so funny, she didn't know - said she just couldn't stop. To her, everything is either great, wonderful, etc or it is the worst. No medium for her. It seems like when things are nice, quiet and calm, she has to take everything up 10 notches. Like life is boring unless there is drama going on.

    sigh.... KSM
  4. InsaneCdn

    InsaneCdn Well-Known Member

    Very strange medications swap, in my opinion.
    Stratera is a non-stimulant ADHD medication.
    Fluoxetine is a mood-disorder medication.

    It wouldn't be unusual to be on BOTH, but to drop S. and add F instead???

    Fluoxetine is NOT going to address the focus issues etc. that are predominant in ADHD. That takes either a stimulant (ritalin, concerta, etc.) or a non-stimulant ADHD medication like stratera.
    The problems she's dealing with right now - the behavior issues etc. - are going to be related to the ADHD. Classical executive function problems, in my opinion. Impulse control, planning, organization, initiation, completion... And it wouldn't have been even half as bad over the summer... school starting... WHAM.

    Sometimes, the executive functions challenges need more than an ADHD medication. Not instead of, but in addition to.
    Something to turn down the speed at which her braincells are spinning. It doesn't help that she's 13... hormones!

    I'd talk to the psychiatrist about medications again. Specifically discuss the executive functions issues, and see what they might suggest on that front.
    You might end up with three medications... which means it will take time to find the right combo, right dosing, and right timing of doses... but its worth fighting for.
  5. keista

    keista New Member

    They don't have to "officially" diagnosis it it as such to treat it as such.

    DD1 is diagnosed with mood disorder not otherwise specified and anxiety. She doesn't fit the clinical description of anything, but something is definitely wrong. She's been on 3 SSRIs and 2 have CAUSED more problems and the third she had an unacceptable but 'benign' side effect (chronic fatigue)

    A related disorder that I've been researching lately is cyclothemia or cyclothemic disorder. It can be diagnosed in kids.

    How and when was she diagnosed with ADD? It is absolutely possible to have both, but also possible to get those "hyper" periods mis-diagnosed as ADD. DD1 very often (more often now since she's off all medications) appears to have ADHD, but it was ruled out with the TOVA. Also the screening sheets given to me and teachers don't indicate ADD - either type - or anything else, for that matter.
  6. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Straterra is an SNRI antidepressant drug. Therefore it would be a bad idea for most to be on two antidepressants. They do use to Straterra for ADHD.
  7. pepperidge

    pepperidge New Member

    both of my kids, neither of whom has bipolar, had serious issues with disinhibited behavior on Prozac/Zoloft. if you are seeing an upsurge of what looks like a lack of inhibition of appropriate behavior, please talk to you doctor. Though most I have dealt with pooh pooh the potential for disinhibition. but others on this board have had similar reactions.
  8. Methuselah

    Methuselah New Member

    Hi Ksm. Prozac can cause a hyper feeling or mania or both together. When your daughter is saying she talks a lot, is she rambling from topic to topic or is she just not shutting up? The former may be an indicator of mania and the latter hyperactivity. If it is mania, it could be due just to the medicine or it could be bipolar. The half life of Prozac (I don't know about the generic) is about two days, so you could try to give it to her every other day to see if it nips the mania but still helps with the rages. Personally, I would talk to the doctor first. Good luck.
  9. ksm

    ksm Well-Known Member

    I got a call from the nurses office - and they are having me cut each pill in half until we are seen in 10 days. Maybe this will be better. I will ask J if she is just talking on and on - or jumping from topic to topic. Even with out medications - she has a tendency to talk - alot. It seems like she is always an expert on each topic... Her go to phrase is "Well, actually... then go on and on with information she has on the subject... but it usually isn't relevant to what is being said. She states things like she knows all about it - but when you point out the discrepancy she then back tracks and says it was just an opinion. But she states it like it is a fact. It is just frustrating to deal with. KSM
  10. InsaneCdn

    InsaneCdn Well-Known Member

    Just about classical ADHD. But that doesn't make ADHD the right diagnosis... its probably "classical" for a couple of other things too.
    But I know what you mean about frustrating!
  11. flutterby

    flutterby Fly away!

    According to our doctor, the half life of Prozac is longer than other SSRI's and takes a couple of weeks to clear the system.
  12. Liahona

    Liahona Guest

    I know there have been kids younger than 18 diagnosis as bipolar.
  13. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Bipolar doesnt arrive on your 18th birthday like some wrapped up package with a big bow attached! what a bunch of hogwash...lol. What is it the day before the 18th birthday? In hiding waiting for its grand day to come out of hiding and yell, Surprise, have I got news for YOU!!!!!! I am just so sick and over that old decades old thinking. Someone needs to read textbooks not written in the 1950s.

    I happen to know without a shadow of a doubt that I have been bipolar since I was at least 2 years old and I am closing in on 50 very fast. My son was diagnosed at 13 and that was when I figured out what I had. It took me that long.

    Dont let anyone tell you bipolar cant be dxd in kids. It has and it will be forever. You just have to find better doctors. they will help you fght the insurance company.
  14. seriously

    seriously New Member

    I am not a doctor but I have some strong reactions to your story based on my personal experiences and experiences with my son.

    Stop the prozac today if there is even the smallest chance she is bipolar.

    Sounds like hypomania to me - as in the kind I get where I giggle and can't stop talking. No I don't jump around topics, just tend to have poor impulse control then so I will interrupt others, say slightly inappropriate things, touch you on the arm or elsewhere while I'm talking (when ordinarily I wouldn't do that), take over the conversation. I also tend to eat quickly, dress differently (louder colors mainly), do everything quickly and get impatient with others who go slower than me.

    If her friends are noticing it then it is likely to be way out of the norm for someone her age. Which would suggest hypomania too.

    Find a different psychiatrist if possible. Preferably a child psychiatrist.

    If she's having trouble sleeping, getting up really early, becoming more impulsive, I would be watchful and make sure all medications are locked up. And get her to a good psychiatrist ASAP.

    Hope things settle down soon.
  15. ksm

    ksm Well-Known Member

    I understand they can have the symptoms of bipolar when lots younger, but the medical community here usually just calls it a mood disorder, unspecified. I know they don't want to label kids. When we stopped the Strattera, they thought it might be wiser to treat the anxiety than the ADD. And that maybe if the anxiety level was better, then the ADD might be better.

    I just know that it is a big fight with the insurance company to have anything done other than just prescribe more pills. I am pushing for more testing. We haven't seen a psychiatrist - only the ARNP that works under him. She has seen her three times since April. But is is mainly to take vital signs and check her weight. Not a lot of issues are discussed. Thanks for all the suggestions. In the back of my mind the bipolar issue has worried me. I see all the mistakes of her biomom and wonder if that is what is in store for her future. The bio mom refused any mental health treatment, until she was hospitalized a couple years ago at age 40. She was given medications then, but I doubt that she is still being treated. I just don't want my difficult child to age out and not be ready to be an adult. It is hard enough as a capable teenager - worse when you have mood/behavior issues. Thanks for all the ideas. KSM
  16. seriously

    seriously New Member

    I neglected to say that anxiety can be a symptom of bipolar and/or a comorbid condition. If her anxiety seems to vary along with the silliness I would be leaning toward mood swings to some degree. In which case the more typical treatment would be an atypical antipsychotic and maybe something in addition for the anxiety.

    I am strongly opposed to kids being given mind-altering medications by people who are NOT trained to do that. A nurse practitioner, in my opinion, has absolutely no business prescribing psychiatric medications to a child with a strong family history of major psychiatric illness. A general practitioner doctor does not have the training to do so either.

    PLEASE get your child to a child psychiatrist before you consider further treatment.
  17. ksm

    ksm Well-Known Member

    The ARNP works for the psychiatrist - who is supposed to OK all the medications. I understand what you are saying - but I am in a catch 22 - Insurance is denying any testing or appts with psychiatrists, and except for the ARNP/and the physcian that supervises her, the psychiatrists in our part of the state won't see people under 18. THe only one that will is what our therapist feels is worthless, and wouldn't reccommend a child seeing that one. A company called "Cenpatico" manages the Healthwave insurance company when it somes to mental health. They just deny everything. You can only see people on their list of providers, and only see them IF they OK it. I hate it. But, I am signed up for a NAMI (National Alliance on Mental Illness) series of classes - one night a week for 12 weeks with hopes I can learn more and advocate for my child at school and with the insurance company. KSM
  18. keista

    keista New Member

    Well, you don't necessarily have to fight the insurance company. You can advocate with the ARNP. Write out the information you have learned, write out difficult child's symptoms, and discuss with the nurse. Just because insurance won't PAY for a formal evaluation, doesn't mean difficult child can't get evaluated, and that is part of the ANRP's job - to asses (evaluate) and treat.
  19. seriously

    seriously New Member

    Ugh. If you can get the $$ together is it possible for you to get a consult with an outside child psychiatrist? Is there even one in the area where you live?

    The other option is to look at www.clinicaltrials.gov and see if there are any clinical trials within a reasonable travel from you that your child might qualify for and call them. If they think there's a chance of qualifying they will do at least a screening. Sometimes you can get them to pay reasonable travel expenses like gas or transit fees and it's definitely worth asking about that if your child qualifies for the clinical trial.

    Since I don't know what state you live in I can't help much more than that. I know some of the upper central midwest states have virtually no child psychiatrists in the state. Maybe one or two in the largest city and they are usually affiliated with a University medical school or medical center.

    I would go ahead and force them to give you a written denial for her to be seen by a psychiatrist and do a written appeal. Many times after such an appeal the service is magically approved. And if they deny it again there is probably a State agency that oversees the insurance industry to whom you can complain.

    If you see the in-network child psychiatrist and he is a quack you can then ask for a 2nd opinion from an out-of-network psychiatrist. This should be covered by your plan but again you may have to do the appeal process.

    Good luck.