Nervous about Starting Medication...

[JulienSam]

Long story made short... my neighbor is a behavior specialist within our school district, most recently having worked in daughter's elementary school. I spoke with- her at length about Sam & his behavior issues, and gave her copies of all the material I have (evaluations, IEP, parent write-up). She highly recommended a pediatrician. psychiatrist that she has worked with (some of her students have seen this Dr.), but commented it might take a while to get in to see him.

God had really been looking out for us -- I called the Dr.'s office on Monday & they were actually able to get us in this Wed. (today).

In the past couple of weeks Sam has started some alarming behaviors -- running away from the house, playing with knives (cutting a pencil, threatening to cut someone's arm in the middle of a meltdown). With these behaviors, I was so excited to get in to see the Dr.

I liked his manner -- he didn't speak down to Sam & asked Sam a number of direct questions. The Dr. isn't a warm, fuzzy kind of guy, but not a cold fish either. According to my neighbor, the Dr. is a fervent believer in The Explosive Child, and is more interested in dealing with the behaviors than attaching a diagnosis/label to a child.

At the end of the session he said Sam does indeed show signs of ODD, but said he thinks Sam's actions are more likely rooted deeply within him as depression or anxiety. I've never seen signs of depression in Sam -- and he doesn't usually act anxious, but there have been times when I've seen him anxious. Does that make sense?

Dr. prescribed Zoloft and Risperdal... .25 mg once a day for 2 weeks of the Risperdal, followed by .25 twice a day after the 2 weeks. Zoloft will be 10 mg once a day for 2 weeks, bumped up to 20 mg once a day after that.

husband and I have discussed medication before... it's not our 1st choice, but if it can help Sam to a point where the Collaborative Problem Solving could actually be used, and where we can help him learn the skills he needs to manage his anger/frustration better, we thought it would be worth it.

Now that I actually have the prescriptions, I'm nervous about starting them... Does that seem weird?

Maybe it's because I've heard more horror stories about medication in kids than success stories. My neighbor (who has worked with kids like Sam, and kids with even bigger problems) is a strong proponent of medication -- she says it gets the kids on an even playing field, allowing them to focus on the skills they need to manage their behaviors.

Guess I'm just looking for some support that this is the right thing to do (although I'm not sure what else we can try at this point other than medication)... I know it's our decision, but it would be nice to hear that the same decision has worked for others...

Julie

 

[trinityroyal]

Hello Julie,

Medicating our children is never an easy decision.
That being said, if you have gotten to the point where you've exhausted your other options then maybe now is the right time to consider them.

The right combination of medications has worked wonders for my difficult child. However, we had to go through years of the wrong ones and their disastrous effects on difficult child's behaviour before we got to the right combination.

You may need to makemany adjustments before you find what works best for your child.

 

[Andy]

Read the brochures inside and out. Write down every question/concern you have. Take those back to the doctor. If you are still uncomfortable with these medications, ask for alternatives.

I know it is extremely difficult to start the medication route. I know with my difficult child, I want to make sure that we don't get to the point were the medications are just covering the problems. I want difficult child to be able to work through his issues and make choices on how he wants to live. We have been sooooo happy with his medications of fluoxitine and clonazepam for anxiety. We will work on getting off clonazepam by the end of Summer.

I just learned today that it is extremely important to let your doctor know everything about behavior. Don't assume that it is just his age and normal or it is just "him". Our difficult child is starting to be disrespectful toward teachers. He does not have a history of this so I finally brought it to the counselor's attention. Guess what, although it does not cause back talk, clonazepam seems to increase the tendency. It reduces stress so difficult child does not have the stress level needed to stop himself from talking back. So, he needs to be aware of how he is appearing to the teacher and work harder at following directives without arguing. I thought I had a rude difficult child on my hands but there is hope that it is just the medications for now.

Don't get me wrong - you know that all medications have side affects and these side affects differ from person to person. That is the scary part - no one can guarantee how the medications will affect your difficult child. You just need to be able to live with these to meet the greater goal of a better life. I would much rather work with difficult child in the disrepectful arena than listen to his anxiety trying to make himself hurt himself or even feeling suicidal.

Hopefully board members who have experience with Zoloft can help ease some concerns.

If you are at the end of your rope without medications, it may be a good time to try medications just to see if it helps?

 

[KTMom91]

Medication is never an easy choice. I tried everything I could think of with Miss KT before putting her on medications. We prepared for pill swallowing by practicing with mini M&M's, after she successfully swallowed them, she got to eat some. Medication made a world of difference in her behavior, and we were fortunate that we didn't have to try a lot of different combinations, like some of the moms here.

 

[smallworld]

Julie, are both medications being started at the same time?

 

[JulienSam]

Smallworld --

Yes, he wants us to start both medications at the same time. He mentioned that the Risperal would be a shorter term drug, while the Zoloft would be something Sam would stay on for an extended period of time. Of course, trying to take all this in, I didn't ask for a definition of short/extended period of time.
Dr. does want Sam to be on the medication for at least 6 weeks unless he has a negative reaction to one of them.

Julie

 

[Sara PA]

If he's starting a major tranquilizer at the same time he's starting an antidepressant, how will you notice if he's having an adverse reaction to the antidepressant? The most likely one is the triggering of mania/hypomania. If he has an adverse reaction, the Risperdal might disguise it but it won't prevent it from happening.

 

[smallworld]

We have three different child psychiatrists for three children, and they all recommend starting one medication at a time so you know without a doubt which medication is causing which reaction (positive or negative). If you start two medications at once and your son has a bad reaction, you have no idea which medication is doing it.

Having said that, I understand what your psychiatrist is doing. Zoloft takes 3 to 6 weeks to take effect. I'm guessing that he's using Risperdal, which works within days, to smooth out Sam's behavior until the Zoloft kicks in.

If you are willing to tolerate unstable behavior for a few more weeks and don't want to start two medications at once, you could call the psychiatrist back and ask whether you can just go with Zoloft at this point. But it really does depend upon where your comfort level is.

Zoloft is an SSRI antidepressant that can be quite effective for childhood anxiety and/or depression. However, if your son has a latent mood disorder in the bipolar realm, Zoloft might trigger mania in the form of increased aggression and mood instability. I am not trying to scare you, but giving a child who has not had a thorough evaluation an SSRI is a gamble.

 

[Sara PA]

However, if your son has a latent mood disorder in the bipolar realm, Zoloft might trigger mania in the form of increased aggression and mood instability.

Whether or not there is a mood disorder, latent or otherwise, is irrelevant. The drugs themselves can cause these side effects in people who don't otherwise have any mood disorders. This is know because of how some people respond to the drugs when they are prescribed for conditions other than psychiatric. The most notable example is the study for Cymbalta to treat female incontinence. There was a "higher than expected" incidence of suicidal ideation in the test subjects. (The expected incidence for a studly like that would be zero.)

It's also why many people make a complete recovery when the medication is discontinued.

 

[smallworld]

Sara, that's true, but one of this child's potential dxes is mood disorder.

FWIW, my son had a manic reaction to Zoloft after 3 weeks at 25 mg and did not recover when the medication was stopped. We have only recently gotten him stable after 2.5 years of medication trials.

 

[Sara PA]

After taking an AD for a over a year and a half, it took a good 6 years for my son's brain to recover from the damage caused by the antidepressants before e could begin to function fairly normally. He had immediate reactions to antidepressants -- litereally within hours he was hypomanic and started sleeping 3 hours a night (and yet that wasn't a red flag for his doctor ).

 

[JulienSam]

Sarah PA & Smallword --

I'm glad I have you to do some thinking for me when I'm not thinking clearly. I think starting one medication at a time is an excellent idea...

Re: Zoloft... I know each individual is different, but one reason the Dr. mentioned using Zoloft was because when I was diagnosis'd in 2001 with mild clinical depression (I guess I should add that to my sig, huh), Zoloft worked really well for me. However, after 3 years it wasn't as effective for me and now I'm on Wellbutrin & Effexor.

Re: evaluations... I'm not sure what more we can do. The local children's hospital psychiatric dept. diagnosis'd him with ODD; the school district's evaluation team definitely saw some characteristics of ODD, but also saw some anxiety; then the psychiatrist today also said some characteristics of ODD, but theorized Sam's behavior is really based in depression or anxiety. And at the beginning was the social worker/therapist who diagnosis'd him with a mood disorder (but I pretty much discount that diagnosis).

The local children's hospital has a multi-disciplinary team in Child Development, but they would only see him because he has some potential sensory issues -- our pediatrician. said that she thought that we wouldn't find out anything new with Child Development, that they focused more on children with Cerebral Palsy and the like.

The only Developmental pediatrician. in our area only sees kids 4 and under.

I know the psychiatrist we saw today does this for a living and must see who knows how many children, but there is a part of me that feels a bit uncomfortable that he was willing to write 2 scripts after meeting with- me & Sam for an hour. And that was based upon mostly interviewing me, and only a cursory glance at the evaluations from the SD and the children's hospital psychiatric. dept.

Again, my neighbor who works with these kids for a living and has for the past 15 or so years, highly respects this psychiatrist.

arg. I just don't know what to do...

Julie

 

[smallworld]

The initial psychiatric evaluations my children have undergone have involved four sessions: one hour with parents alone for history, two separate one-hour sessions with the child alone to get a handle on what's going on and then one hour again with parents to give feedback and disucss interventions. Furthermore, none of the psychiatrists we currently see gave out prescriptions right away. Even though my son was experiencing a manic reaction to Zoloft when we first got to his current psychiatrist, the psychiatrist watched him for six weeks before starting him on medications (the Zoloft was already discontinued). My daughter M saw her psychiatrist weekly for two months before the psychiatrist decided to start medications because her eating disorder was getting into the life-threatening realm.

My two older kids have also undergone neuropsychologist testing, and my youngest will start testing in late May. Have you tried to locate a pediatric neuropsychologist to do some independent testing on Sam?

 

[JulienSam]

Thanks so much for the advice... I've had a night to think about it (not much sleep here).

Although Dr. K came highly recommended by our neighbor, the behavior specialist, I don't think he's the right doctor for us. A few red flags:
- at the end of the session he jumped directly into a discussion of medication, without even broaching any non-medication options
- We left with 2 prescriptions, one for Zoloft and one for Risperdal, both at very low doses
- I'm uncomfortable with the fact that Dr.K was comfortable writing prescriptions for Sam based upon an hour's worth of questions. He didn't really look at the documents I brought (the evaluations from kids hospital, school district, as well as a parent overview). We're not treating an upper respiratory infection here -- an antibiotic usually won't have lasting effects, but the medications usually used for behavior issues directly affect the brain -- not something I want somebody just guessing at after a preliminary interview.

I don't doubt that Dr. K has successfully treated & worked with- a number of challenging kids, but I'd really like to find a p-doctor who is willing to take the time to get to know Sam before prescribing something.

So what to do next? We have an appointment next week with an Occupation Therapist to look into sensory issues with Sam. I'm going to pursue getting an evaluation from a pediatric neuropsychologist. There aren't many in town, so there might be a wait, but finding out more information can only help us in better identifying how best to help Sam. I'm also going to check out another p-doctor recommended by both our regular pediatrician and our neighbor.

The good news/bad news is that we've already met our deductible for the year, so for the most part, cost is not a concern. And there's a plan in place to help Sam once he starts kindergarten in the fall -- so our focus can now be on his behavior at home.

Onward & forward (we hope!)...

Julie