difficult child update - rising anxiety

[Andy]

Thursday night difficult child told me that he was nervous about this weekend. He and husband were going to sister in law's to pick up a love seat. They would go down to the cities Friday afternoon, attend a Viking's Game and come back on Saturday (today).

Diva and I went to my sister's also in the cities (about 1/2 hour away) for overnight and most of the day. We drove seperate from difficult child and husband.

difficult child stated he felt God was putting me in the cities because He knew something bad was going to happen to difficult child and wanted me close by.

So, I asked difficult child about the new medication. It helped him feel better, "clearer", when he first started taking it about a month ago. It is a very low dose. He then told me that it stopped working a couple weeks ago and he is back to feeling confused.

I called psychiatrist office on Friday to see if we might need to up the medication. psychiatrist was off until Tuesday (might check notes on Monday) so his nurse talked to me awhile and passed the info onto the on-call psychiatrist. I received word back to go ahead and increase the citalopram (? spelling) by 5 mg and use the PRN Xanax if needed this weekend.

I know that as school approaches his anxiety is rising. He is still doing great in keeping it under control, however, we don't want him to have to live with feeling weird all the time if we can find an answer. I also considered his comment about something bad would happen this weekend. I think that concerned me most showing me that his anxiety is still active.

I struggle trying to keep the medication route and him using his tools in balance. Am I really reading him correctly? If I increase medication, am I expecting too much of the medications as a way of protecting him from facing fears? If I don't increase, am I expecting too much of his coping skills ability wanting him to fight something at a level he just can not? Some days, as now, I am not too sure. I am so scared that he will have a panic attack and plunge back down. However, he also needs to be allowed the chance to overcome those attacks, get control before they happen using his own skills to gain confidence to face new situations.

I do try to "detach" and let him take the lead because as of now, he is choosing his skills over the Xanax and he has overcome without a panic attack since Spring. He knows when he needs the Xanax. Now pressures are rising again - can he continue?

I made the choice in asking if an increase was appropriate mainly based on his comment that the "weird" feelings were back again. Maybe an increase will take the edge off while his school anxiety is building? I need to trust the psychiatrist would not allow it if it was not appropriate. It is a small increase that will take awhile to build and he still has room for safe increases if needed.

This weekend went very well! difficult child stated his uncle allowed him to leave their Viking's game seats on his own to go through crowds to reach a concession stand for a treat and find his way back to the seat. So, that is very huge for him to feel secure to do making me wonder if the increase is needed. But then I remember, school is only one week away and that 1st day will be the biggest test yet!

I think (or do I hope?) that I made an o.k. choice in asking for that increase?

I know many of you also struggle with the "Should I" or "Shouldn't I" in the medication changes and will understand why I am not sure - evidence seems to be there but what if they really are not?

 

[smallworld]

According to a psychopharm book I own, the usual dose range for Celexa is 20 to 60 mg so your difficult child really is on the low end. I personally would not worry about going to 20 mg because he is struggling with feeling "weird" at times. My own feeling is that it's just as bad to undertreat as it is to not treat at all.

 

[BusynMember]

With my own anxiety, cognitive therapy worked as much as the medications. This is just me and could be different for your son. I DID take medications with the therapy and, of course, I was an adult. Xanax made me feel really strange, so I take Klonopin. It is longer acting too. It did help a lot although I also helped myself. But he's young. I would make sure he stays off caffeine, even chocolate has caffeine, if you notice that may trigger anxiety.

My experience with upping a medication (and, again, this is just MY experience) is that once a medication "poops out" (as we call it) upping the dose has never worked for me. In fact, I felt even worse and more depressed. Once a medication pooped out for me, such as Prozac did, the best result for me was to switch medications. All medications can poop out. I've been fortunate that the Paxil to date never has.

It's your call and your child. If he is complaining that he feels "weird" I would try to ask how what he means to see if he can express it. Is he just frightened all the time? Does he have feelings of impending doom (for me this always precluded a bad depression, almost like an aura). Does he feel like he's in a dream and outside of his own body (depesonalization/derealization--very common but terrifying anxiety symptom--the worst one I ever had).

I have a great book that literally dissects a panic attack. Once I read the book, panic never "had me" the way it had in the past. I understood the physiology of a panic attack and could slow down my body. Of cousre, sgain, I was an adult. It is called "Don't Panic" by Wilson and Reid (I don't know their first names--I don't think their first names are on the book). I recently saw this book at Barnes and Noble and smiled because it was my Bible for a bit. I carried it around in my purse, even at work, and read it in the bathroom stall when I had to...it REALLY helped me slow down my body so that I COULDN'T panic. This may be asking too much of a child, but he sounds very bright. Can't hurt.

I wish you and your sweet little boy lots of luck with this. Panic/anxiety for me was strange. And still is (although it's no longer usually troubling enough for me not to function). Panic attacks would happen when stress occurred. I could go years without panic attacks. Then it would rear it's ugly head.

Give your boy a hug from me...tell him Auntie Pam on the board understands his feelings and hopes he feels better soon.

Andy, I really care about your boy, even though I don't know him, as I had so much of the same stuff as him. GOOD LUCK!!!! (((Hugs)))

 

[Wiped Out]

Andy,
I understand the thoughts you are struggling with. I'm sorry difficult child's anxiety is on the rise especially with school starting. It does sound like he is doing a good job right now of handling it, however, I think you did the right thing calling his psychiatrist. Sending supportive hugs your way.

 

[Andy]

Thank you! As always, your support and words of wisdom helps so much. Many times I find that some of the things are such good reminders of things I have forgotten (like the caffeine). Thanks for keeping me on track.

Smallworld - is the 20mg a normal dose for a child? difficult child is less than 100lbs if that makes a difference. I so agree with your comment about it is just as bad to undertreat than not at all. I do not want to undertreat but also do not want to overtreat. I want to make sure he is getting exactly what he needs. At this point I feel that because he is doing so well it would be easy to undertreat. He is getting to the point were instead of telling me what is going on, he is willing to "live with it" which he shouldn't have to do if we can find the right level and type of medication. The on-call psychiatrist agreed to increase the medication by 5mg so he is on 15 as of yesterday. His own psychiatrist who is more familiar with him will review that decision and let us know if he should increase it again. I will call and give a report next week as to how he is doing with this increase. Maybe we are headed toward 20 or beyond? I think the on-call psychiatrist was being cautious because he/she does not know the case as well. I like that - I think their role is to get us through until the assigned psychiatrist can step back in with the true treatment plan?

Midwest - Thank you for the reminder of caffeine. I will start watching that again. He is very good about getting non-caffeine beveridges but once in awhile he does get into caffeine splurges. The Xanax is just a PRN for him. He did not feel the need for it this weekend so still has not had it since the last day of school. He did state last Spring that it helped a lot. It took away the panic. I need to look up that book.

Wiped Out - Thank you for the support.

I saw last year's teachers earlier this week. They had just returned from a conference and one of the teachers told me their first workshop was on mental health. She stated that the first topic was anxiety and on a printout they received was a list of symptoms. Except for excessive crying, difficult child displayed every single symptom at school. I am glad the teachers received this confirmation. I think anxiety can be an unseen illness depending on the person. difficult child does try to hide it from people so I think there are those out there who may not believe he has it and I am just an overprotective mom.

It is also easy for me to think that because things are going well that the anxiety is gone. However, I don't know that it will ever be gone and he will always have to be aware of how it affects him. It may subside but the possibility of a panic attack will be there. The panic attacks are actually what throws him so far back in wellness. They scare him so much and put him back to step one. I think as he matures, he will be able to handle those better knowing them for what they are.

 

[smallworld]

Andy, psychiatric medications are typically dosed by clinical response. You're looking for that "sweet spot," where the child feels a remission of symptoms without feeling too energized, if that makes any sense. The range for Celexa I gave is for adults, but you know from the adult range that 15 to 20 mg would be fine for a child. For 3 years my own daughter, who now weighs 80 pounds, has been taking 7.5 mg Lexapro, which is roughly the equivalent of 15 mg Celexa (their close cousins).

See how the 15 mg goes and talk the psychiatrist. You may be fine at that dose. When I resonded earlier, I didn't realize you had already updated your signature to reflect the dosing increase.

 

[Josie]

My daughter just went through CBT therapy for Obsessive Compulsive Disorder (OCD) where they do Exposure Response Prevention (ERP). In chatting with the therapist, he mentioned that panic attacks could be dealt with by using ERP. Somehow, they recreate the feeling of panic and teach the person to cope. I think this is used for people who limit themselves for fear of a panic attack, so I am not sure if this applies to your difficult child. I just thought I would mention it as a possible supplemental approach.

I agree undertreating is just as bad, if not worse, than not treating. The trouble with medications is that not everyone reacts the same, so it is somewhat of an experiment seeing which ones and what dose work for each person. I think all you can do is find a psychiatrist you trust and do your own research to make sure you understand their approach.

My daughter was on Lexapro, which is 2nd generation celexa, and took the very highest dose before she weighed 100 lbs. I have been told by several psychiatrists that kids metabolize drugs quicker and you can't just go by body weight when dosing. Sometimes kids need higher doses than adults due to their faster metabolism. She was able to take it and get off from it when needed without any side effects.

 

[timer lady]

Andy, I didn't read all of the responses so sorry if I'm being a bit repetitive.

Along with the medications is difficult child doing relaxation & other skills that will help him work thru the anxiety. You not feeding into is good - I was infamous for asking the tweedles if we needed to amputate when the anxiety & hurt over a scrap got out of hand. "Mom, you can't do that for a scrap". So how about a bandaid & a kiss?

wm is using a notebook to work out the pros & cons of some things while using his art to self calm.

kt is using her journal a great deal & reading to self calm.

This has taken years of practice; years of constant reminding to use their self calming tools. And the tools have changed over the years.

I've learned that the medication is just one small part in this process.

Hope difficult child settles a bit before school starts. Maybe he needs to sit down & start writing a book on anxiety from the teen's point of view. Hmmmmmm.

 

[BusynMember]

Overmedicating can CAUSE anxiety, if the person is afraid of the way the medications make the person feel. Actually, you really need to look for that "exact" dose. Hard, I know . I tried umpteen medications before I hit the jackpot, and I had to be put on quite a high dose of Paxil for the Paxil to work--60 mgs. And it took eight weeks before it kicked in and I was ready to think, "Great. Another medication isn't working." The benzos helped me at once, although I personally never cared for the dreamy way Xanax made me feel. It reminded me of my depersonalizatioin/derealization, which was hello. I think a lot of therapy is extremely helpful. Each session reminds you of what you are supposed to be working on, and I always really worked hard on the skills. Desensitizing is great for a focal fear, such as heights. I'm not sure how it could work for generalized anxiety disorder or a fear of something like illness. I do know first hand that anxiety can be well managed if approached on several fronts. Therapy in anxiety disorder is invaluable and many people respond to the more "reality based" methods.

You really need to strike a good balance. I had as bad a time with undertreating as with overtreating. Anxiety prone people are very tuned into their body sensations and if a medication gives off an unpleasant side effect, we think about it more and worry about it more. And sometimes, as I said earlier, once a medicine poops out on a lower dose, it has pooped out on you completely and you need a fresh medication. I was alarmed when this happened to me on Prozac, which had seem miraculous for me. I felt GREAT!!! Then one day it pooped out and I was more depressed than when I started it. The doctor increased it to 20 mg. then 40 mgs. but each increase only made me feel worse and I had to switch ADs completely.

Try the increase and see. This is pretty much all trial, error, and therapy. Good luck!!!