Interesting case study - treatment of oppositional teen with high dose SSRI + Oxcarbazepine

[mindinggaps]

Hello all, in case it is of interest to any parents, I wanted to share an interesting case study I came across - Intermittent Explosive Disorder in an Adolescent Treated... : Journal of Psychiatry Spectrum

Here a teen with severe conduct issues, formally diagnosed with Intermittent Explosive Disorder (IED) was treated with incredible success. She was 17 years old with a long history of behavior issues. At treatment her symptoms were severe physical aggression, school refusal, low mood, fatigue, and death wishes. She had explosive episodes of aggressive behavior involving physical assault lasting for over one hour which were unprovoked. After several months of treatment with a high dose of SSRI (sertraline) in combination with a medication I am not familiar with oxcarbazepine, she was symptom free with absolutely zero aggression.

I thought this was very interesting because I've been treated with high dose SSRI (fluoxetine) since age 5 for similar issues, also with a high level of success. My cocktail is different than the one here, but what is worth flagging is that high dose SSRI seems to be key - the authors of this case study say that there is increasing evidence that high dose SSRI are an essential part of limiting aggressive behaviors in personality disorders.

Anecdotally, I can confirm that if my SSRI levels are not kept high enough, extreme outbursts are likely.

 

[Deni D]

This is an interesting case study. I like that it talks about behaviors and limits the discussion on what the specific neurotransmitter effects are from the medication, for us lay people. Of course the other case studies where they go deep on what neurotransmitters are affected and how are very important for ongoing research.

I really wish we were further along with determining which medications, and which dosages, work best for individuals. I haven't kept up on current news on the genetic testing to help figure out what medications will work best. My son had the testing done years ago. But then as promising as it seemed it was going to be, it fizzled out with anecdotal evidence that it didn't really help.

 

[mindinggaps]

@Deni D Agreed - it's always interesting to find publicly available case studies presented in a manner which can be easily understood by those outside of the medical community. As you say, everyone is able to understand the behaviors and how they are impacted by the medication, but the research on how the medications are impacting brain chemistry is not easy to digest.

I really wish we were further along with determining which medications, and which dosages, work best for individuals. I haven't kept up on current news on the genetic testing to help figure out what medications will work best. My son had the testing done years ago. But then as promising as it seemed it was going to be, it fizzled out with anecdotal evidence that it didn't really help.

Unfortunately, not a tremendous amount has changed with genetic testing. It does tell you how a medication is metabolised in the body, but there still isn't tremendous evidence that indicates this maps onto how effective the medication will be. We are still very much in the trial and error phase of things. However, I do think lots of progress is being made on understanding which classes of medications should be used in a given set of circumstances. As outlined here, while we don't know exactly which medications to use, we know that in the case of extreme aggression where things like atypical depression are ruled out, high dose SSRI is a good place to start. In my opinion, part of the challenge is that ODD and CD in children can lead to many different diagnoses in adults. So first you have to get the right diagnosis in adulthood and whatever it is almost always requires treatment with several medications of different classes, so it becomes a huge challenge. I take 5 medications across 4 different classes and this is by no means unusual...

I do hope things improve with further research. I've had a lot of experience with medications and always volunteer my data to be used for case study research in the hope that it can help.

 

[Nomad]

Someone just the other day asked me about genetic testing for psychiatric medications. I know little to nothing about this. Would like to learn more.

A medication…Trileptal ….was mentioned in the article. Some knowledge of it. Worked like a (for lack of a better way of putting it) gentle mood stabilizer for our now adult child. Do not recall any noticeable side effects.

 

[Nandina]

My son was on Trileptal as well (actually the generic Oxcarbazepine). I think it helped manage his anger but as soon as he turned 18, he stopped all medications and subsequently all his troubles began.

 

[mindinggaps]

@Nandina Thanks for sharing. It seems Trileptal is more common that I was aware of for aggression and anger.

I am very sorry to hear that your son stopped his medications. It is extremely challenging because as a parent, there is little you can do in this situation. Unfortunately I think this is extremely common and results in problems of varying severity. For many disorders, the desire to stop medication is actually part of the disease. I myself stopped medications at age 18 in an act of rebellion. The results were disastrous. However, fortunately there was intervention before things spiraled out of control or things like addictions entered the picture. But as a parent, it is out of your control.