medications question

[KarenB]

I noticed that a few of your difficult children take Lexapro for anxiety. I have posted a few times about my difficult child and his behaviors lately. I believe the Zoloft simply has to go. I called the psychiatrist's office yesterday about my concerns. I described the suspension for taking a knife to school, the slicing our kitchen counters and stabbing holes in our walls with knives, stealing, elaborate lies, breaking into our neighbor's house, defiance, etc..I voiced my concerns about the recent increase in Zoloft. The psychiatrist wasn't in the office yesterday, but I was assured he would call today. NO call!

At any rate, I was wondering if maybe Lexapro could help him. I think his hoarding food is, like some have mentioned here, a result of anxiety. He doesn't sleep well at night either. Any opinions about Lexapro?

 

[smallworld]

Obviously, we're not doctors and can't diagnosis or treat over the internet. This is JMHO, but I would wean him from Zoloft and then get a baseline on his behavior (is it worse, better or about the same without Zoloft). That baseline willl give you a lot of information on how you should proceed.

Zoloft and Lexapro are both in the same class of medications (SSRI antidepressants). Some kids have a bad reaction to one SSRI and then do fine on another. Some kids actually have a mood disorder (with anxiety at the core) instead of straight anxiety/depression and need mood stabilizers instead of SSRIs. Some kids (like my daughter) can handle an SSRI like Lexapro only with a mood stabilizer on board first.

If you are not satisfied with this psychiatrist, please seek out a second opinion with a skilled board-certified child/adolescent psychiatrist.

 

[gcvmom]

Smallworld makes excellent points, as usual

For my difficult child 1, Lexapro helped him with a needle phobia and his overall anxiety in general. He's now able to get through blood draws without Ativan and without Emla numbing cream and without ME! I have standing orders to wait in the lobby while my little big man saunters in by himself. He says he still has to psychiatric himself up for it and use deep breathing techniques that he's learned, but he doesn't have panic attacks over it anymore and he feels more in control of the situation than ever before.

 

[flutterbee]

I love Lexapro, both for myself and my daughter (however, she's currently not being medication-complaint....'nother story). The anti-anxiety portion starts to work almost immediately.

That said, I agree wholeheartedly with Smallworld. I would wean him off the Zoloft and see where you're at. If at that time he still needs something for anxiety and you try another SSRI, I would start low and increase slowly.

 

[pepperidge]

I would be incredibly reluctant to try any other SSRI, if indeed the SSRI is causing the disinhibtion you are seeing. I would want to begin titrating down immediately, though you shouldn't do that without psychiatrist's ok. If it were my kid, I would do it anyway, but that is just me. Smallworld's advice to seek out a highly qualified psychiatrist is a good one. I'd make sure it is one with lots of experience prescribing mood stabilizers and ant-psychotics.

my oldest (who had a bad reaction to both Prozac and Lexapro), has high anxiety and depression. For him the combo of Lamictal which really helps with the depression and Risperdal seems to have reduced his anziety. Also we are able to use only a real low dose of Adderall. We had to more than double his dose of Adderall to maintain while he was on Prozac, which didn't help his anxiety. it was bad all the way around.

You may find if you d/c the SSRI that you are able to lower his dose of Concerta a bit which might help also with anxiety.

Zoloft does seem to help my youngest a bit with his obsessive looping about things, but after my oldest's experience with SSRI I refused to try it until we had tried everything else. It is helping, but even so I am reluctant to raise the dose. So I am not anti SSRIs, but I am really really gun shy about them.

 

[smallworld]

About a year ago, I had the opportunity to ask Dr. Daniel Pine, an NIMH psychiatrist who specializes in childhood anxiety, about bad reactions to SSRIs (which are the treatment of choice for anxiety). He said there are three types of reactions: 1) disinhibition, which is related to medication and dose and goes away when the medication is discontinued; 2) hallucinations, which again are related to medication and dose and go away when the medication is discontinued; and 3) mania, which is related to a mood disorder and does not go away when the medication is discontinued. In the first two cases, Dr. Pine prefers to trial a second SSRI before he rules the entire class of medications out.

My son experienced the third type of SSRI reaction so he needed to be put on mood stabilizers and an atypical antipsychotic. Same with my daughter A. But my daughter M experienced the first type of SSRI reaction. Even though her psychiatrist wanted us to trial another SSRI before ruling out the medication class, we declined because of the family history and instead are trialing Remeron, which is in a different class of antidepressants. Like pepperidge, I am extremely gun-shy about SSRIs.

Clearly, medication reactions, both positive and negative, vary widely by child. The only advice I can offer is to find a competent psychiatrist who will work closely with you and your child to find the best combo of medications for him.

 

[Sara PA]

Is Zoloft the only antidepressant your son has tried?

 

[BusynMember]

Lexapro is pretty strong. I hear it's like Celexa-plus. I've trialed most antidepressants and have given Prozac to my son and daughter short term. I would be leery about putting any child who had one bad reaction to an SSRI on another one. It just isn't a risk I'd want to take. SSRIs can help anxiety, if the person is compatible with the particular SSRI. However, there are no guarantees and SSRIs can make one considerably worse. My daughter pulled a knife on herself. My son got manic. I ended up in the hospital on Zoloft. Paxil worked for me big time, but I wouldn't even give that one to a child. For anxiety in my opinion, if it was my child, I'd prefer trying something like a low dose anti-psychotic first. Those can also have bad side effects--you have to watch ALL medications--but at least they don't make a child manic or suicidal. JMO (from long experience)

 

[Sara PA]

MWM -- You mention your daughter pulled a knife while on an AD. Both my son and my nephew were overly interested, shall we say, in knives when they were on ADs. My son pulled a knife on me more than once, used a knife to cut himself more than once; my nephew use to play with a knife in his bedroom, putting little cut marks in everything. KarenB's son is taking an AD and to many of us it seems obvious he's having a bad reaction and he got in trouble with a knife. I wonder if this is a coincidence?

As for the Celexa/Lexapro connection -- Lexapro is the same chemical composition as Celexa but the parts are arranged differently. Lexapro is suppose to be "refined" Celexa and have fewer side effects. Nevertheless, like Celexa, it isn't approved for use by children or adolescents. The recommended dose of Lexapro is 10 mg; the recommended dose of Celexa is 40 mg. That makes it about 4 times stronger, mg for mg, than Celexa.

 

[KarenB]

I thank you all for your replies! I feel the support here from all of you, and it is like a weight off my shoulders.

Sara,
I'm also wondering about the knife interest also. He has stabbed our walls, sliced our counters in the kitchen, been suspended twice now for taking a knife to school, and my husband has confiscated three knives recently difficult child had hidden in his bedroom. And, he also carved the words "kill me" in his arm.

Yes, Zoloft is the only AD difficult child has ever been on.

I know it's not advisable, but since the psychiatrist doesn't seem to feel the need to call me when I described all these behaviors I think I will cut his 100mg Zoloft in half starting Monday, if I can't get in touch with him. His 50mg dose was doubled about 6 weeks ago. I think disinhibition is what's going on, but we'll see how things go. I'm not ruling out a mood disorder. I still feel getting him off both medications would be a good thing. He just started seeing this psychiatrist, and has only been to him twice. I got the sense this psychiatrist was willing to work with me and listen to my suggestions, unlike the previous psychiatrist.

 

[Sara PA]

Zoloft has the longest half life of any of the SSRIs. Withdrawal is usually easier than with the others. Halfing the does of ....say.. Effexor might be too much too fast but it should be ok with Zoloft.

 

[Steely]

I think I would agree with you Karen. I think you are completely on target with d/cing the Zoloft and seeing if this helps. In the meantime I hope you can find a dr that is more attentive and educated about the effects of SSRIs and mood liable children.

I think this has been mentioned before, but your son is on 2 medications that can increase mania, and impulsivity - in my opinion a dr needs to reassess difficult children whole medication regimen. Has your son had a neuropsychologist exam? Thinking about this further, your son sounds as if he is a danger to himself and others right now - why not put him in a phosph so that they can try and get his medications right in a safe environment?

 

[Sara PA]

Someone has to be an eminent threat to himself or others before he can be commited to a hospital. Chances are, their insurance won't pay for a stay long enough to safely remove an antidepressant. Even cold turkey, acute withdrawal lasts about two weeks, give or take, depending on which AD. The night my son tried to kill himself he pulled a knife on his father and me. He was crazed, clearly, and dangerous. He spent slightly longer in the psychiatric unit than he spent in intensive care. He was home in less than a week.

 

[Steely]

True for some circumstances - however - I have had difficult child in phosph for up to 3 weeks at some places because he was suicidal and violent. A lot of it depends on the city, the doctors., the insurance, as well as how pushy and adamant you are as a parent that the kid is not ready to return home. In fact the last place difficult child was, they did not want to release him after a week, but because I felt they were doing such a poor job of treating him, I wanted him out. I actually had to sign an AMA waiver to get him released which was a huge surprise to me. I know this is quite opposite from the norm, but I think we have to realize it varies for each situation and each person.

Personally I would never rule phosph out as an option because even 3 days can be a wake up call, a fresh set of eyes, and new connections for the parent to make with doctors and counselors.

 

[crazymama30]

I don't know much about the SSRI's, but I know (or I feel) that a good psychiatrist has to be responsive when called with a serious concern. The reaction is very serious and concerning, and I would discontinue the medication also, but I would find a different psychiatrist it at all possible, in my humble opinion.

 

[Sara PA]

Well, it's no secret I blame the medical industry for almost destroying my son. If the doctors had recognized an adverse reaction to an AD when they saw it, things would have never gotten as bad as they were. But noooo, instead we got "that doesn't happen, these drugs are safe and effective, it must be your parenting." After our first experience with phos, I decided my son would go back to one over my dead body, literally.

 

[jannie]

My 8 year old is now on 10 mg lexapro. He started it about three months ago and it really seems to make a difference. He seems less agitated and more flexible with his thinking. He is just a bit more laid back and responsive.

My older difficult child 2 was on zoloft for about two months and it make him hyper/manic. He stopped zoloft on started lexapro..he was on 5 mg and then 10 mg...back down to 5 mg and now he's off it comletely and he's trialing lamictil. I think the lexapro was making him a bit manic...although now that he isn't on lexapro he's a bit less willing to try new things...he also gets overwhelmed in large settings..at times.

 

[KarenB]

Thanks everyone!

So now the plan is to call the psychiatrist tomorrow. If no response, I will half the Zoloft until I can get a response, and start looking for a new psychiatrist.

 

[Futurama91]

I know it's not advisable, but since the psychiatrist doesn't seem to feel the need to call me when I described all these behaviors I think I will cut his 100mg Zoloft in half starting Monday, if I can't get in touch with him. His 50mg dose was doubled about 6 weeks ago.

It's super dangerous to decrease it yourself and it's very dangerous to do it aggressively. My daughter went to the hospital for a few days and they kept telling me not to give her her Zoloft. Well, she got very, very sick. We couldn't figure it out. They tested her for crazy things.

We were back at the Dr. just 90 minutes after they released her. She was so sick!

I called her psychiatrist and asked him it was possible that these symptoms were withdrawal. He said possibly. I gave her a dose that night and a dose in the morning and she was totally better.

At that point she hadn't eaten in about a week, she had a fever, she was nauseous. SSRI withdrawal is serious. Be careful.

 

[KarenB]

Thank you. I hope I can get in touch with the psychiatrist.