Need medication advice

Discussion in 'General Parenting' started by smallworld, Nov 10, 2009.

  1. smallworld

    smallworld Moderator

    My daughter A is 14 (will be 15 in February) and in 9th grade. Except for two small Lamictal increases last fall and this spring, she has been stable on the same medications since December 2006.

    Not only has A had a difficult time this fall adjusting to the greater academic and social demands of high schools, but we also believe she is experiencing hormonal shifts (she hasn't yet gotten her period, but we think she is getting closer).

    She called me to pick her up halfway through school yesterday with a stomachache. She didn't eat much and then didn't go to school today because of a headache and dizziness. No fever, no sore throat, no congestion, no cough. While she could have a virus, I'm suspicious anxiety may be at play because her symptoms are vague and she's experienced somatic issues before when her mood wasn't stable.

    In the last few weeks, she's been having trouble getting her homework done on time because she says she's not motivated. She claims she doesn't like her classes or her teachers. A is also worried that one of her close friends has a boyfriend, and she doesn't. This is all very unlike her.

    A week ago we increased her Lamictal dose by 25 mg (to 250 mg), but it either hasn't kicked in or it isn't going to help. She also takes 7.5 mg Lexapro for anxiety/depression and 25 mg Seroquel for sleep. Her psychiatrist is talking about increasing Lexapro to 10 mg, but I'm worried about a bad SSRI reaction. A became nearly psychotic on Paxil at age 10, her brother J has had manic reactions to 5 SSRI/SNRIs (even with a mood stabilizer on board) and her sister M became disinhibited on Prozac.

    Any thoughts on a Lexapro increase? And if we don't go with a Lexapro increase, any thoughts on what we should do?

  2. klmno

    klmno Active Member

    I think I would try it- right before the weekend maybe so you can personally watch for signs of instability yourself. Really, you're the medication "expert" here so I hestiate on this. LOL!

    My guess is that hormones are playing into this, as you suspect, and she's trying to adjust to 9th grade- I'm assuming she just started a new school this year. Plus, that all-dreaded female insecurity when she's worried that she's not fitting in as well as another girl. Do you think it's gone so far to classify it as depression yet? Will she talk to a therapist? Anything you can join her up in at school that might help her meet people? Does she have any old friends that she hasn't seen in a while that she could get together with for a sleep over or something else fun and reassuring? Would you feel comfortable "briefing" any of her teachers and letting them know she could use a little extra support at school right now?

    ETA: I'm just throwing those questions out to brainstorm, not that you need to answer them.
    Last edited: Nov 10, 2009
  3. pepperidge

    pepperidge New Member

    Hi smallworld.

    Don't have any good advice, though might be subclinical case of the flu.

    Reading your post my gut reaction was to wonder if perhaps some of this might be typical teen puberty stuff rather than difficult child mood disorder stuff. I wonder if she feels bad that she hasn't started her period? High school is such a big transition. Is it possible for her to take a reduced load next semsester or in some way scale back? Maybe she is feeling that pressure to perform now that she is in high school -- not from you but from peers etc in a high achieving community. Is she worried about her brother being away or being sent away herself?

    Maybe I am reacting to what I sensed unstated in your post, but it didn't strike me as much a medication issue as it did more of a teen/puberty/girl type thing. But then what do I know, I don't have girls.

    Sorry for all that you are going through.

    If I went up on Lexapro, I think I would wait until right before Thanksgiving vacation to see if there is any obvious overreaction. I would be worried too if I were you about medication increase especially if you are not totally convinced that it is something medication can address.

    Big hugs, P.
  4. flutterby

    flutterby Fly away!

    typical teen stuff or not, if one has an underlying predisposition for depression or anxiety, it makes typical teen stuff all the more difficult.

    My easy child is making an appointment tomorrow to get an AD. He's definitely typical teen, but is predisposed to depression and the normal teen issues are really effecting it.

    I know you know this. I'm just clarifying what I'm thinking. I'm also over-tired, so bear with me.

    I haven't found studies that show Lamictal to be any more effective over 200mg than at 200mg for a mood disorder. However, I haven't really looked very much and I know that Janet takes quite a bit more than 200mg and it helps her.

    Lexapro is very different from Paxil, although they are in the same class. She's been stable at 7.5mg without disinhibition, which would make me inclined to try the increase to 10mg - over a long weekend would be ideal. The nice thing about Lexapro is that improvements happen quickly, so you should know early on if it is really a medication issue or not.

    I'm sorry, I don't she in therapy? If so, any ideas coming from that direction?
  5. crazymama30

    crazymama30 Active Member

    That is such a small dose, I am with the one's who say start it before the weekend so you can watch her. I think what is going on with her maybe typical teen stuff, but for difficult child's it is just never that simple. I would have thought the Lamictal bump would have helped if it was going to, when we took my difficult child from 200mg to 250mg I could see a difference in a week.

    With that being said, I have heard some say that 200-250mg is the top theraputic dose. Not sure if I believe that as I have heard of people taking 400mg, but I am guessing you already know this.

    As for what else to try? I think at this point I would try the lexapro increase. Take it one thing at a time. If I get too many options spinning in my head it is not good for me, and therefore not good for my family (I realy can keep it together for them, I just fall apart here cause I can). If it does not work call the doctor and hopefully he will have another option in mind, from dealing with husband's & difficult child's psychiatrist many times they have a plan b and even plan c.

    Here's hoping the Lexapro increase does the trick!
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Yes I was very leery about upping the lamictal to over 200 mgs but it did help me even though I was against it. I am now on 400 mgs. I also think the seroquel helps with the anxiety too though. Maybe raising that just a smidge? I played with the dose of seroquel by cutting mine into tiny pieces for a long time because I really couldnt handle heavy doses. Heavy to me was 50 I was cutting it into 4ths.
  7. klmno

    klmno Active Member

    You must have really good eyesight, DJ! I had trouble keeping up with a whole one after I took it out of the bottle. LOL!
  8. gcvmom

    gcvmom Here we go again!

    What about a low dose (like 10mg) of propranolol/Inderal or something like that? Our psychiatrist rx'd it for difficult child 1 to help with anxiety last year when he seemed to be shutting down in some of his larger classes... although he felt it was more of the panic/overwhelmed type of anxiety. It seemed to help a bit.

    FWIW, difficult child 1 is in the same grade level as your A, and he's having some of the same "I-don't-like-my-class" issues in a couple classes. Does A have any extra-curricular activities she looks forward to at school? Sometimes getting them involved in a club or team sport or some other "fun" activity can help balance out the stuff they don't like about their day and make it more bearable. It gives them a sense of belonging and fitting in (that may be part of the boyfriend jealosy thing you are seeing -- not so much wanting a boyfriend but wanting to feel like she fits in. There are other ways of fitting in that don't hinge on your identity being connected to someone else). For difficult child 1, he's involved in orchestra and the lacrosse team. And he's been enjoying going to the dances (solo).

    This seems to be a tough adjustment year for our kids. Almost as bad as middle school!
  9. smallworld

    smallworld Moderator

    Thank you for all your feedback. I really appreciate it.

    A didn't have school yesterday (Veterans Day). Although she's been complaining of residual headache and dizziness, she made it to school today. She also began her after-school yoga class this afternoon, which seemed to energize and focus her for homework tonight. Her psychiatrist is glad she chose to do yoga for mental health reasons.

    A's not in a new school this year -- she attends a small (300 student) private school that goes from 7th through 12th grades. But her class added 25 new students this year, and the academic demands increased, which has definitely added to her anxiety. She played JV soccer this fall and definitely felt a part of things. Her lack of motivation may have begun around the time the soccer season ended.

    A doesn't seem concerned that she hasn't gotten her period because she knows that her delayed puberty will allow her to grow taller. She's much more concerned about her short stature (4'10"). She hasn't expressed concern that J is away or that we will send her away (she's no where near the difficult child her brother is). She just got her first term grades; they were all As and Bs and she seemed pleased.

    Heather, I think you hit the nail on the head. A has been so steady in her moods for so long that any change brings me back to that dark time in 4th grade when she could hardly get herself to school. I so fear that she will spiral down that I want to do anything possible to stop it as soon as I see the warning signs.

    A has been in weekly therapy since age 10. I think it helps somewhat. Her psychiatrist -- a young woman who is easy to talk to -- practices integrated care, which means she sees A for both medication management and weekly psychotherapy. A likes and trusts her, but she tends to be a bit reserved about her feelings. I think she's getting better about sharing; it's just taking her a while to open up. Her psychiatrist says this is not uncommon for girls her age.

    In terms of medications, I have to admit I have PTSD about SSRIs in general and Lexapro in particular. I realize they're different kids, but two years ago exactly, we increased J's Lexapro to 10 mg, and he ended up in a day treatment program for 6 weeks. I know from their reactions that too much Serotonin is bad for my kids, but I don't know how much is too much for A. Would 10 mg put her over the edge? That's the million-dollar question.

    J takes 400 mg Lamictal, and our neuro says A can go that high if we need to as long as she doesn't suffer from balance or gait issues. Today her mood seemed a bit brighter so maybe we're getting somewhere with the recent Lamictal increase. Time will tell.

    Increasing Seroquel is an option, although we've been trying to limit APs in our kids' medication mixes because of their long-term side-efffect profile. We just successfully weaned J from Seroquel, and we're about to take M off Zyprexa. I'd like to avoid exposing A to increasing AP doses if we can help it.

    gcvmom, Propranolol is not an option for A because it's contraindicated for kids with asthma. We had wanted her to start it for migraine prevention (it works great for J), but our neuro wouldn't allow it because she has several asthma attacks a year.

    Thanks again for your thoughts.
  10. pepperidge

    pepperidge New Member


    you said something that resonated quite a bit with me. I know that when I see the slightest increase in depression or anxiety or whatever in my kids, I internally tend to overreact and think that we are going back to the bad old days. Especially when you don't have any typical teen it is so hard to remember how much there is in the puberty time of ups and downs and whatever. These are difficult times in any kid's life and even more so for our kids. We know how bad bad can be and we don't want to let it get that way. But sometimes I am too quick to think that medication adjustments and whatever are necessary, I think.

    We has such a bad experience with Lexapro that I have PTSD a bit too. From what you say, it doesn't seem things are too far out of hand. Maybe just see how things go for a few weeks and then make a decision?

    Good luck with whatever you decide.

  11. ML

    ML Guest

    I understand your hesitancy about increasing the Lexapro but I would do it over the Thanksgiving week and watch close. You will know right away if there is a bad reaction. Otherwise I'd just keep doing the yoga and continue encouraging her to talk and practice CBT type stuff. Those hormones through you into a whole new ballgame. Oy! Good Luck! ML
  12. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I am interested in the gait/balance problems with lamictal. I didnt realize that could be a problem! Could you tell me more about that Smallworld?

    I have really bad balance problems and some gait problems but I have always attributed them to my ortho problems but they have worsened sense I have been at this upper dosage of lamictal...but then I have been getting worse with the arthritis plus the whole having to relearn how to walk didnt help either!
  13. smallworld

    smallworld Moderator

    Janet, do you see a neuro? My kids see a neuro for migraines. He was the one who said that Lamictal can cause balance and gait issues at higher doses. My kids do not ordinarily have those issues, and every time they go in to see him, he does some basic neurological testing to make sure they're neurologically sound (walking one foot in front of another along a straight line, balancing on one foot with eyes closed, touching index finger to neuro's index finger and then to child's nose). If you're at all concerned that Lamictal is affecting your balance or gait, I'd get a neuro involved.
  14. smallworld

    smallworld Moderator

    Small update on A: We figured out that her headaches and dizziness were side effects to the Lamictal increase and switched around the dosing to ameliorate the side effects. We also discovered that her Lamictal increase kicked in. Her mood is brighter, her work production is back to normal, and she's been talking more openly to her psychiatrist during her last two sessions. So it does seem as if a medication tweak was in order.
  15. DammitJanet

    DammitJanet Well-Known Member Staff Member

    No, I havent seen a neuro since a month out of the hospital last year. They released me to my psychiatric because they didnt want to mess with overlapping medications.