UPDATE-Can anyone help me figure out meds issues?

[JTsMom]

Update:
After we ditched the Prozac, we waited for just a little while, then started generic Zoloft (Sertraline). It was the lowest dose, split in half, and he's been on that for about 3 weeks. The psych was reluctant to try another SSRI, but decided to go for it. He felt with the strong reaction last time, this probably wasn't the type of drug for him.

It's definitely better than the Prozac, but I don't think it's strong enough b/c the anxiety is coming back. We're also still seeing aggressive behavior, including hitting, kicking, and throwing things. He's sleeping much better though, and there has been none of the mania or other side effects. I followed up at the 2 week mark, and he requested we make an appointment because "there is a lot to discuss". That appointment will be on Wednesday. H

I'm reluctant to totally abandon treating the anxiety, but one option would be to try the 5-HTP again, and possibly Intuniv, and hope that the 5-HTP works well enough to get us by. I'm thinking if we turn our attention back to the ADHD, maybe life will be a little easier, because right now, everything is a struggle, especially schoolwork. 5-HTP wasn't strong enough in the past, but there were no side effects, and it was better than nothing.

How bad do the side effects have to be for you to have to give up on a drug? Would the aggressiveness be a deal killer for you? I'm thinking yes, but I'm starting to wonder if we're ever going to find something that works without them.

I'm sure the psychiatrist will have his own thoughts, but I want to go in with an idea of what I want.

_____________________________________________
I just want to brainstorm with you guys a little. I really like our psychiatrist, but I want to go in with a little more knowledge and my own opinions.


Quick summary:

-Jason is 7.5. His current diagnoses are Asperger Syndrome, ADHD, anxiety, and a medical phobia. He also has a serious cardiac condition. The Asperger's diagnosis is a newish one. His psychiatrist has mentioned it might not fit perfectly.

-Current medication-Fluoxetine, 10 mg

-We have tried numerous no-med treatments including multiple diet changes and various therapies with no success. We've also tried different supplements. The only one that made any difference was 5-HTP. We discontinued it around Thanksgiving b/c it wasn't enough, and we wanted to try an SSRI.

-We started off trying to treat the ADHD with stimulant meds (Vyvanse). He was having some side-effects that concerned us, then had one incident that scared the crap out of me, so we switched gears and decided to try to address the anxiety first. Stimulant meds have a black box warning for kids with heart defects. Although his cardiologist has OK'ed the meds, they make me a nervous wreck. At the same time, I know he can't continue to live like this. We also tried Hydroxyzine with no success.

Current major issues- Extreme hyperactivity, inattentiveness, anger, defiance. The anxiety is much better on Prozac, but after we went off the 5-HTP, it was really bad. Like, couldn't function bad.

Current side effects- The hyperactivity is more like mania at this point. I can not even describe the noise level in my house. He is doing things like lying, sneaking around and swearing, which is not typical for him. He is becoming mildly physically aggressive at times. He's not sleeping well at all. It's always been difficult to get him to sleep, but once he was out, he slept well. Now he's sleeping much less, it's almost impossible to get him to sleep b/c he is so wound up at bedtime, and he's waking up at like 6. He's probably getting 3 hours less per night. He's tired during the day, and falls asleep on short car trips. In the past, he's had some OCD tendencies, but they've been gone for a while. Now, they're starting to show up again.



My thoughts- It is obvious to me that he needs some med that will address the anxiety, and that SSRIs help. The side effects are bad though, and making the other issues seem far worse. It's hard to tease out what is causing what though, and I think we're going to be experimenting for a long time. I wonder if any combo will ever work.


I welcome any thoughts you all have.

[TwoBees]

I'm not an expert by any means, but I have a few thoughts:

Have you tried Intuniv, which is a non-stimulant ADHD med?

Have you tried moving the meds to different times of the day or spacing them out?

Have you tried different SSRIs or maybe something that is not an SSRI (Wellbutrin?)

to you mama, I hope you figure this out.

[JTsMom]

Thanks for your input TwoBees.

I'm not an expert by any means, but I have a few thoughts:

Have you tried Intuniv, which is a non-stimulant ADHD med?
We haven't yet, because we decided to try to deal with the anxiety first- I think the psych is trying to do one thing at a time. At some point, that's on my list though. The psych doesn't seem to have high hopes for it b/c of how bad the hyperactivity is, but my hope was/is that dealing with the anxiety might help bring at least some of the behavioral issues under control, and the Intuniv might be enough.


Have you tried moving the meds to different times of the day or spacing them out? Right now, we're only doing the one (plus a multivitamin). I try to give it to him as early as possible at the psych's suggestion, hoping that it will wear off a little so that he can sleep. It doesn't seem to be happening though.


Have you tried different SSRIs or maybe something that is not an SSRI (Wellbutrin?)We've only done this (we're at 3 weeks), plus a couple days of the Hydroxizine. I'm definitely open to suggestions on specific ones, and the psych is good about listening to my ideas. We did discuss Wellbutrin, but he said that in someone with anxiety, it's usually a really bad situation.

to you mama, I hope you figure this out.
Thank you!

[egoldber]

FYI, fluoxetine is what older DD takes.

How long has be been on the SSRI? It takes at least 3 weeks to reach full therapeutic dosage. However, when we tried sertraline (Zoloft) with older DD it was a disaster and we knew it pretty positively by about 14 days in. The psychiatrist had us step down off the Zoloft and on the Prozac at the same time. (I posed about it here: http://windsorpeak.com/vbulletin/sho...ghlight=zoloft)

The Zoloft absolutely increased her anxiety levels and she became defiant and out of control which is not like her.

So the upshot is that while SSRIs can be amazing, it can be very much a trial and error process to see which one works. The psychiatrist had 2 or 3 other besides Zoloft and Prozac to try for her, because these reactions are not uncommon.

Have you talked to the psychiatrist?

[JTsMom]

FYI, fluoxetine is what older DD takes.

How long has be been on the SSRI? It takes at least 3 weeks to reach full therapeutic dosage. However, when we tried sertraline (Zoloft) with older DD it was a disaster and we knew it pretty positively by about 14 days in. The psychiatrist had us step down off the Zoloft and on the Prozac at the same time. (I posed about it here: http://windsorpeak.com/vbulletin/sho...ghlight=zoloft)

The Zoloft absolutely increased her anxiety levels and she became defiant and out of control which is not like her.

So the upshot is that while SSRIs can be amazing, it can be very much a trial and error process to see which one works. The psychiatrist had 2 or 3 other besides Zoloft and Prozac to try for her, because these reactions are not uncommon.

Have you talked to the psychiatrist?

We started at 5 mg 3 weeks ago, stayed at that dosage for 2, then upped to 10mg last week- this is day 7. Do you think there is a chance the side effects will go away if we continue? Or will they just keep getting worse as we up the dose?

I've been emailed with they psychiatrist, but haven't spoken to him yet this week. The issues were similar on the lower dosage, but are more severe on the higher one. I was a little surprised he upped it after my description, but he didn't seem too concerned. He just told me to up it, try to give it earlier, then report back.

Off to read your thread.

[egoldber]

It is possible they will get better, but I would not let it go much longer than a week. I would call the psychiatrist back and ask how long they want to continue because things are NOT better.

[JTsMom]

So after just spending a frustrating hour trying to get through math with him, I just took a few minutes to email the psychiatrist. During the 5 minutes that took, he went upstairs with his little brother, and they both colored all over their entire bodies, and the bed sheets. We have always had behavior and impulse control issues, but he has never done anything like that in his life.

[egoldber]

I would call the psychiatrist ASAP and ask for a med change.

[JTsMom]

He usually gets back to me within an hour or so, so I'm going to give him thirty more minutes, then call if I heard from him by then. I sent a second email describing what I found too. The first one including a bullet point list of all of the issues I'm seeing, so hopefully it will be pretty clear to him.

On a mom to mom note, you could have knocked me over with a feather when I walked into that room. My jaw is still on the ground. I knew I wasn't just imagining the change, but to see it so clearly displayed.... wow. That left zero room for doubt.

[cuca_]

I agree with Beth. Ask for a med change. My DD takes Setraline for anxiety and Vyvanse for ADHD. We are in the process of figuring out her ADHD meds and it has been a long road.

IME a change like the one we are describing is due to the meds. DD had a similar reaction to one of her stimulants. She became defiant, began tantrumimg and was acting in ways that were not typical for her. As soon as we took her off the medication the behaviors stopped.