SSRI experiences with kids

[ginap]

We are planning to supplement my daughter's ADHD meds (Dexedrine) with an SSRI for anxiety and I am wondering if anyone has any experience with Prozac, Lexapro or Celexa with their kiddos. We tried Zoloft and it was not a good fit.

[akafred]

We have only tried Prozac as an SSRI and it was not a good fit, at all. It did an ok but not great job on her anxiety, but it caused sleep disturbances, extremely high impulsivity (she already has ADHD-C), as well as some other behaviors that were almost OCD-ish (intrusive thoughts and perseveration; no rituals that she shared with us). Guanfacine along with the Prozac helped tamp down the impulsivity but only a little bit. She also had a very hard time coming down; the emotional lability was so so hard.

Strattera, while it worked, was actually better for her anxiety than Prozac with far fewer side effects. She is back on it now, but the first time she needed dose increases frequently and "outgrew" the max dose within 6-8 months. She is back on and I can tell she needs more already after just a month or two, but she is already at the max.

[auntie]

DS has done very well on Paxil since he was about 7 1/2. Paxil would not be my first choice today as it has more side effects and black box reports than the other SSRIs, (DS started before these were known risks) but it has been wonderful for him.

DS also did years of therapy; CBT in his case. Assuming average intellectual abilities, medication is 1 leg of a 3 legged stool. Therapy/behavior mods and accommodations/supports are the other two.

When you say "not a good fit" what did you see? Unfortunately, prescribing this class of medication is as much an art as a science. Every one reacts differently to each one and it can take several weeks to find out if there will be an improvement on the medication. Sometimes is you see an improvement within days, it's a sign that the medication will end up being a bad fit or that the dose is too high for that person.

Of those you mentioned, Prozac has the advantage of having the longest track record for safety. Lexapro is considered to have the lowest number of side effects, but I personally found it very sedating. My mother has ADHD with wicked anxiety and some cardiac issues for which stimulants are contraindicated. Her psychiatrist prescribed Trintellix and it's been a real improvement for her.

The Dexedrine might be an issue, it can cause or exacerbate anxiety. Is this new for her? I'm also going to throw out my soapbox opinion that it is best to work with a psychiatrist for psychoactive medications- you want a specialist prescribing.

[agedsubaru]

We are trialing Celexa and while on Stimulants and Intuniv. After our experience, I would recommend trialing. Start at a low dose and work up. We also did a GeneSight. Not all buy into it but for my own reasons, I wanted to try it.

[funchicken]

We started DD1 on Zoloft a little over 2 months ago, and it seems to be a good fit for her. She used to go from zero to panicked in a matter of seconds when she was in anxiety-inducing situations. She's now able to stay calm enough that she can recognize that the anxiety is ramping up and actually use the skills she works on with her therapist and school counselor. Her overall mood seems better, too.

[akafred]

auntie, "not a good fit" in our case means that while Prozac improved her anxiety vs no meds, it wasn't as effective as Strattera, with unpalatable side effects. She developed a perseveration that became a real problem, and her traits that are OCDish (BFRB's including a sniffing habit that I'm not sure if it is a tic or a sensory issue and too frequent cleaning out under her fingernails increased -- I say OCDish because as far as I know they aren't ritualistic and no OCD dx at this time), and her ADHD behaviors, esp impulsivity which was already an 8 on a scale of 1 to 10, grew far worse. Now that she has been off the Prozac for a couple of months and back on Strattera those side effects are gone. Even in her pre-Christmas anxiety period, the impulsivity was down to about a 6 instead of a 10. Not good, far from good, but much less dangerous and challenging.

I'm not saying it's not right for everyone, but it was not a good fit for Charlotte. That is our experience. We may try another at some point but honestly it scares me considering the last 6 months have been really rough, even with lots of therapy and working on CBT and ERP and coping skills.

[auntie]

akafred,

That sounds like activation. FWIW, an uptick in nose-picking and sniffing is more often triggered by a stimulant according to DS's psych. In kids for whom sensory drives the bus, a stimulant can make them even more aware of sensory triggers.

It could be that even a small dose was too much for her. It could be that SSRIs in general, or Prozac specifically, aren't a good fit for her. Anecdotally, I know a few families who had similar reactions in kids both on and off spectrum who went on to become diagnosed with bipolar in adolescence. Aside from one who can not tolerate a neuroleptic (did great except for recurrent priapism), tiny doses of Risperdal or Abilify managed the anxiety without activation.

I wish it were possible for you to be working with a psychiatrist for Char given that it's been such a challenge to find the meds that would allow her to be her best self. I hope the Strattera holds for a while this time.

[akafred]

auntie, I wish it were possible too. My almost 17 year old niece wants to be a nurse practitioner in pediatrics, and I am trying to gently guide her toward pediatric psychiatry (as a nurse p) or developmental pediatrics. The need is so great across the country and in particular in my area. DD has a great pediatrician though. Unfortunately that is who does meds with Medicaid as a general rule in our state, so for better or worse they do tend to have experience with these meds.