Medicating kids for anxiety

[mswax]

PDQ

DS3 (he's 7) has been struggling.  He's always struggled with anxiety, new/different situations, etc.  The shutdown in the spring was awful, and he spiraled quickly; refusing to do remote school, exploding at everyone in the house over seemingly minor things, and physically lashing out in BIG ways.  I reached out to his pediatrician who put us in contact with a therapist.  We've been seeing the therapist via Zoom since late April/early May.

Things improved over the summer (still not good, but I was no longer worried he was going to hurt himself or others in a serious way), and were operating in this not good but survivable way through December.  Things started to go downhill with the holidays...we didn't do our normal Christmas, etc. He started twisting/pulling his hair to the point where he has bald spots.

Then, our babysitter got covid and everyone had to quarantine and get tested.  That was the straw that broke the camel's back.  He had a full-on panic attack before his testing appointment.  We can't get him to do the most basic of tasks; shower, brush teeth, etc.  School has become a nightmare.  He won't leave the house.

He has all these BIG feelings and emotions, and even after "seeing" a therapist for 6 months, he can't/won't verbalize them so we can help.  The telehealth appointments are just not working for him...and the current situation of explosions and refusal to do necessary self care activities is not sustainable for anyone in the house.  His therapist agrees it's time to discuss medication. 

If anyone else has been there, what should I know/ask about before we take this step.  It feels like I've failed him, but I'm at the end of my rope and don't know what other options we have.

Thanks.

[longtimenopost]

My 8 year old DD was diagnosed with adhd a couple years ago and anxiety this past summer, and we have been trialing meds for the past few months. We started adhd meds with the pediatrician first, but she felt out of her depth when moving beyond that (which I respected and appreciated) and she referred us to a psychiatrist at our children's hospital. We have tried a couple of SSRI's - lexapro and prozac. They do work to decrease the anxiety and we are having fewer instances where she just gets caught in a loop and stuck which was leading to absolute meltdowns.

Physical side effects have been mild - some stomach issues the first few days and they do take a while to kick in. The hardest thing about the SSRIs we've seen is the (common) side effect of disinhibition (which is why they carry a black box warning). She generally no longer gave a f*ck about the rules at school or at home, and her impulse control lessened even more. We've had a heck of a time finding the right adhd med to balance that out. It might not be a problem for your DS if he doesn't already struggle with impulse control, though.

[mswax]

longtimenopost, We definitely have impulse control issues. Once he gets "set off," he will lash out physically are people and stuff. We call it "scorched Earth" mode. I guess I was hoping that the medication would help with that, certainly not make it worse, but it sounds like it something I should ask about for sure.

[kdubs923]

Aw, hugs. I don't have advice about medicating DS for anxiety, but I can tell you about the decision to medicate DS for ADHD. I similarly felt like I had failed him. We had tried so many different strategies, at home, at school. We tried so hard to avoid medicating. He got to the point where he was getting depressed because he knew he wasn't like other kids, was always having bad days, always having negative attention. We were always trying to manage his impulses, his hyperactivity, his behavior, etc. And he was always on edge, knowing he was supposed to be managing his impulses & behavior, but it was out of his control... It felt like that was all there was about him, he wasn't just enjoying and living. I can imagine your son might be feeling the same way. I'm sure he doesn't like the way he's feeling either. It probably feels very out of control for him and he likely wants to be 'normal' (back to his old self, normal).

Medication has been life changing for DS. All the coping strategies in the world couldn't help if he wasn't in the place to be able to accept them and implement them. Medicating him has gotten him to a state where he can stop, think, and use the tools we've worked on, instead of just trying to force his way through life in a way that wasn't working for him.

I had similar experiences myself, being medicated, first for depression, then for anxiety. There's so much pressure - you know you shouldn't feel anxious/depressed, but you feel it anyway, which makes you feel worse, you kind of spiral about how you should feel vs. how you actually feel. Meds might be able to get him to a place where therapy and the strategies he learns there, can actually be implemented.

It's all a very personal decision. It's something you can try. If you decide it's not working well for your family, then you can always decide to take him off the meds (after talking to your doctor about the proper weaning strategy). It doesn't have to be permanent. (though if you decide to medicate - discuss with your doctor about how long you should keep him on it to see it's full effects).

Lastly - when deciding to medicate DS, the pedi asked if DS had difficulty seeing, if we would choose not to have him wear glasses. Of course not. Glasses are a tool that will help DS. Medication should be viewed the same way. It's a tool that will help your son be successful. DH actually need glasses as a kid and grew out of it - maybe DS will grow out of needing medication, too. Or he might be like me that needs glasses/contacts (and meds, lol) for the rest of their life. Needing glasses/meds/therapy/etc is just one small part of a person, it doesn't define them.

You're a good mom. You're not failing him. You wouldn't be here, asking for advice if you didn't care so deeply. <3

[rooster222]

That was the age that things became unmanageable with my dd. We did years of therapy before we tried meds. She takes zoloft now (a very low dose) and things are 90% better. She's still high maintenance but as she's gotten older it's been easier. I'm very very anti-jumptomeds but we weren't able to function as a family. Honestly, we should have done it sooner.

[rooster222]

Also, the part about not verbalizing things to the therapist is spot on what we dealt with. My dd's therapist said that she was like working with a much older child that refused to open up. As much as we reassured her, it had no impact. She hated seeing a therapist and was a master at changing the subject or talking around it.

[mswax]

rooster222, That is really good to hear. The current state of affairs is impacting DS1 and DS2 as well...the idea of being able to "function as a family" resonates with me so much!

[tealblue]

I think I mentioned this in the ADHD medication list. Ds was originally dx with anxiety. We tried just therapy for several years but he was still having issues at school, lashing out and getting in trouble for being physical with kids.

I decided there was not much more we could do with therapy alone and to add in medication. I don’t remember what all we’ve tried but one that he took earlier this 2020 school year, would make him ravenous. He was so hungry that he was shoving all the food (and buying extra snacks) at lunch and inhaling it all. In turn, he would end up making himself sick and vomiting pretty regularly at school. At home over the summer/weekends, he was eating a lot of food but more spread through the day so not making himself sick, but just gaining weight pretty quickly for him. I asked his NP to switch meds because he was eating too much food at school lunch (in a short period of time). Since we’ve switched meds again, it’s been better.

However, we were having issues with impulsivity as well - mostly being quick to hit or punch when he gets upset. So we added in adderall to help and it has been a huge change overall. There was discussion we may be able to stop his anxiety meds but not a priority until we get the adhd meds at a good level.

[rubiakt]

We started my daughter on Sertraline (generic Zoloft) for anxiety after working with a therapist for several year with little results. I was amazed at how much difference even the low dose seemed to make.

It was not that she was suddenly not anxious or having panic attacks, but that all the years of therapy and tools that she had learned but had been unable to access when she needed them, were suddenly available to her. Prior when we tried to help her calm her breathing or to focus on relaxing her thoughts she would spiral further into panic, but on the medication she seemed more open to trying techniques that she had been taught. I had no idea that this would be the way medication “worked” in her.

We have been very happy with the choice. In 6th grade she asked to stop taking it and I agreed to let her try because I wanted her to feel like it is her choice and that she is involved in decisions surrounding her body. At the beginning of 7th (this year) she asked me to make an appointment so that she could talk with the doctor about restarting because she felt like she needed it.

[tealblue]

Also, just wanted to say you are being a great mom with all this. It’s so stressful on our end as well and frustrating at the whole process and dealing with constant negative criticism from others (school, etc).

I’ve felt like such a shit mom, honestly. I know it’s not me but just the overall feeling is there. Hoping everything starts to look up for you both!

[gretchenindisguise]

My daughter is older (11) and she is currently on medicine for anxiety. I wish we had started earlier, but I was pushed back by her pediatrician. We finally started seeing the doctor within the practice who specializes in behavioral health and it was great. We are on our 2nd medication and the change in the past 3 months has been incredible. Shortly after we also finally hooked up with the right therapist for her, after striking out with two others. The combination has helped to get our daughter back.

One thing we struggled with a bit was our daughter's resistance to the medication. Her brain challenged it and made her feel worse for needing it, "I shouldn't need it" "I should be able to do this, "this proves how messed up I am" etc etc etc. We never pushed that on her, we normalized as much as we could, her therapist did as well. It took awhile but now she takes it without a fight and I think without shame.

[wanderingback]

I’m not a parent, so no experience there, but I just wanted to say that anxiety disorder is a medical condition just like anything else so you did not fail. I’ve had a lot of kid patients do really well with medication for anxiety or depression and there’s no shame in that at all.

[dcrunnergirl52]

Jan 21, 2021 12:16:51 GMT -5 alicethellama said:

My DD was 7 too when we made the decision to start medicating for her OCD and anxiety, after a year+ of unsuccessful therapy. She was having huge outbursts and struggled too with self care tasks, going to school, etc. Basically she wasn’t functioning well at all, our family seemed in shambles from the stress, and we finally resorted to meds (Sertraline), which I felt immense guilt about.

It was the best decision we ever made. The road wasn’t easy, and we had to do several dosage increases (OCD in particular seems to require higher doses), but I have my daughter back. With the meds she was able to be receptive to therapy which we continued, and make strides there. I feared the pandemic would cause a huge setback for her, but she’s been able to handle all the stress and change it brought remarkably well, which I don’t think would be the case at all if she wasn’t on meds.

Please don’t feel like you’re failing your son. I felt guilty and so scared when we were considering meds, and shame for not being able to help her without it. My physician uncle told me something at that time that lifted that guilt: it was nothing I did, nothing she did, this was just her brain chemistry. And just like I’d give her insulin if she were diabetic, the med was a tool for her health. Wishing you peace and strength as you navigate this.

I was going to type out a long response but our experience with DS2 was pretty much the same as this. We started meds around 6.5 years old. Prior to that, he was diagnosed with ODD and OCD, both resulting from anxiety. To say it was impacting our whole family is an understatement. DD and DS1 resented how much attention that DS2 got, and DS3 (a toddler) started imitating DS2's outburts. It was awful.

What worked, and it took trial and error, is a combo of Lexapro to help with the anxiety (which took care of the OCD really fast) and guanfacine to help with the outbursts of anger and impulse issues that come with anxiety. We've worked closely with his development pedi, at times being in contact at night and on weekends to tweak things. We're in a somewhat good place now.

You did not fail your son. Our dr. basically said that this is his brain and there was no way we could "parent" our way out of the issues he was having with our regular toolbox of parenting techniques. Thankfully, we didn't have any hesitation moving to meds b/c DS1 has been on meds for years for ADHD, and we saw what a huge difference it made for him.

[longtimenopost]

Jan 21, 2021 10:44:21 GMT -5 mswax said:

longtimenopost , We definitely have impulse control issues. Once he gets "set off," he will lash out physically are people and stuff. We call it "scorched Earth" mode. I guess I was hoping that the medication would help with that, certainly not make it worse, but it sounds like it something I should ask about for sure.

So I want to clarify that she was more scorched Earth prior to the medicine, and while the impulse control worsened, it's different. Fewer tantrums, but more apathy when she is told to do something or not do something. She'll just do it anyway. It reminded us of the main guy in the Office Space movie  . It was tough at home, but way worse at school. She has to be able to follow the rules. Adding a stimulant has helped. 

[longtimenopost]

Jan 21, 2021 13:31:44 GMT -5 gretchenindisguise said:

My daughter is older (11) and she is currently on medicine for anxiety. I wish we had started earlier, but I was pushed back by her pediatrician. We finally started seeing the doctor within the practice who specializes in behavioral health and it was great. We are on our 2nd medication and the change in the past 3 months has been incredible. Shortly after we also finally hooked up with the right therapist for her, after striking out with two others. The combination has helped to get our daughter back.

One thing we struggled with a bit was our daughter's resistance to the medication. Her brain challenged it and made her feel worse for needing it, "I shouldn't need it" "I should be able to do this, "this proves how messed up I am" etc etc etc. We never pushed that on her, we normalized as much as we could, her therapist did as well. It took awhile but now she takes it without a fight and I think without shame.

My daughter is younger, more like OP's son, but we call her brain pills her "steering wheel." I came across somewhere, maybe here? an explanation of ADHD/anxiety as having a super strong, super fast brain. The medicine helps her control her thoughts and feelings, like a steering wheel. She also sees her dad and I take medicine for our medical needs and her sister wears glasses so we normalize in that way as well. 

[ellipses84]

I haven’t been in that exact situation, but I have been home with a highly anxious 8-9 year old during this past year and have a stepson who was on medication for ADHD when he was a kid. We’ve had some bad days and I’d definitely consider medication if there were more bad days than good ones and therapy wasn’t improving things.

I think you can look at it like you would look at other medical issues. There’s not many medical issues that you would let impact your life on a daily basis and not try a medication for after 6 months. It may help immensely, it may be temporary, it may be situational, it may help him recognize what it’s like not to feel hyper anxious so he can learn coping skills. If it doesn’t work, he can stop. You may also want to consider a different therapist or a different type of therapy. I’m not sure what he is doing and I knows it’s difficult on video calls, but I’m wondering if a more occupational type therapy would work and if there would be in person options for it if you were willing, or something with more concrete behavioral / coping goals.

[lilles]

Something to consider is that perhaps the therapist is not the right one for him. That and/or the fact that it’s via zoom. For that age play based therapy is usually best which is hard to do online.
So something I would suggest is switching to in person therapy as soon as it is possible in your area.

My six and eleven year olds are in therapy (we are fortunate that they can do it in person while wearing masks) and the eleven year old has an appointment with her pediatrician on Wednesday to see if she needs medication for depression.

I understand the feeling that we are failing them but remember that if you are doing the best you can especially in the midst of a pandemic. You are a good mother.

[dcrunnergirl52]

I agree with lilles that the therapist might not be a good fit, and neither may telehealth appts. And, honestly, my son couldn't really fully use the tools that he was learning in therapy until he was on meds...he was just too anxious.

Even on meds, sometimes the telehealth appts aren't great. His therapist is great at finding ways to do fun activities with him online to mimic play therapy (online sandbox to tell stories, reading books together, watching videos, etc.) but it's not the same as in-person. His appts usually only last about 25 minutes and then he's DONE (esp since he also does virtual school and he is just done with virtual stuff by then), but since he got on meds, he's been able to learn some techniques in there (in fact, he uses them on me sometimes when I'm getting upset, LOL).

[mswax]

Thank you all for the replies and kind words. We actually have an in-person therapy appointment this afternoon (if I can get DS3 to get in the car and go...TBD). I really appreciate everyone sharing your experiences. I feel very isolated when it comes to this, because no one I know IRL has any experience with this. We have have an appointment in 1.5 weeks with the behavioral doc who can prescribe meds, so I'm looking forward to another opinion and more solutions.