My 12 yo's irritability is off the charts

[Anonymous]

I would hold him back in some nurturing private school and have no requirements for the year. Let him sleep when he wants to sleep. Learn new things. Let him see that its not just his environment that's bad but his reaction to it. That he will have to change in order to have a better experience.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Anxiety often looks like irritability in children. Autism can make that irritability worse. Stimulants can make anxiety worse. You need to talk to your psychiatrist if the stimulants might be contributing (have you had a recent dose or medication change) or if a SSRI or mood stabilizer (ie, abilify) might be appropriate. Abilify saved our family and I resisted it for far too long.

Op - I have talked to our psychiatrist another it, and our gp, and both say that ssris are not a first line treatment for a child of this age and they would prefer to exhaust numerous other approaches before going down that road. These are both highly respected nyc private practitioners - this is not quackery

What other numerous approaches are there besides therapy?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Anxiety often looks like irritability in children. Autism can make that irritability worse. Stimulants can make anxiety worse. You need to talk to your psychiatrist if the stimulants might be contributing (have you had a recent dose or medication change) or if a SSRI or mood stabilizer (ie, abilify) might be appropriate. Abilify saved our family and I resisted it for far too long.

Op - I have talked to our psychiatrist another it, and our gp, and both say that ssris are not a first line treatment for a child of this age and they would prefer to exhaust numerous other approaches before going down that road. These are both highly respected nyc private practitioners - this is not quackery

No one said SSRIs were first line treatment, but the OP has tried therapy alone already. Meds are indicated when therapy isn't sufficient.

[Anonymous]

Anonymous wrote:My 12 yo (adhd/ possibly audhd but experts have different povs on that) irritability is off the charts and i dont know what to do. EVERYTHING annoys him. I keep trying to do nice things with and for him and he's just annoyed. He has sooo much anger. He says he's tired all the time, or has headaches (have been to neurologist and all fine). He's in therapy with a great therapist, but i'm at a loss. I prefer not to put him on more medication on top of the stimulants but it's just a little heartbreaking. any advice?

Irritability is a sign of depression, especially in boys. My child with ADHD was this way (irritable) and it was depression. I didn’t realize it for years, and the depression seriously escalated. They are now on medication- stimulant for ADHD and anti-depressant. The anti-depressant is amazing and has had a major positive impact. Don’t be afraid of the medication. I know it is serious and scary. Children with disabilities are at a higher risk for depression.

https://www.mayoclinic.org/diseases-conditions/teen-depression/symptoms-causes/syc-20350985

[Anonymous]

Anonymous wrote:

Anonymous wrote:Anxiety often looks like irritability in children. Autism can make that irritability worse. Stimulants can make anxiety worse. You need to talk to your psychiatrist if the stimulants might be contributing (have you had a recent dose or medication change) or if a SSRI or mood stabilizer (ie, abilify) might be appropriate. Abilify saved our family and I resisted it for far too long.

Op - I have talked to our psychiatrist another it, and our gp, and both say that ssris are not a first line treatment for a child of this age and they would prefer to exhaust numerous other approaches before going down that road. These are both highly respected nyc private practitioners - this is not quackery

OP I understand your reluctance to jump straight to SSRIs - I have been on a dozen different ones as an adult before doctors figured out that like 30% of patients, I don’t tolerate them well and the side effects never resolved properly.

There is an abundance of evidence that lifestyle changes can be as effective as SSRIs at treating and managing depression and anxiety.

I would drill down hard on sleep hygiene (zero access to devices or TV during sleep hours), early morning light exposure either from outside activity (morning walk together?) or use of light box in the morning, meaningful exercise every day, meditation/breathing exercises, journaling, and cleaning up the diet - purge the added sugars and load up on whole food, cut the ultra processed stuff to the bone.

I struggled with refractory major depression, generalized anxiety and periods of suicidal ideation for years. I’m meds free and managing my mental health really well by reducing the negative aspects of modern society by giving my body the things it evolved to need and which promote optimal brain health: food that makes a healthy gut + hydration, plenty of sleep, exercise, light exposure outdoors as much as possible, quiet time away from devices.

Good luck with your boy, and hang in there.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anxiety often looks like irritability in children. Autism can make that irritability worse. Stimulants can make anxiety worse. You need to talk to your psychiatrist if the stimulants might be contributing (have you had a recent dose or medication change) or if a SSRI or mood stabilizer (ie, abilify) might be appropriate. Abilify saved our family and I resisted it for far too long.

Op - I have talked to our psychiatrist another it, and our gp, and both say that ssris are not a first line treatment for a child of this age and they would prefer to exhaust numerous other approaches before going down that road. These are both highly respected nyc private practitioners - this is not quackery

What other numerous approaches are there besides therapy?

One right above your q

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anxiety often looks like irritability in children. Autism can make that irritability worse. Stimulants can make anxiety worse. You need to talk to your psychiatrist if the stimulants might be contributing (have you had a recent dose or medication change) or if a SSRI or mood stabilizer (ie, abilify) might be appropriate. Abilify saved our family and I resisted it for far too long.

Op - I have talked to our psychiatrist another it, and our gp, and both say that ssris are not a first line treatment for a child of this age and they would prefer to exhaust numerous other approaches before going down that road. These are both highly respected nyc private practitioners - this is not quackery

OP I understand your reluctance to jump straight to SSRIs - I have been on a dozen different ones as an adult before doctors figured out that like 30% of patients, I don’t tolerate them well and the side effects never resolved properly.

There is an abundance of evidence that lifestyle changes can be as effective as SSRIs at treating and managing depression and anxiety.

I would drill down hard on sleep hygiene (zero access to devices or TV during sleep hours), early morning light exposure either from outside activity (morning walk together?) or use of light box in the morning, meaningful exercise every day, meditation/breathing exercises, journaling, and cleaning up the diet - purge the added sugars and load up on whole food, cut the ultra processed stuff to the bone.

I struggled with refractory major depression, generalized anxiety and periods of suicidal ideation for years. I’m meds free and managing my mental health really well by reducing the negative aspects of modern society by giving my body the things it evolved to need and which promote optimal brain health: food that makes a healthy gut + hydration, plenty of sleep, exercise, light exposure outdoors as much as possible, quiet time away from devices.

Good luck with your boy, and hang in there.

Op - this is awesome to hear!

I’m British and I do find the American attitude to ssris so odd. Look don’t get me wrong they’re a godsend if you need them and can be life changing, but to me it’s more of a journey to figure out what’s wrong first (therapy is part but not all of this) and try to address the root cause before jumping to ssri which regardless of what others may think is not a slam dunk choice for a kid. Even an adult on ssri needs to do this work whether before or after they start their medication. Even if I put him on ssri I still have to figure out what’s not working for him about his life. I do think screens are a big piece bc I’ve noticed him extra irritable when that time is interrupted. But then he has very little downtime too so that could play a part. School also starts way earlier than I wish it did and he has trouble getting to sleep so that’s a piece

[Anonymous]

Anonymous wrote:Even if I put him on ssri I still have to figure out what’s not working for him about his life. I do think screens are a big piece bc I’ve noticed him extra irritable when that time is interrupted. But then he has very little downtime too so that could play a part. School also starts way earlier than I wish it did and he has trouble getting to sleep so that’s a piece

OP you said you were British, right? I think I've hit on the reason you're getting all this SSRI advice. What you describe here - your thought process about what's not working for your kid, and the questions you're asking - it's pretty basic. Of course you need to figure out your own kid first. American families are bigger on communication, feelings, and therapy. The SSRIs aren't prescribed in a vacuum, we are doing the hard work along with it. And gently, based on your post here, you have a ways to go with this.

What advice do you need from us to help you figure out what's not working for your DS?

[Anonymous]

Did the irritability, fatigue, and headaches coincide with starting stimulants. I’m a big believer in how helpful stimulant medication can be. However, these are all possible side effects. Sometimes adjusting dosing or the medication can help.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m going to just be super blunt. You lost me at “I prefer not to put him on meds.” Families and the kids themselves deserve some relief. If my parents had towed the “I prefer not to put my depressed and irritable teenage daughter on meds” line, I’d be long dead by suicide. Your child is suffering from a real condition, just like cancer is real. He, and you, deserve relief.

op - sorry i 'lost you' but SSRIs for tweens are no joke. I have been told this by multiple psychiatrists. Every parent should start from a place of reluctance where these hardcore medications for kids this age are concerned. I encourage you to search on this board for multiple examples of why SSRIs are not a first line answer to these issues before you come with such certainty.

I started my adhd and ASD level 1 son on an SSRI at age 5.5 due to his unstable mood. He’s 7 now. Life was not sustainable for anyone that way. I hesitated before starting each medication he is on but I also trust my doctor in guiding us.

Prozac has been a huge help for him. It’s not perfect - he still has his moments with frustration tolerance and in some ways the Prozac heightens his hyperactivity, but he generally doesn’t fly off the handle anymore. Stimulants exacerbate irritability and when you’re treating more than one condition, unfortunately usually more than one medication is necessary.

Have you tried therapy for coping mechanisms? I would try that in tandem with medication.

[Anonymous]

Anonymous wrote:Love that only like 1 person on this thread actually asked why kid might be feeling like this. Everyone just goes straight to Prozac. Bananas

OP said her kid is adhd and likely ASD as well. Parents of similar kids know why her son is feeling this way. He’s neurodiverse and in addition, his medication to treat adhd also exacerbates irritability. Unfortunately a lot of parents end up in a medication cascade like this, even though it’s medically the best option for our struggling kids. Nobody wants to put their kid on one medication, let alone two or three. But the parents here haven’t “jumped to Prozac.” We had had struggling kids who are not able to function. At best, they have a diminished quality of life (as do their families) and at worst, they can be dangerous to themselves and others.

[Anonymous]

If you're reluctant to start meds (or even if you're not), I would recommend checking out any possible allergies or anything dietary that might be shifting what's going on in his gut. 90% of the seratonin in our bodies is created in the gut. My son (AuDHD) suddenly started getting all kinds of GI issues when he was around 11, and we just tried taking him off dairy on a lark, and it made a HUGE difference for him. You can actually do a blood test for most food allergies. Often that kind of irritability is driven by something physiological, so good to start there. And also work to get him on your team -- you can validate that he feels bad and you want to help him figure out what's going on, and find ways for him to feel better overall.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’m going to just be super blunt. You lost me at “I prefer not to put him on meds.” Families and the kids themselves deserve some relief. If my parents had towed the “I prefer not to put my depressed and irritable teenage daughter on meds” line, I’d be long dead by suicide. Your child is suffering from a real condition, just like cancer is real. He, and you, deserve relief.

Just to be super blunt as well, stimulant meds are known to cause irritability as a side effect, so prioritizing your kids academic success over their mental health is something to be questioned.

He’s not on tbem for academics - but your defensiveness about ssris and assumptions are both highly unhelpful additions here so please move along

Ok so why give him a medication he doesn’t need that is causing anxiety/irritation …

[Anonymous]

Anonymous wrote:Op, I, too, have spoken to numerous psychiatrists, neuropsychologists, and several neurologists and an epilologist and they ALL said Prozac is incredibly well tolerated and without long term side effects in children. My son has severe special needs and attended very expensive private schools where I met countless parents of other special needs children many many of whom started their journey on Prozac before stimulants for this reason. Go back to the drawing board and stop attacking other posters’ learned experience. If you want names and credentials you can DM me.

+1. I have taken an SSRI for anxiety and for that reason know very well that they have significant side effects … but also that they are otherwise extremely effective for anxiety. I would not hesitate to put my child on an SSRI if they were having life limiting anxiety or OCD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anxiety often looks like irritability in children. Autism can make that irritability worse. Stimulants can make anxiety worse. You need to talk to your psychiatrist if the stimulants might be contributing (have you had a recent dose or medication change) or if a SSRI or mood stabilizer (ie, abilify) might be appropriate. Abilify saved our family and I resisted it for far too long.

Op - I have talked to our psychiatrist another it, and our gp, and both say that ssris are not a first line treatment for a child of this age and they would prefer to exhaust numerous other approaches before going down that road. These are both highly respected nyc private practitioners - this is not quackery

OP I understand your reluctance to jump straight to SSRIs - I have been on a dozen different ones as an adult before doctors figured out that like 30% of patients, I don’t tolerate them well and the side effects never resolved properly.

There is an abundance of evidence that lifestyle changes can be as effective as SSRIs at treating and managing depression and anxiety.

I would drill down hard on sleep hygiene (zero access to devices or TV during sleep hours), early morning light exposure either from outside activity (morning walk together?) or use of light box in the morning, meaningful exercise every day, meditation/breathing exercises, journaling, and cleaning up the diet - purge the added sugars and load up on whole food, cut the ultra processed stuff to the bone.

I struggled with refractory major depression, generalized anxiety and periods of suicidal ideation for years. I’m meds free and managing my mental health really well by reducing the negative aspects of modern society by giving my body the things it evolved to need and which promote optimal brain health: food that makes a healthy gut + hydration, plenty of sleep, exercise, light exposure outdoors as much as possible, quiet time away from devices.

Good luck with your boy, and hang in there.

Op - this is awesome to hear!

I’m British and I do find the American attitude to ssris so odd. Look don’t get me wrong they’re a godsend if you need them and can be life changing, but to me it’s more of a journey to figure out what’s wrong first (therapy is part but not all of this) and try to address the root cause before jumping to ssri which regardless of what others may think is not a slam dunk choice for a kid. Even an adult on ssri needs to do this work whether before or after they start their medication. Even if I put him on ssri I still have to figure out what’s not working for him about his life. I do think screens are a big piece bc I’ve noticed him extra irritable when that time is interrupted. But then he has very little downtime too so that could play a part. School also starts way earlier than I wish it did and he has trouble getting to sleep so that’s a piece

Ok but it is making zero sense that you are so cavalier about stimulants (which could certainly be causing the irritability) but so intensely reluctant about SSRIs.