Meds for kid with anxiety and panic attacks

[Anonymous]

DS is on the spectrum and has really bad anxiety. He's been on Zoloft for going on 4 years and it really helps (especially with his tics which were debilitating b4 the Zoloft). He's also on Seroquel for aggression, to help him get to sleep, and general mood instability. His biggest problem is the aggression which is almost always the result of a panic attack. He mostly throws things but will be directly physical and will also run and hide. He's extemely remorseful after the fact which then makes him want to avoid the situations that cause panic which just causes more panic. I feel like something short term that he could take occasionally to head off the panic (I'm thinking specifically of the first couple days of school right now) therefore settling in and having a more successful experience would help immensely. We have tried a small dose of Seroquel in the am as recommended by his psych and that didn't seem to help. He's been on Risperdol before the Seroquel and that just made him dopey, asleep, and chubby. I don't want to medicate the heck out of the kid, but just wondering if anyone else has this type of situation and has a med that they use. It's really hard to get him to participate in normal kid activities because of this, but I can usually handle most things through quiet talking it through, laying out the plans, giving the escape plan if thing go wrong. However, school is wildly unpredictable and I doubt my middle schooler wants me to follow him around doing cognitive behavioral therapy. He does have a 1:1 which helps immensely but the sheer panic still rises up. Thoughts?

[Anonymous]

We've been close enough to your situation that I have lots of sympathy, but no magic bullets. Could it be time to increase the dose of Zoloft?

[Anonymous]

That's a good question. It's been about 16/17 mos since last increase and he had a big growth spurt in there. I'll ask the psych what she thinks. Thx!

[Anonymous]

As someone who has had panic disorder since I was a kid, the best solution in addition to upping his dosage of meds may be to add in CBT. If he's in middle school, I think he'll be old enough to understand and get a lot out of it. It REALLY helped me a lot. GL!

[Anonymous]

Once we dumped Seroquel and moved to Abilify it made a world of difference. Was he on the Risperdol with the Seroquel? That could be a big weight gain problem. We use Celexa + Abilify. It works quite well, but we do need to keep the boy very active so he doesn't gain weight.

[Anonymous]

OP here this is so helpful. We tried Abilify for a few days with Zoloft a couple of years ago and it was a disaster. Really bad reaction. When he was on Risperdol it was with Zoloft and no Seroquel. The Seoquel is relatively recent (9 months?). We seem to have no side effects with the Zoloft/Seroquel combo so that's good.

I have had CBT for my own anxiety and so I use it quite a bit with him (talk things through beforehand, give escape plans, etc. etc.). The problem is just that moment of sheer terror when it all goes to pieces. I agree that he should be able to do CBT and am planning on working that into our lives. He also has PTSD from a series of assaults by an adult who was his autism aide at school so he has trouble going to see any dr/therapist. So we have to build up the ability to not have too much anxiety to go to anxiety treatment! Fun!

I agree CBT is a really great tool. It is definitely on our treatment plan for the future if not now.