My 12 yo's irritability is off the charts

[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.

[Anonymous]

Is the irritability mostly with you/other family members or everyone? I have a very very sweet 11 year old and she has bouts of like out of body levels of irritation with us recently, which we have been told might be hormone related and part of the puberty process. I mostly just try to emphasize acceptable behavior but also try not to take it personally. I remember finding my family so irritating at this age. Plenty of exercise, enough sleep and 1:1 time focused around her interests help some. But I do think it can be normal even if it’s painful.

If it’s causing major problems outside the house and none the things you are trying are helping I do think you can tell yourself you are not “jumping straight to meds”.

[Anonymous]

Also please don’t dismiss the headaches so quickly. I would definitely pursue that and try and understand why he’s having lethargy and headaches. I have had migraines my whole life and have several times had to keep food and lifestyle logs to identify my triggers. It’s a pain in the back but important.

[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

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

This.

OP, I say this as a parent of an ADHD kid and as someone who is probably ADHD myself and as someone who volunteers in mental health support and education (so I’ve heard many parent stories in a wide range of needs and solutions).

In this situation, after therapy and stimulants, in a kid who has already been diagnosed as ADHD/AUD, trying an SSRI is not “jumping to meds as a first line” therapy.

You seem to have some misconceptions. SSRIs are not inherently more or less dangerous than stimulants. Yes, there are some warnings on SSRIs, but those are there to alert you to look for certain reactions which would indicate the med should be stopped. You also seem to be weighing using SSRIs and the possible negatives against no SSRIs without considering the negatives of non-treatment. “Exhausting numerous other approaches” may come at a negative cost to your child.

I absolutely respect your sense that prescribing a pill is not some magic solution, but it can be tremendously helpful. Trying an SSRI may or may not help. The unfortunate reality is that you won’t know until you try it, maybe not even until you try a few different ones. Trying a medication doesn’t mean you have to stay on it forever. Some meds can be more easily discontinued - like Straterra for instance, than others, like Zoloft, for instance, which is better to step down than stop abruptly.

Here are some medical and non-medical things I would do in your position:

1) explore whether altering the current medication dose or timing might help with irritability.
2) explore if a different stimulant or non-stimulant med might help instead of the current one (or in addition)
3) does your child have a school plan - 504 or IEP - and does something there need to be adjusted
4) explore changes in routine - exercise, diet, downtime, etc.
5) explore other medical causes or contributors - blood work for thyroid, vitamin D and anemia, all of which can cause irritability/depression - as well as a sleep evaluation (sleep apnea and its contributors from mouth/teeth/tongue crowding, obesity, etc.)

Personally, my child was on a stimulant and SSRI in HS, and the SSRI helped tremendously with irritability. I regret not encouraging it sooner. He probably should have had it in middle school. My trying so many other approaches first came at a tremendous cost to him in terms of negative impact on peer and family relationships, self-esteem, and academics (and, no, I don’t mean grades). He willingly took the SSRI for several years because he himself thought it was helpful. He went off the SSRI before college (his decision). He also went off the stimulant because he chose an educational path and career field that played to the strengths of ADHD and minimized weaknesses (and probably provided some form of self-medication through adrenaline).

You may not realize it, but by treating meds as dangerous and never a first line, IMO, you are contributing to the stigmatization of mental health. I mean if your kid needed insulin, would you insist that he make a tremendous effort to go without insulin through a highly restricted diet plan and mandatory exercise and fail that first before trying insulin?

Some people need meds as a first line - either because their biology is such that they’ll never manage without meds, or because their environment is such and unchangeable enough that meds would be helpful, or because no meds is such a heavy lift it sucks the ability away from doing other things, or because meds could provide a short-term space that allows room to develop the framework to manage life off meds.

You might consider whether what you are hearing back from your “highly respected” doctors is not their “recommendation” but rather their “reflection” of your stated principles. If you as a parent come in and say that your philosophy is that meds should be a last resort after trying everything else, your doctors will reflect back what they heard and give you a recommendation in that context. They understand that even if they think your kid could benefit from an add-on medication, you have stated you are not interested in hearing it and suggesting or encouraging a med would merely undermine the doctor-patient relationship. If your kid’s condition degrades enough that you become willing to ask for another med, then they can more successfully suggest something.

Hope you can hear the above with the kindness intended.

[Anonymous]

Anonymous wrote:

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?

op - are you joking?

'gently based on your post' - you have no idea what my parenting is like based on my post. I've actually lived in the US for 20 years, my mother is american, and i was brought up in what can only be described as the kind of environment that would be portrayed as a pastiche by barbra streisand or nora ephron where all feelings were welcome. I have duplicated that for my own children and lean heavily into validation, family systems and other therapeutic methods I have learned thanks to numerous professionals with fewer stereotypes about brits (thankfully) than you seem to possess But thanks for the feedback and, gently, FU.

[Anonymous]

Anonymous wrote:

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 …

because he does need it for emotional regulation and impulse control that was causing social difficulties