How did you decide to start/not start your child on SSRIs for anxiety?

[Anonymous]

How did you decide to start (or not start) your child on medication for anxiety, specifically SSRIs?

Our 9 year-old son has been diagnosed with ADHD and anxiety. He has been on medication for ADHD for over a year. We first tried therapy only and that did not seem to help too much. We are now faced with the psychiatrist's suggestion to add a low-dose SSRI. The therapist thinks our son does not understand his feelings due to his anxiety so that CBT is not an option without anxiety medication first.

I am quite reluctant to add an SSRI to the medication mix as I think the ADHD medication is worsening the anxiety symptoms. I also think that adding an SSRI will very much increase the chance that my little guy will seriously harm himself.

So how did you decide to start down this path? Did you get a second opinion before starting meds?

Also, if your child has been found "gifted," how have you factored in those traits with the anxiety? Does your team of specialists include things such as Dabrowski's overexicatablities in when balancing medications and therapy?

Up to this point I feel like I am the only voice standing firm on trying CBT for an extended period of time before changing/adding medications to the mix. I am curious if others have faced a similar situation and would like to learn how you proceeded.

[Anonymous]

I was alot like you two years ago. Took my son to CBT for two years thinking I want to avoid medicine and you know what? When he is too anxious he is unable to use the tools he has learned in therapy. His therapist suggested I reach out to a psychiatrist and I did. Finally realized I was doing him a disservice and now he is on SSRI. Can't believe how much happier he is and how much happier my family is too. His teachers have noticed so many positive changes. Do your homework but don't let fear hold back something that could really help your child.

[Anonymous]

We enrolled our then 8 yo in an NIH anxiety study (he also has ADHD medication which did not impact his anxiety but his anxiety definitely impacted his ADHD symptoms) . We tried CBT but when he was in an anxious state, he was unable to use the tools/techniquest he learned - much like what it sounds your psychiatrist has noted. The NIH team recommended generic Prozac and it made an incredible difference. He still had a low level of anxiety but he was able to control IT rather than IT controlling him. We saw no negative side effects. I don't know how Dabrowski would enter into your decision to reduce a child's suffering. It's not like medication will limit their giftedness/creativity/potential. Why would your primary concern be about your DS harming himself? Does he also suffer from depression or expressed thoughts about harming himself?

[Anonymous]

OP, DS, 10, also has both ADHD and anxiety. The anxiety used to be severe. He started an SSRI (Zoloft) in first grade - the psychiatrist prescribed too high a dose and he became "disinhibited" and had to go off it. We switched psychiatrists (the same one was unsuccessfully also trying to treat the ADHD). In 3rd grade, his new psychiatrist suggested generic Prozac at a very low dose -- eventually, it, therapy, and a new ADHD medication made a significant difference.

He was on Prozac for almost 1.5 years - longer than his psychiatrist prefers generally. He went off it this year but he did not significantly regress - he still has anxiety but generally has been able to control it much better.

ADHD and anxiety symptoms are often very similar. We found that treating both was helpful and has improved things significantly. Yes, both still create difficulies for DS but there really is a big difference.

Good luck!

[Anonymous]

When my DD with ADHD and anxiety started an SSRI it made her feel so much better that she was angry at us for not doing it sooner. Keep that in mind. There comes a point where your son pays the price for your reluctance to medicate.

It sounds like his doctor is far from a knee-jerk medication doc. He waited a year to make this recommendation. I would give it great weight.

[Anonymous]

DD has ADHD and anxiety. She has a therapist but we decided, along with therapist and psychiatrist, that adding SSRI would help her benefit from therapy. So far it has, although I do sometimes wonder about the disinhibition.

[Anonymous]

OP here -- many thanks to all of you for the helpful posts! Your experiences helped me think through options and organize approaches in my mind.

DS saw his therapist yesterday and began using a new workbook as part of his CBT. The therapist explained to him that he would need to work with her through the book, which will include homework, and we have set up a points system so he has a series of rewards when he completes the homework. He seems very excited about this approach. We are going to give this workbook a try (it is about 16 weeks long) and if at the end we do not see an improvement, we'll make the move to SSRIs.

To the PP that said the psychiatrist waited a year on the SSRI recommendation -- actually, the very first meeting we had with the doctor, he wanted to start DS on Zoloft that day. It was due to our insistence that he opted only for a med for the ADHD. So I am not exactly "sold" on this psychiatrist.

[Anonymous]

There comes a point where your son pays the price for your reluctance to medicate.

+1000

[Anonymous]

Anonymous wrote:OP here -- many thanks to all of you for the helpful posts! Your experiences helped me think through options and organize approaches in my mind.

DS saw his therapist yesterday and began using a new workbook as part of his CBT. The therapist explained to him that he would need to work with her through the book, which will include homework, and we have set up a points system so he has a series of rewards when he completes the homework. He seems very excited about this approach. We are going to give this workbook a try (it is about 16 weeks long) and if at the end we do not see an improvement, we'll make the move to SSRIs.

To the PP that said the psychiatrist waited a year on the SSRI recommendation -- actually, the very first meeting we had with the doctor, he wanted to start DS on Zoloft that day. It was due to our insistence that he opted only for a med for the ADHD. So I am not exactly "sold" on this psychiatrist.

I'm PP and perhaps I should not have pointed that out. I sure wish my DD's psychiatrist had recommended an SSRI from the beginning. if your DS was as anxious as you are making it seem, this was not an unreasonable suggestion.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here -- many thanks to all of you for the helpful posts! Your experiences helped me think through options and organize approaches in my mind.

DS saw his therapist yesterday and began using a new workbook as part of his CBT. The therapist explained to him that he would need to work with her through the book, which will include homework, and we have set up a points system so he has a series of rewards when he completes the homework. He seems very excited about this approach. We are going to give this workbook a try (it is about 16 weeks long) and if at the end we do not see an improvement, we'll make the move to SSRIs.

To the PP that said the psychiatrist waited a year on the SSRI recommendation -- actually, the very first meeting we had with the doctor, he wanted to start DS on Zoloft that day. It was due to our insistence that he opted only for a med for the ADHD. So I am not exactly "sold" on this psychiatrist.

I'm PP and perhaps I should not have pointed that out. I sure wish my DD's psychiatrist had recommended an SSRI from the beginning. if your DS was as anxious as you are making it seem, this was not an unreasonable suggestion.

OP here -- how do you define "as anxious as you are making it seem?"

On most days he is absolutely fine and has no issues. About once every 6 to 8 weeks, he has an issue where he gets REALLY worked up and he says, "I can't do this at all!" Every two to three months, he'll have one of Those Days and he'll get even more worked up, to the point where he hits himself in the head.

So if a 9 year-old boy hits himself in the head while getting upset one time in September, one time in March and another time in May, does that warrant starting SSRIs?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here -- many thanks to all of you for the helpful posts! Your experiences helped me think through options and organize approaches in my mind.

DS saw his therapist yesterday and began using a new workbook as part of his CBT. The therapist explained to him that he would need to work with her through the book, which will include homework, and we have set up a points system so he has a series of rewards when he completes the homework. He seems very excited about this approach. We are going to give this workbook a try (it is about 16 weeks long) and if at the end we do not see an improvement, we'll make the move to SSRIs.

To the PP that said the psychiatrist waited a year on the SSRI recommendation -- actually, the very first meeting we had with the doctor, he wanted to start DS on Zoloft that day. It was due to our insistence that he opted only for a med for the ADHD. So I am not exactly "sold" on this psychiatrist.

I'm PP and perhaps I should not have pointed that out. I sure wish my DD's psychiatrist had recommended an SSRI from the beginning. if your DS was as anxious as you are making it seem, this was not an unreasonable suggestion.

OP here -- how do you define "as anxious as you are making it seem?"

On most days he is absolutely fine and has no issues. About once every 6 to 8 weeks, he has an issue where he gets REALLY worked up and he says, "I can't do this at all!" Every two to three months, he'll have one of Those Days and he'll get even more worked up, to the point where he hits himself in the head.

So if a 9 year-old boy hits himself in the head while getting upset one time in September, one time in March and another time in May, does that warrant starting SSRIs?

Not the PP you’re responding to but what you’ve just posted is significantly different than your original post were you say CBT isn’t helping, the ADHD medication is worsening the anxiety and your worried your DS will harm himself if he starts SSRIs. No matter where you’re looking for assistance and advice, you need to be a better reporter of symptoms and frequency. Your follow up post doesn’t describe anxiety that has an impact on ADL.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here -- many thanks to all of you for the helpful posts! Your experiences helped me think through options and organize approaches in my mind.

DS saw his therapist yesterday and began using a new workbook as part of his CBT. The therapist explained to him that he would need to work with her through the book, which will include homework, and we have set up a points system so he has a series of rewards when he completes the homework. He seems very excited about this approach. We are going to give this workbook a try (it is about 16 weeks long) and if at the end we do not see an improvement, we'll make the move to SSRIs.

To the PP that said the psychiatrist waited a year on the SSRI recommendation -- actually, the very first meeting we had with the doctor, he wanted to start DS on Zoloft that day. It was due to our insistence that he opted only for a med for the ADHD. So I am not exactly "sold" on this psychiatrist.

I'm PP and perhaps I should not have pointed that out. I sure wish my DD's psychiatrist had recommended an SSRI from the beginning. if your DS was as anxious as you are making it seem, this was not an unreasonable suggestion.

OP here -- how do you define "as anxious as you are making it seem?"

On most days he is absolutely fine and has no issues. About once every 6 to 8 weeks, he has an issue where he gets REALLY worked up and he says, "I can't do this at all!" Every two to three months, he'll have one of Those Days and he'll get even more worked up, to the point where he hits himself in the head.

So if a 9 year-old boy hits himself in the head while getting upset one time in September, one time in March and another time in May, does that warrant starting SSRIs?

Not the PP you’re responding to but what you’ve just posted is significantly different than your original post were you say CBT isn’t helping, the ADHD medication is worsening the anxiety and your worried your DS will harm himself if he starts SSRIs. No matter where you’re looking for assistance and advice, you need to be a better reporter of symptoms and frequency. Your follow up post doesn’t describe anxiety that has an impact on ADL.

Thanks. The CDT has not helped in the past and I think (due to asynchronous development) DS wasn't ready to fully participate in the therapy. I also think that due to whatever reasons (one of them being his intellect) he knows how to "game the system" and with the moving target of med changes and additions and sleep issues and anxiety, it has made this really complicated. I also do not have full faith in the psychiatrist as DS does his "game the system" stuff, and I am sure the psychiatrist knows it.

I think having a "we'll try the CDT with the workbook" plan with a specific end date is a good plan for this portion of the journey.

And I agree -- I am a horrible reporter of symptoms and frequency. Unfortunately I am not with DS 24 hours each day (matter of fact I am only with him from 4 pm until 8 am the next morning on school days) and cannot fully account for each and every symptom and frequency. Since you are better than I am at such reporting, would you please recommend some tools and techniques that I might use to improve on such accounting? Thanks!

[Anonymous]

^^should be CBT above -- I am obviously both a horrible reporter and keyboardist

[Anonymous]

OP, your original post made it seem like nothing was working but you subsequently made it seem like his anxiety is completely under control except for a single event every 2 or 3 months. Don't take it personally that we are confused, we are trying to help. Its just difficult to offer advice when we aren't sure what the real issue is.

If the anxiety is so rare, why does the psychiatrist think he won't be able to access the CBT? And why are you afraid he will harm himself on an SSRI?

If your concern about SSRIs have to do with the black box warnings about suicide please know that most child psychiatrists believe that there really isn't a basis for the black box warnings. Since they have gone on SSRIs, teen suicide rates have gone up because parents are afraid to use these meds. Unless there is something particular about your child, and you haven't indicated anything, I think you can take this off the list of concerns.

[Anonymous]

Anonymous wrote:OP, your original post made it seem like nothing was working but you subsequently made it seem like his anxiety is completely under control except for a single event every 2 or 3 months. Don't take it personally that we are confused, we are trying to help. Its just difficult to offer advice when we aren't sure what the real issue is.

If the anxiety is so rare, why does the psychiatrist think he won't be able to access the CBT? And why are you afraid he will harm himself on an SSRI?

If your concern about SSRIs have to do with the black box warnings about suicide please know that most child psychiatrists believe that there really isn't a basis for the black box warnings. Since they have gone on SSRIs, teen suicide rates have gone up because parents are afraid to use these meds. Unless there is something particular about your child, and you haven't indicated anything, I think you can take this off the list of concerns.

Thank you for your reply.

The social worker was the person that felt that DS would not be able to access the CBT. I bought the workbook she recommended for the CBT and DS brought it with him for his session yesterday. She told me that the session went quite well and they had come up with an agreed upon reward strategy for doing the workbook.

I am afraid of the black box warnings on SSRIs especially since DS is on two different meds for his ADHD (Vyvanse and Intuniv). I have an older son who also has ADHD who is simply on one med and has done CBT (with the same workbook approach) in the past. But older DS' medication management is handled by our pediatrician.

So I guess I am simply not a real fan of the psychiatrist. I don't really trust him and think he is just playing chemical experiments with my DS. If anything I would like to back off the ADHD meds and not add yet another med into the mix.