Medication for Anxiety but not SSRI

[Anonymous]

My DS has severe anxiety. He also has ADHD, inattentive. We tried several medications for his anxiety, that is his biggest health issue, but while Prozac does work and so does Lexapro on his anxiety, he can't be on SSRIs as the other effects are just horrific. He becomes unhinged, talks completely inappropriately, acts inappropriately. I mean to the point that he could be expelled or even worse. We tried Buspar for a while, but it didn't seem to have much effect. ADD medication is helping him focus and hence helping with anxiety some, but it is in some cases making it worse. Is there a medication you could recomend that works and it is not SSRI? Thank so much.

[Anonymous]

OP,

Please start with the psychiatrist, not crowd sourcing anti-depressants. This may be a dosage issue or a diagnostic issue.

Talking and acting inappropriately aren't typically "side effects" of anti-depressants. He may need counseling. If his behavior is border lining on expulsion, please consult a behavioral therapist for FBA (functional behavioral assessment) to help identify the triggers.

[Anonymous]

And if you find something that works decently, have you thought of yoga and meditation? Circle Yoga has great reviews for their children's mindfulness classes, apparently. I know it can't take the place of that initial medication, but in the future, when you might be thinking of lowering the dose, it might be a good buffer.

Also get a full medical check-up. Sometimes the thyroid goes screwy or something, and anxiety is a by product of a physical disorder.

Good luck.

[Anonymous]

Have you tried therapy?

[Anonymous]

Also, it may take up to 3 months for a body to process an anti-depressant properly and to see true effects.

[Anonymous]

OP here. Of course, he is seeing a psychiatrist, and trying to figure it out. His thyroid was checked. It was a bit elevated but not much. I will ask for PANDAS check as well. I was just wondering, in the meantime, if any other medication than SSRI has worked for somebody's kid. Three months is nothing for DS, he has been on and off SSRI for years, so yes, I know how long it takes. Longer he is on it, worse he gets.

[Anonymous]

SSRIs can set off manic behavior if the underlying issue is bipolar. In children bipolar is often rapid cycling and can present like ADHD (and they can occur together too.) Ask your psychiatrist if she/he has ruled out bipolar. This does affect the range of meds to be looking at, though there is certainly overlap between meds and disorders.

[Anonymous]

We use topomax for anxiety for my kid that also cannot be on SSRI. It's a migraine medicine that used to be used for anxiety before they found out SSRIs were better. I think it is helping my son, albeit slowly. Ask your doctor.

[Anonymous]

OP, sounds very challenging. I'm sorry. I have a child for whom SSRIs did absolutely nothing, but we didn't have the adverse reaction you describe. This did happen to my niece who was in high school and it turned out she was bipolar as a PP describes. Bipolar tends to show up later, but it is not unheard of in a younger child.

You say the thyroid was elevated. I assume that means his TSH was higher than lab normals. Know that lab test normals for TSH are set too high. If his was above the lab normals, I would definitely get it checked out with an endocrinologist because it means they are quite a bit higher than they should be.

He could have Hashimotos, which causes thyroid levels to swing widely, and I definitely could see that evidencing as behavior problems. Hashimotos is widely viewed as a middle aged female thing, but males, including young males, do get it, but it often remains undiagnosed because they don't fit the profile. (My DS was dx'ed with this.)

I also think PANDAS, which you raised, is worth exploring. Checking it out means a rapid strep test plus culture. In addition, his ASO and anti-DNASE B levels should be checked. My Hashimotos DS also has PANDAS.

[Anonymous]

^^Forgot to add that SSRIs can have paradoxical effects on children with PANDAS. If they are used to treat them, the advice is to start very low and increase very slowly relative to what would be done for other children.

Also, in the meantime, I would try magnesium, in the form of Epsom salt baths if nothing else. It has very soothing effects. If you prefer oral, do Natural Calm, but start at a low dose to avoid diarrhea.

[Anonymous]

Anonymous wrote:We use topomax for anxiety for my kid that also cannot be on SSRI. It's a migraine medicine that used to be used for anxiety before they found out SSRIs were better. I think it is helping my son, albeit slowly. Ask your doctor.

Thank you so much for this recommendation! I will ask his Dr. about it.

[Anonymous]

Anonymous wrote:OP, sounds very challenging. I'm sorry. I have a child for whom SSRIs did absolutely nothing, but we didn't have the adverse reaction you describe. This did happen to my niece who was in high school and it turned out she was bipolar as a PP describes. Bipolar tends to show up later, but it is not unheard of in a younger child.

You say the thyroid was elevated. I assume that means his TSH was higher than lab normals. Know that lab test normals for TSH are set too high. If his was above the lab normals, I would definitely get it checked out with an endocrinologist because it means they are quite a bit higher than they should be.

He could have Hashimotos, which causes thyroid levels to swing widely, and I definitely could see that evidencing as behavior problems. Hashimotos is widely viewed as a middle aged female thing, but males, including young males, do get it, but it often remains undiagnosed because they don't fit the profile. (My DS was dx'ed with this.)

I also think PANDAS, which you raised, is worth exploring. Checking it out means a rapid strep test plus culture. In addition, his ASO and anti-DNASE B levels should be checked. My Hashimotos DS also has PANDAS.

Thank you for replying. My mom has Hashimotos, so that is something to look into. He did go to pediatric endocrinologist, so I would hope she would check, but maybe she didn't look for that? He is extremely skinny. PANDAS, I am also bringing up at his next pediatrician and psychiatrist appointments. It is just so disheartening to see him struggle so much. I don't know about bipolar, I read about it, and I will ask about it, but he just seems more like deer in the headlights and there is no hyper or maniac behavior even on SSRI that is described, but maybe his unhinged talking is that maniac symptom? When not on SSRIs he shows no maniac behavior.

[Anonymous]

Anonymous wrote:And if you find something that works decently, have you thought of yoga and meditation? Circle Yoga has great reviews for their children's mindfulness classes, apparently. I know it can't take the place of that initial medication, but in the future, when you might be thinking of lowering the dose, it might be a good buffer.

Also get a full medical check-up. Sometimes the thyroid goes screwy or something, and anxiety is a by product of a physical disorder.

Good luck.

Thank you for your suggestion. He has tried meditation, but can't do it. His ADHD and anxiety are too severe. He acts like a veteran with a PTSD and evaluates each situation as a war zone. It took me a while to understand that even though his ADD is inattentive, that didn't mean he was inattentive at all, whatever paradox that is. Once on medication he explained to me, that he sees and hears everything, all the stimuli are coming at him and add to that severe anxiety, it is incredible that he is an A student and can function to the level he does. (He was an A student without medication) I have done exposure therapy, he can now travel alone to Europe(he is a teen), I keep telling him how proud I am of him and everything he does, but it is never enough for him, he is his own worst critic.

[Anonymous]

Clomiprimine has been amazing for us. Oldie but goodie for efficacy.

[Anonymous]

Pp here I should say son has adhd and anxiety and had same response as yours to Zoloft and Lexapro. He does not have bipolar. He does have a fragile x varient