New psychiatrist recommending Lamictal for 9 year old

[Anonymous]

Hi everyone. I posted a few weeks ago about difficulties we're having with my ADHD/anxiety fourth grader, and I am so grateful for all the helpful responses and support I received. Yesterday, we saw a new psychiatrist who came highly recommended, as we felt it might be time for a fresh approach and reevaluation of his medications. He currently takes Adderall XR 20 mg and Zoloft 50 mg. The main difficulties we are having currently are over-reactivity, argumentative attitude, inflexibility, difficulty with losing or getting "out" in a game, and emotional regulation. He does things like yell and overreact when asked to brush his teeth when he'd rather be reading/playing, claiming it is unfair, I must not like him, he "never" gets to have fun, he would rather his teeth rot, etc. His outbursts are mainly at home, but he has increasingly had trouble at school complying with teacher requests, putting effort into tasks he doesn't like, and having an argumentative attitude with the teacher when things are not going the way he would like. He has a lot of trouble accepting responsibility for his behavior, although he feels remorseful after the fact. He does have a few friends, but I see him being inflexible about rules of games, etc. and I worry he will push them away. He is not generally physically aggressive, but has on occasion angrily pushed/pulled on his younger brother when they were arguing. When he is not having an outburst, he is generally a pretty pleasant kid, although we deal with the other difficult aspects of ADHD like lack of organization and focus, etc.

The new psychiatrist would like to wean him off the Zoloft, and I agree with that - we have seen signs of increased impulsivity/lowered inhibitions when we have tried dosage increases, and the doctor feels that an SSRI just isn't a good fit for a kid with my son's profile. However, before we start the weaning process with Zoloft, he would like to add Lamictal, in addition to Deplin, which is a "medical food" folate supplement. After reading about Lamictal, I am just not sure this is the route I want to go. Lamictal is a mood stabilizer, and I understand the doctor's intention with regard to my son's over-reactivity, but I am nervous about what feels like a "heavy duty" drug when we are dealing with issues that, while serious, are not necessarily extreme. Of course, I am worried that things will get worse, and that as he gets older and moves on to middle school, the consequences will be increasingly serious if he cannot regulate his emotions in an age appropriate way. Part of me would love to wean him off the Zoloft first, see where we are with anxiety and emotional reactivity, and then figure out if and/or what he needs in it's place. Of course that is scary too. I also just started reading the Explosive Child book, and I'm curious to see whether that approach might help us, but I have not yet implemented it. There is also talk of adding Vayarin to see if it increases/extends the efficacy of the Adderall, but not until we address the Zoloft piece.

Has anyone had a child with a similar profile try Lamictal, and how did it go? Is this a reasonable option, or too extreme? I admit I am very hesitant about this medication, and the potential rash side effect is scary too. But I want my child to be the best he can be. Any advice welcome.

[Anonymous]

I can't answer if Lamictal is the right medicine, but I take Lamictal myself and I don't see it as a heavy duty drug. I have no side effects at all. The rash sounds scary and you do have to monitor for it closely at the beginning, but it is a rare side effect and completely reversible if you catch it early. If you do choose Lamictal, just take your kid to the ER with any little rash, it will probably be something else.

If are still concerned about Lamictal, ask about Tegretol or Depakote, which do the same thing but don't cause the rash.

[Anonymous]

I’d be leery, too. Is he in therapy? Is there a behavioral counselor working with the family? Unless he’s really falling apart where you are worried about his safety I would try getting off the Zoloft and seeing how he is then. I tried Zoloft for a year but went back to Lexapro because Zoloft just didn’t work like it was supposed to for me.

[Anonymous]

I’m in a similar situation with my DS. He was taking Vyvanse and ritalin. I felt like they stopped working so I just stopped them to get a good picture of my DS. We are now looking for a new psychiatrist to reevaluate. IMO, I would wean off the Zoloft and then add a new drug.

[Anonymous]

My son takes lamictal for seizures. Many psychs really like ir ours included. Ask why but I don’t believe it’s understood tone more intense than the anti psychotics

[Anonymous]

SJS is a risk with a lot of drugs, including some SSRIs. I wouldn’t let that put you off of it.

I’ve been taking it for six years to manage my seizures and it’s been great for my anxiety as well — my psych was able to significantly decrease my SSRI dosage as a result.

If the SJS rash appears it is easy to identify. I understand the concern but I wouldn’t let that keep you from trying something that could be highly effective.

[Anonymous]

DD takes Lamictal for seizures. It's been a great medication for her. Would much prefer over Tegretol or most other AEDs. Keppra had many side effects for her as well.

[Anonymous]

Have you tried a non-stimulant ADHD med? I would be concerned that stimulants are making anxiety worse not better. Also, like any kind of scientific experiment, it can be hard to really understand the effect of a medication when you are changing 2 meds at once. I would want to make sure i had exhausted adhd med options before starting on mood stabilizers like lamictal, depakote or tegretol, which are generally prescribed for bipolar or seizure. Or maybe your pdoc thinks the ADHD is misdiagnosed as bipolar? That does sometimes happen but 4th grade seems young to jump to that diagnosis if you have not extensively tried ADHD meds.

have you ever had a speech/language evaluation? kids with ADHD sometimes have problems with pragmatic communication. My DC had speech/language therapy for a couple years to help him with what people expect in terms of oral communication and how to talk and communicate. Especially where one aspect of the ADHD is slow processing, participating in group conversations and responding quickly and on topic can be difficult. My DC still gets frustrated in conversation with us because he is still processing but the conversation has already moved on and by the time he has formulated a response it is too late. Having more insight and understnding into his language deficits as an aspect of ADHD lets us give more time for response and guide him in Q/A or negotiation in a way that is less adversarial.

[Anonymous]

DD13 started taking Lamictal as a 12 y.o. Her issue is primarily anxiety that is expressed as anger, inflexibility, and irritability but with some oppositional tendencies, too. Aside from talk therapy (which I'm not sure is that effective), she's on lexapro for anxiety which as been helpful but didn't quite address the irritability and mood issues. After about 9 months or so of just lexapro, we added lamictal. That has helped noticeably with DD's mood overall but there is no magic bullet. She still has many irritable moments but they're expressed much less aggressively or angrily -- she's more just like a typical snarky young teen. Her psychiatrist started her off with a low dose and very slowly increased. The doctor told us very clearly about the scary rash and we watched for any signs of it, which I understand would be not hard to miss.

I think it's a tough call but if you feel like the current mix of meds isn't getting your DS and your family the quality of life, it's reasonable to try something different. I think if you monitor DS carefully for ill effects, just like with any new med, it may be worth a shot.

[Anonymous]

You said it yourself. You think your child's issues are serious, but not extreme. I would find another psychiatrist who was willing to work with you within this framework, including a period where he is weaned from all drugs for a time so you can get a better baseline. Obviously you'll need a lot of support to monitor and support his behavior during this time.

[Anonymous]

Anonymous wrote:You said it yourself. You think your child's issues are serious, but not extreme. I would find another psychiatrist who was willing to work with you within this framework, including a period where he is weaned from all drugs for a time so you can get a better baseline. Obviously you'll need a lot of support to monitor and support his behavior during this time.

Also, another thought that might clarify your thinking/values. When it comes to your own health, how do you measure the risks and benefits of medications? I know for me, I am HIGHLY unlikely to take a medication if the risk profile seems to outweigh the benefits, or if I have serious side effects. I'm not anti-medication (at all) but I just prefer to try to max out all the other possible approaches unless what I'm dealing with is fairly acute. So for example, I have taken Prednisone when it was really important to avoid permanent nerve damage; I take beta blockers for periodic anxiety; but I have (so far) avoided SSRIs because I've found that therapy works for me; and despite suffering from chronic insomnia, I don't take Ambien because I had a bad reaction to it, and Benadryl just makes me feel awful the next day - instead I found a CBT approach that really worked for me.

Adding all this up means that for my child, I try to avoid medications unless truly indicated. That means that I have done a "wait and see" approach to treat ear infections and non-symptomatic strep (I fill the script but wait 24 hours to see how the symptoms go); sought out an asthma doc that would support intermittent steroids for asthma provoked by colds; but you better believe I'm the first in line at Children's when something serious happens and my kid needs meds for croup or whatever.

I just feel like for myself (my own body), if it was possible that psychiatric drugs were making me really cranky, reactive, or otherwise feel really bad, I'd probably try a different approach or a break from meds. But that's predicated on the underlying condition not being truly awful or life and death.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You said it yourself. You think your child's issues are serious, but not extreme. I would find another psychiatrist who was willing to work with you within this framework, including a period where he is weaned from all drugs for a time so you can get a better baseline. Obviously you'll need a lot of support to monitor and support his behavior during this time.

Also, another thought that might clarify your thinking/values. When it comes to your own health, how do you measure the risks and benefits of medications? I know for me, I am HIGHLY unlikely to take a medication if the risk profile seems to outweigh the benefits, or if I have serious side effects. I'm not anti-medication (at all) but I just prefer to try to max out all the other possible approaches unless what I'm dealing with is fairly acute. So for example, I have taken Prednisone when it was really important to avoid permanent nerve damage; I take beta blockers for periodic anxiety; but I have (so far) avoided SSRIs because I've found that therapy works for me; and despite suffering from chronic insomnia, I don't take Ambien because I had a bad reaction to it, and Benadryl just makes me feel awful the next day - instead I found a CBT approach that really worked for me.

Adding all this up means that for my child, I try to avoid medications unless truly indicated. That means that I have done a "wait and see" approach to treat ear infections and non-symptomatic strep (I fill the script but wait 24 hours to see how the symptoms go); sought out an asthma doc that would support intermittent steroids for asthma provoked by colds; but you better believe I'm the first in line at Children's when something serious happens and my kid needs meds for croup or whatever.

I just feel like for myself (my own body), if it was possible that psychiatric drugs were making me really cranky, reactive, or otherwise feel really bad, I'd probably try a different approach or a break from meds. But that's predicated on the underlying condition not being truly awful or life and death.

Oh, sorry, I forgot one last important point! My child had a severe reaction to Penicillin at one point - among other symptoms, they thought he had a rash that could have turned into Stevens Johnson (look it up, horrifying -- it's a drug reaction that basically makes your body one giant blister.) Ever since then I've taken side effects REALLY seriously. A med with a serious side effect profile has to be exceedingly warranted for me. That's why the warning on the "little rash" with Lamictal would absolutely make me make EXTREMELY sure that the drug was warranted and there was no other option.

[Anonymous]

Anonymous wrote:SJS is a risk with a lot of drugs, including some SSRIs. I wouldn’t let that put you off of it.

I’ve been taking it for six years to manage my seizures and it’s been great for my anxiety as well — my psych was able to significantly decrease my SSRI dosage as a result.

If the SJS rash appears it is easy to identify. I understand the concern but I wouldn’t let that keep you from trying something that could be highly effective.

SJS (stevens johnson - skin peeling off your entire body) risk is more severe for Lamictal. "Adverse skin reactions occur in 8.3% of patients taking lamotrigine, with 0.04% of patients developing SJS/TEN. This rate of SJS/TEN is far greater than that reported for other well-known trigger medications "

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312199/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You said it yourself. You think your child's issues are serious, but not extreme. I would find another psychiatrist who was willing to work with you within this framework, including a period where he is weaned from all drugs for a time so you can get a better baseline. Obviously you'll need a lot of support to monitor and support his behavior during this time.

Also, another thought that might clarify your thinking/values. When it comes to your own health, how do you measure the risks and benefits of medications? I know for me, I am HIGHLY unlikely to take a medication if the risk profile seems to outweigh the benefits, or if I have serious side effects. I'm not anti-medication (at all) but I just prefer to try to max out all the other possible approaches unless what I'm dealing with is fairly acute. So for example, I have taken Prednisone when it was really important to avoid permanent nerve damage; I take beta blockers for periodic anxiety; but I have (so far) avoided SSRIs because I've found that therapy works for me; and despite suffering from chronic insomnia, I don't take Ambien because I had a bad reaction to it, and Benadryl just makes me feel awful the next day - instead I found a CBT approach that really worked for me.

Adding all this up means that for my child, I try to avoid medications unless truly indicated. That means that I have done a "wait and see" approach to treat ear infections and non-symptomatic strep (I fill the script but wait 24 hours to see how the symptoms go); sought out an asthma doc that would support intermittent steroids for asthma provoked by colds; but you better believe I'm the first in line at Children's when something serious happens and my kid needs meds for croup or whatever.

I just feel like for myself (my own body), if it was possible that psychiatric drugs were making me really cranky, reactive, or otherwise feel really bad, I'd probably try a different approach or a break from meds. But that's predicated on the underlying condition not being truly awful or life and death.

Oh, sorry, I forgot one last important point! My child had a severe reaction to Penicillin at one point - among other symptoms, they thought he had a rash that could have turned into Stevens Johnson (look it up, horrifying -- it's a drug reaction that basically makes your body one giant blister.) Ever since then I've taken side effects REALLY seriously. A med with a serious side effect profile has to be exceedingly warranted for me. That's why the warning on the "little rash" with Lamictal would absolutely make me make EXTREMELY sure that the drug was warranted and there was no other option.

Given that experience, I can understand why you'd be concerned with Lamictal. SJS is not a "little rash," but it look that way at the start. If SSRIs aren't right for your kid, then consider an SNRI like Cymbalta or Effexor. My kid could not take SSRIs either, but is doing great on Effexor.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You said it yourself. You think your child's issues are serious, but not extreme. I would find another psychiatrist who was willing to work with you within this framework, including a period where he is weaned from all drugs for a time so you can get a better baseline. Obviously you'll need a lot of support to monitor and support his behavior during this time.

Also, another thought that might clarify your thinking/values. When it comes to your own health, how do you measure the risks and benefits of medications? I know for me, I am HIGHLY unlikely to take a medication if the risk profile seems to outweigh the benefits, or if I have serious side effects. I'm not anti-medication (at all) but I just prefer to try to max out all the other possible approaches unless what I'm dealing with is fairly acute. So for example, I have taken Prednisone when it was really important to avoid permanent nerve damage; I take beta blockers for periodic anxiety; but I have (so far) avoided SSRIs because I've found that therapy works for me; and despite suffering from chronic insomnia, I don't take Ambien because I had a bad reaction to it, and Benadryl just makes me feel awful the next day - instead I found a CBT approach that really worked for me.

Adding all this up means that for my child, I try to avoid medications unless truly indicated. That means that I have done a "wait and see" approach to treat ear infections and non-symptomatic strep (I fill the script but wait 24 hours to see how the symptoms go); sought out an asthma doc that would support intermittent steroids for asthma provoked by colds; but you better believe I'm the first in line at Children's when something serious happens and my kid needs meds for croup or whatever.

I just feel like for myself (my own body), if it was possible that psychiatric drugs were making me really cranky, reactive, or otherwise feel really bad, I'd probably try a different approach or a break from meds. But that's predicated on the underlying condition not being truly awful or life and death.

Oh, sorry, I forgot one last important point! My child had a severe reaction to Penicillin at one point - among other symptoms, they thought he had a rash that could have turned into Stevens Johnson (look it up, horrifying -- it's a drug reaction that basically makes your body one giant blister.) Ever since then I've taken side effects REALLY seriously. A med with a serious side effect profile has to be exceedingly warranted for me. That's why the warning on the "little rash" with Lamictal would absolutely make me make EXTREMELY sure that the drug was warranted and there was no other option.

Given that experience, I can understand why you'd be concerned with Lamictal. SJS is not a "little rash," but it look that way at the start. If SSRIs aren't right for your kid, then consider an SNRI like Cymbalta or Effexor. My kid could not take SSRIs either, but is doing great on Effexor.

Yep, it totally reoriented my values on costs v benefits of all medications and procedures. Not to the point of being anti-anything, but very cautious. What really helps is finding care providers who are mainstream but help me make a decision in light of my values. So I trust them if they say "you must do X!"