How long to know if anxiety is related to adhd meds?

[Anonymous]

DS is 8 and has been on Adderall for a couple years with good results. At some point last year, he started having some greater irritability and defiance, and some other quirks, which are probably anxiety related. We know that stimulants can bring out underlying anxiety in predisposed kids so we're wondering if the Adderall is the trigger here, or if it's just plain old anxiety.

We've tried some other stimulants, but the anxiety was the same (and those other meds were less of a good fit for DS's adhd). I hate to have to spend 6 months trying all the stimulants at different dosages, potentially chasing a perfect med that doesn't exist (i.e., what if all stimulants cause the anxiety? Or what if the anxiety isn't stimulant-caused? In either case, no stimulant will do better for DS than Adderall). We could try intuniv, but it takes a while to kick in.

Instead of testing every other med, it seems like the easier solution is to take DS off Adderall for a period of time and see what happens. We've tried for a weekend, and think we still seen the anxiety. Maybe we need to try for longer? How long does he need to be off all stimulants before we can tell if the anxiety is triggered by them versus just regular anxiety?

[Anonymous]

Anonymous wrote:DS is 8 and has been on Adderall for a couple years with good results. At some point last year, he started having some greater irritability and defiance, and some other quirks, which are probably anxiety related. We know that stimulants can bring out underlying anxiety in predisposed kids so we're wondering if the Adderall is the trigger here, or if it's just plain old anxiety.

We've tried some other stimulants, but the anxiety was the same (and those other meds were less of a good fit for DS's adhd). I hate to have to spend 6 months trying all the stimulants at different dosages, potentially chasing a perfect med that doesn't exist (i.e., what if all stimulants cause the anxiety? Or what if the anxiety isn't stimulant-caused? In either case, no stimulant will do better for DS than Adderall). We could try intuniv, but it takes a while to kick in.

Instead of testing every other med, it seems like the easier solution is to take DS off Adderall for a period of time and see what happens. We've tried for a weekend, and think we still seen the anxiety. Maybe we need to try for longer? How long does he need to be off all stimulants before we can tell if the anxiety is triggered by them versus just regular anxiety?

Why don’t you take the summer off meds? We’ve been able to see this summer that my son is definitely more chilled out off Adderall but he’ll need to go back on it in the fall for school. I know it doesn’t cause it, it just heightens it.

[Anonymous]

You need to talk to your psychiatrist and if you haven't already, take him to a psychologist for a differential diagnosis to tease out the anxiety and ADHD.

Many, many children have both, and their treatment needs to take both issues into account.

[Anonymous]

Anonymous wrote:You need to talk to your psychiatrist and if you haven't already, take him to a psychologist for a differential diagnosis to tease out the anxiety and ADHD.

Many, many children have both, and their treatment needs to take both issues into account.

Honest question: how would the psychologist tease those out? And how would that help us understand if it's med related?

Going off meds all summer not an option because he needs them to attend morning camp

[Anonymous]

Anonymous wrote:

Anonymous wrote:You need to talk to your psychiatrist and if you haven't already, take him to a psychologist for a differential diagnosis to tease out the anxiety and ADHD.

Many, many children have both, and their treatment needs to take both issues into account.

Honest question: how would the psychologist tease those out? And how would that help us understand if it's med related?

Going off meds all summer not an option because he needs them to attend morning camp

We had a round of neuropsychological testing done at Mindwell Psychology for this reason, and to determine if there were other undetected learning issues that might be contributing to his issues.

We went into it certain it was ADHD, and were surprised to find that anxiety was far more of an issue (much more elevated levels than ADHD, which was mild to borderline). The test also identified depression, which was a total shock. It definitely affected medication choices, and how the therapist my child sees approaches their treatment.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You need to talk to your psychiatrist and if you haven't already, take him to a psychologist for a differential diagnosis to tease out the anxiety and ADHD.

Many, many children have both, and their treatment needs to take both issues into account.

Honest question: how would the psychologist tease those out? And how would that help us understand if it's med related?

Going off meds all summer not an option because he needs them to attend morning camp

Stimulants are not going to create anxiety where it doesn't already exist to a certain degree. They can exacerbate anxiety though.

Children change -- a child that doesn't have anxiety at 6 may well develop it by 8 or 12 or 13. And a child with ADHD is always at a higher risk.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You need to talk to your psychiatrist and if you haven't already, take him to a psychologist for a differential diagnosis to tease out the anxiety and ADHD.

Many, many children have both, and their treatment needs to take both issues into account.

Honest question: how would the psychologist tease those out? And how would that help us understand if it's med related?

Going off meds all summer not an option because he needs them to attend morning camp

Stimulants are not going to create anxiety where it doesn't already exist to a certain degree. They can exacerbate anxiety though.

Children change -- a child that doesn't have anxiety at 6 may well develop it by 8 or 12 or 13. And a child with ADHD is always at a higher risk.

If it's exacerbated by adhd meds, wouldn't it be good to know that? If it's not related to the adhd meds, you might need to add in an anti-anxiety med. But if you can confirm it's exacerbated by the adhd meds, and find another adhd med that helps without the anxiety, you may be able to get away without needing an anti-anxiety med? Less meds is generally better....

[Anonymous]

We knew DS’s medication, Focalin XR, was causing his anxiety within a week of getting off the med. He was on Focalin for about three yrs at that point from 7 yrs old to 10.
DS has ASD/ADHD and he is a tournament chess player since he was 8 in the top 100 list in the USA for his age.

The anxiety started last October because he started losing on time at chess tournaments which he never did prior and steadily got worse: by Dec, he was losing on time a lot afraid to make the wrong move.

We took DS off his medication in May and it was like pushing a switch. DS started playing chess way too fast making blunders/silly mistakes which he hasn’t done since he was a beginner. Literally like a different kid.

Within three days of being off the med, DS was having reciprocal conversations with his peers at his initiative without prompting. Stopped stimming - he would stare at his hand while moving them palm up, palm down and zoning out - everyone had thought these were stims from his ASD but apparently not because he no longer did this once off the Focalin. He stopped being fully independent in writing at school, needs a lot more assistance and prompts to stay on task academically including in math - which he never did before on the Focalin.

DS is not on any medication for the summer. DS is over his time issue in chess: it took a few months but he managed to slow down without medication. He is going to Auburn this fall and we are going to see if he needs go back on ADHD medication once School starts.

Try going off the ADHD med for the summer, you maybe surprised. We were.

[Anonymous]

Anonymous wrote:We knew DS’s medication, Focalin XR, was causing his anxiety within a week of getting off the med. He was on Focalin for about three yrs at that point from 7 yrs old to 10.
DS has ASD/ADHD and he is a tournament chess player since he was 8 in the top 100 list in the USA for his age.

The anxiety started last October because he started losing on time at chess tournaments which he never did prior and steadily got worse: by Dec, he was losing on time a lot afraid to make the wrong move.

We took DS off his medication in May and it was like pushing a switch. DS started playing chess way too fast making blunders/silly mistakes which he hasn’t done since he was a beginner. Literally like a different kid.

Within three days of being off the med, DS was having reciprocal conversations with his peers at his initiative without prompting. Stopped stimming - he would stare at his hand while moving them palm up, palm down and zoning out - everyone had thought these were stims from his ASD but apparently not because he no longer did this once off the Focalin. He stopped being fully independent in writing at school, needs a lot more assistance and prompts to stay on task academically including in math - which he never did before on the Focalin.

DS is not on any medication for the summer. DS is over his time issue in chess: it took a few months but he managed to slow down without medication. He is going to Auburn this fall and we are going to see if he needs go back on ADHD medication once School starts.

Try going off the ADHD med for the summer, you maybe surprised. We were.

Wanted to add that DS does not have anxiety according to his two neuropsych evaluations at 7 and 10 (he got tested not on any medication both times). Also, we took DS off his ADHD meds at his insistence. Everyone, his psychiatrist, neuropsych, teachers, etc and we his parents were against going off it, but now am glad to have listened to DS. DS has ADHD, combined type, and ASD and tests above grade level academically across the board. We are hoping that small class size will be enough but if not, DS will go back on medication just not Focalin.

[Anonymous]

Anonymous wrote:DS is 8 and has been on Adderall for a couple years with good results. At some point last year, he started having some greater irritability and defiance, and some other quirks, which are probably anxiety related. We know that stimulants can bring out underlying anxiety in predisposed kids so we're wondering if the Adderall is the trigger here, or if it's just plain old anxiety.

We've tried some other stimulants, but the anxiety was the same (and those other meds were less of a good fit for DS's adhd). I hate to have to spend 6 months trying all the stimulants at different dosages, potentially chasing a perfect med that doesn't exist (i.e., what if all stimulants cause the anxiety? Or what if the anxiety isn't stimulant-caused? In either case, no stimulant will do better for DS than Adderall). We could try intuniv, but it takes a while to kick in.

Instead of testing every other med, it seems like the easier solution is to take DS off Adderall for a period of time and see what happens. We've tried for a weekend, and think we still seen the anxiety. Maybe we need to try for longer? How long does he need to be off all stimulants before we can tell if the anxiety is triggered by them versus just regular anxiety?

We took our DC off his stimulant medications for the summer and it's been terrific so far. He is ASD/ADHD (impulsive) and also takes Lexapro (for the anxiety). We had been seeing increases in irritable and aggressive behavior and wondered if it was associated with the stimulant. Without them, he is MUCH more even, and engages better with peers. This summer hasn't been without bumps, but we're now optimistic that we can keep the stimulant (Vyvanse) at bay when school begins again.

Your question was about timing. While we saw changes immediately, wasn't until 8-10 days out that we saw a new pattern of behavior. There was some increased edginess as his body got used to NOT being on the stimulant (day 2-7 or so). Are you taking a vacation at all this summer? Any bigger block of time where you can look and see? It was a game changer for us, realizing that anxiety was driving A LOT of the behavior we'd been seeing and that the stimulants were exacerbating it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We knew DS’s medication, Focalin XR, was causing his anxiety within a week of getting off the med. He was on Focalin for about three yrs at that point from 7 yrs old to 10.
DS has ASD/ADHD and he is a tournament chess player since he was 8 in the top 100 list in the USA for his age.

The anxiety started last October because he started losing on time at chess tournaments which he never did prior and steadily got worse: by Dec, he was losing on time a lot afraid to make the wrong move.

We took DS off his medication in May and it was like pushing a switch. DS started playing chess way too fast making blunders/silly mistakes which he hasn’t done since he was a beginner. Literally like a different kid.

Within three days of being off the med, DS was having reciprocal conversations with his peers at his initiative without prompting. Stopped stimming - he would stare at his hand while moving them palm up, palm down and zoning out - everyone had thought these were stims from his ASD but apparently not because he no longer did this once off the Focalin. He stopped being fully independent in writing at school, needs a lot more assistance and prompts to stay on task academically including in math - which he never did before on the Focalin.

DS is not on any medication for the summer. DS is over his time issue in chess: it took a few months but he managed to slow down without medication. He is going to Auburn this fall and we are going to see if he needs go back on ADHD medication once School starts.

Try going off the ADHD med for the summer, you maybe surprised. We were.

Wanted to add that DS does not have anxiety according to his two neuropsych evaluations at 7 and 10 (he got tested not on any medication both times). Also, we took DS off his ADHD meds at his insistence. Everyone, his psychiatrist, neuropsych, teachers, etc and we his parents were against going off it, but now am glad to have listened to DS. DS has ADHD, combined type, and ASD and tests above grade level academically across the board. We are hoping that small class size will be enough but if not, DS will go back on medication just not Focalin.

DS tells us it was much easier for him to slow down his chess off his medication (which he is able to do, took about 10 wks) than when he was trying to speed it up and not lose on time while on the Focalin: he was unable to do it even after 6 months of trying his hardest. Anxiety can suck even more than the ASD/ADHD.

[Anonymous]

I know you have discussed some options. Have you discussed these options with the therapist? Each child is different so it would be hard to know for your DS how long to discontinue a medication. It's important that you check with the professional before stopping any medications. Medications all have a life span in the blood system and when you discontinue them you have to wait until it gets out of the system. Maybe consider speaking again with the therapist/psychiatrist. Wishing you both well.