Reply to My 12 yo's irritability is off the charts

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]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.[/quote]

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 [/quote]

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.[/quote]

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 
[/quote]

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. [/quote]

op - no one with an adhd kid is 'cavalier' about stimulants. As ADHD parents we know that there is no substitute for stimulants. To know if there's no substitute for an SSRI would require you to confirm it is depression and then work through a litany of options to better get at the root of what is wrong before you intervene medicinally. That is not the same for ADHD. [/quote]

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