SSRI's, yay or nay

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We had a meeting with DD's consultant yesterday ( a new one, as the one she had previously had moved). I found it very positive and tbh I'm a lot more comfortable with her than I was her previous doctor. We talked over the many issues surrounding DD, and the main worry we both have is her transition up to senior school this september. She has just sat her SATS this week and now has the next few months of worry and upheaval to get through. I told her that DD seems to be 'escalating' in aggressive behaviours atm, ie screaming, throwing things, kicking, rage etc, and she has suggested trying her on some SSRI's to try and help settle her before she actually starts secondary. Now I have said up until this point that I would prefer not to medicate in any way, but always said that if we felt it was needed then it would be considered. Her doctor thinks it would help alleviate her anxiety and stress levels before she has to deal with everything to come, and would be very beneficial to her. So thought I would come on here and see what individual experiences there are of their use

DD is diagnosed aspergers/ADHD/dyspraxia

We have just started my son on an SSRI, and I can vouch for it's effectiveness. He wasn't agressive, but rather more anxiety ridden (which sounds similar in some ways to your daughter -- sounds like she's under pressure right now).

The difference before the SSRI and after the SSRI is amazing. We have our relaxed, happy son back. He is himself -- not a different version of himself. I really have to think that in some way, some "chemical" was missing, and now it's been put back into place.

Based on our experience, I would highly recommend the SSRI. Apparently, when you find one that works, they work extremely well.

We have also just started our son on an ssri for anxiety as well. It has only been two days, so we haven't seen any huge changes as of yet. However, what has happened is he takes it at bedtime and he has had two really good nights of sleep which makes him a MUCH happier boy on waking. I am hopeful that in three weeks we might see some of his anxiety decreasing so he can function and cope.

We've stuck with the "manage the environment plan," in part because I took Meds for post partum depression and (a) found them near impossible to go off, (b) got really tired of needing to sleep so much more, (c) and read about all the studies showing they are no more effective in trails than placebos (although I have no doubt that they make real changes, given that I experienced them, it's just how much of that is the actaul intended result?), leading to (d) I don't think we truly understand how or why they work.

We found that giving my son a study hall period grades 6 - 8 instead of an elective did the trick for him. It gave him extra time to do homework, a teacher to help him stay organized, and an advocate for certain in-school conflicts. Amazing difference, although giving up the elective was definitely a hard choice to make.

But, he isn't a naturally anxious kid. He just gets anxious when situations get challenging or life moves too fast. For him, I see it as a life plan, that he will always need to make some choices to keep things at a comfortable level, and he can have a nice life within the range of those choices. Maybe not a parent's dream of ultimal success, but that isn't what drugs are for. Some kids on this board, however, are anxious practically at the sight of their shadow so, for them, medication has been life changing. But most kids fall in the middle, leaving the path pretty darn unclear, and that is where mommy instinct gets called into play, and discussions with / opinions from your child, as well. Just be careful, and make sure you've considered all the possible environmental/adaptive changes (professionals don't give enough effort to those, IMO, so we have to).

FYI, if I had to vote based only on the information in the one post, I'd say her reaction at this point to the major change is normal, and not a sign of more chemical anxiety. Kids should be allowed to react to the stress of life, and taught ways to manage it. My NT daughter starts middle school next year and she's been hell to deal with ... Hormones, girl world social problems, so many rages and tears ... All normal, apparently, although writing this I'm wondering if I should talk to her doctor ... No, it's still within the range of normal, we have no AS to make anyone think otherwise, and if a standard ends up medicating10% of the kids at school then the standard is wrong. What needs to change is what we ask of the kids.

But, one post isn't all the facts, so none of us can really tell you yeah or neah.

Last edited by DW_a_mom on 14 May 2011, 11:14 pm, edited 1 time in total.

I know nothing about SSRIs as prescribed for children, but I have recently stopped taking Prozac for myself because of its side effects. So, and while I do like the idea of your bedtime administration, I would suggest minimal dosage and watching for side effects. For herself, Temple Grandin says "less is better" here, but I do not recall why/how she had found that to be true.

Oh for sure, it is a very low dose and I am keeping a very close eye out for side effects. Made sure the school knows the side effects as well. We are also following up with the pediatrician in two weeks time to monitor it as well. I was very reluctant to go the medication route, but the fact that my son was just not coping despite all the things I was trying to help him spurred me in that direction. I had such an emotional day yesterday because I hate the reality of medicating my child But as you said, yes for sure, we are monitoring very closely. Thank you for your concern and comments!

When I was 13 years old I was on SSRI called Fevarin for my depression and social anxiety but i had to stop taking it because of the side effects (i didn't sleep for three nights, had terrible headaches)
After that, I was/still am on SSRI Zoloft, but I don't find it affecting me in anyway. I don't even feel anything if i forget to take my pills for a few days.
My mother had a completely different reaction to these medications, she said to me that when she was on Zoloft she felt too happy, too euphoric, like she was high all the time. Zoloft was prescribed to her for her major depressive episode.
Also there was a 17 year old in the hospital, who was on Zoloft and she said that these meds were making her feel apathetic and that she can't really communicate with people then. Zoloft was prescribed to her for her adjustment disorder.
The other girl was on Paroxetin Actavis, and she said that it's helping to reduce her symptoms of anxiety and fear a lot.

This was my mother's experience with Zoloft as well. She also said Zoloft "made her stupider" - she wasn't as engaged with the world and didn't think about things any more. Sometimes the side effects are things that you might not notice in a child. If your child is better behaved because he is more apathetic and duller, you may only notice the "better behaved" part.

SSRIs do not all have the same effect. My mother is currently on fluoxetine (formerly Prozac), and that seems to let her ease off when she needs to, without disengaging with the world generally.

Usually a proper omega 3:omega 6 essential fatty acid ratio in the diet will fix issues like this without needing SSRIs.

My 8 year old son was on Celexa for approx. 9 months. He had aggressive behavior, would hit, kick, head butt, scream, throw things etc. We had already tried all the adhd drugs over the course of about 3 years (the docs thought adhd at first) they all seemed to make him more on edge, more high strung, and angry all the time. We all thought maybe his anxiety was the cause of his behavior so on to SSRI's. The Celexa seemed to not have any effect until the maximum dose of 20mg was used. This took approx. 2 months to get up to. His behavior didn't really improve, rather change to more like mood swings and manic behavior. We thought for a while maybe early onset bipolar was setting in and due to a family history of alcohol, violence, depression, and anxiety (and researching that an SSRI can cause this behavior if someone is bipolar) we wanted to have another assessment with a psychiatrist to rule out/in or to see if the SSRI was causing this behavior. The psychiatrist didn't think he could be bipolar and that the meds were not causing his behavior and told us not to take him off the Celexa (we were already in the process of weaning off based on my hubby's and my gut feeling that this was not right) We were not happy with his assessment and continued to go with our gut taking him off, and he started to improve the more the dose was lowered. He's been drug free for approx. 3 months now, things are soooo much better. I can count on one hand the meltdowns, and before he couldn't go more than 3 days without at least one rage like episode. I call them rages because that's what the meltdowns turned into with the SSRI, it was very different, more intense and violent. He also gained an unhealthy 25 pounds in those 9 months. It seemed to alter his metabolism because his appetite didn't really change. So for us it was a huge nay, but it does seem to help a lot of others.

Couple of things:

1). Try to make your best guess how much of the agression is rooted in anxiety and/or stress. There are other reasons for agression, and SSRI's usually only help things underlied by depression/stress/anxiety. For example OCD has a large anxiety component, some things do not.

2). Even if they ARE appropriate, It is critical to note that each person's DNA response to SSRI's is different. For example reseachers talk about them in terms of "thirds" - 1/3 of people are greatly helped, 1/3 are somewhat helped, and 1/3 are not helped at all.

Same with side effects, you will likely not have the same combinations of side effects you read about here because they vary a lot between people.

3). Getting off the meds - its true for some people's DNA its a bit difficult, but will not be disatrous if very slow tapering is used.

Sweet

We were anti-meds for years. We finally all agreed that we could not go on living like we were, it wasn't fair for our ASD kid and his siblings for our whole lives to revolve around my son's anxiety. He was diagnosed with anxiety disorder separate from the ASD, because it was pretty severe. He is on 25 mg of zoloft, and it has made a HUGE difference in the quality of our lives. Yes, he still has frustration issues that lead to meltdowns,, attention problems, agression, sensory problems, etc., but his anxiety is almost non-exsistent compared to what it was!! I wish we would have made the decision to try meds earlier, instead of what our family went through for years. It is a tough decision to make.

SSRI's are not a bandaid for bad behavior. They tend to cause mood wings and rage issues in adolescents as well as suicidal thoughts. Most of them are only indicated for use in depression and some of them have been shown to be somewhat effective in treating OCD and certain anxiety disorders. Note the word disorders.

There are plenty of types of anxiety that is not a disorder, and the type of anxiety someone with AS experiences during times of transition is not one of them. They are natural emotions.

SSRI's have a lot of other nasty side effects as well. A lot of them cause weight gain which definitely isn't something one wants to hoist upon a young lady who struggles socially and they can cause prolonged sexual dysfunction issues, which of course isn't something one would be concerned about in a teen as they shouldn't be doing such things anyway but the trouble is that this can last beyond the teen years into adulthood and have a negative impact on potential romantic relationships. NOT good for someone on the spectrum.

Your daughter likely just needs assurance that the new situation isn't as scary as it seems and a reminder that she has endured big changes before and eventually settles into the new situation. You might draw up a bit of an outline of what's in store for her so she knows what's coming in terms of school and life and illustrate that there are people to help her along the way and that she won't have to go it alone.

You also need to keep in mind that a lot of her behavior is probably hormonal and actually quite normal for her age. Some teenagers just act horrible.

I think other approaches should be tried before one resorts to medication and I base this on years of experience with the medications.

I'm glad the medication has helped your son but I have to say he's the exception.

I think probablyone of the reasons that they don't fair much better than the plecebos is because they are over prescribed, and prescribed for things that they can't actually treat.

For example, there is depression that is of a purely biological basis and is an actual disorder, and there is depression that is environmental. I don't think the medication is going to be very effective against this environmental depression, because the depression is really a natural response to an external situation. But if you lump these individuals in with those who have a biologically based depression, for which the medication does treat, and do your study, you have diluted your sample and you dilute the effectiveness of the medication.

It is like not distinguishing between a sore throat from strep throat and a sore throat from everything else, giving everyone with a sore throat antibiotics, and then concluding that the antibiotics don't work better than a placebo because it doesn't seem to be as effective as it should, when in actually, it could only treat those who actually had strep throat.

Basically, the drug companies have shot themselves in the foot.

Thank you all very much for your replies The doctor is recommending fluoxetine for her, which may have a different name in the US, so not sure if it's been mentioned already.

To go into a bit more depth regarding DD. The behaviours I was talking about are not new, they just seem to be increasing in regularity. At school she cries, gets upset very easily, is irritable due to noise levels and behaviours in class, gets anxious and stressed if things of hers are moved or used etc. Finds it very difficult to sit still and concentrate, and this has always been the case with her, hence the doctor recommending the SSRI to try and help her cope better. She has always had bad meltdowns, but as her anxiety levels are increasing they are becoming more frequent, and trying to manage them doesn't seem to be very effective. I think in the UK we're not as quick to medicate children, perhaps due to the fact they get free prescriptions over here, so I'm feeling that perhaps this is being put forward as a necessary step for her.

That is the Prozac I had been taking (and Temple Grandin still does).




You already seem to be very astute in all of this, and yet I would suggest (since autism is not a problem of physiology needing medication to "balance the brain" or whatever) being sure you do not miss the complete absence of both neurology and psychology in the above. At best, medications can only suppress the effects of the autistic's neurologically-based difficulties.