Desperate for help

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My son was diagnosed with Asperger's when he was 11. He started Prozac (30 mg)when he was 10 because of anxiety. Everything has been fine until this year. He's a senior in high school. A National Merit Commended Student (Top 5% in the nation). Back in October he was struggling with an AP class. His high school allowed him to take an AP Physics class without the prerequisite regular Physics class. He was diagnosed with depression in Oct. and dropped the class. The psychologist he saw (twice) felt like maybe the Prozac wasn't working for him anymore so our family doctor switched him to Celexa, Abilify, and Ativan as needed for the panic attacks. He stayed home for a week to get him going on the meds then went back to school. That lasted until Nov. 27th. He started panicking again. Long story short, those meds didn't work. We took him off Celexa (and back on Prozac and added Risperdal) because we thought that was making him more anxious. We finally got into a psychiatrist on Dec. 27th. He determined the Abilify was causing Akathesia (sp?) and when we took him off that, the major panic seemed to go away. Here are the med changes so far:

Dec. 27th: Increase Prozac to 40mg, Ativan(1mg twice daily) as needed, Buspar (5mg twice daily), continue Risperdal (1mg)

January: When things weren't improving we upped the Prozac to 60mg and Buspar to 10mg twice daily. Eventually Buspar to 15mg twice daily. Also added NuVigil (started at 150 then upped to 250mg) to help with focus and alertness because he said he was so tired.

He got back to school on Jan. 24th and seemed to be doing somewhat better. Things weren't perfect but he was trying....until Feb. 22nd.

Feb. 16th: Decided he was still depressed so we're reducing Prozac to 40mg and adding Pristiq (50mg). After two weeks I noticed he was still anxious, having problems controlling temper. Doctor wanted to wait until 1 month to change anything.

March 7th: I took him to the hospital. He had the 2nd major panic attack: fits of crying and anger in less than a week. I thought it was best to get him evaluated for possible inpatient care. We got there at 11:50pm. He was very angry and nasty with staff once we got there. Doctor did basic vitals. They gave him 2mg of Ativan at around 1:00am. By 2am he was sleeping. He didn't see a psychiatrist for an evaluation until 5:30am. Then waited until 7am to see the head psychiatrist. They determined he would be better serviced by an outpatient program (which he told them he would not do because it involved group therapy) but since he said he wouldn't hurt himself and wouldn't hurt anyone else they wouldn't admit him.

March 18th: He was improving over the next 11 days. Had some mild anxiety but doing better. Doctor thought upping his Pristiq to 100mg would help him improve further.

Now we're back to square one. He's back to panic attacks and decided to stay home and go on home instruction to finish out his senior year. He's dropped every class except the 2 he needs to graduate however he's really struggling to complete work, can't focus, and has started having panic attacks again.

He seems much more angry than before. I've explained this to the doctor and finally convinced him to at least go back down to the 50mg of Pristiq. Tonight he's sobbing and angry again. He turned 18 in March so unless I call the police I can't make him go to the hospital. Frankly, I don't know that they'd keep him anyways. All I want is for him to get through the next 2 months so he can graduate. He's already decided to take a year off before college but tonight he says that makes him mad too. He was accepted to the 2 schools he applied to and even received a full-tuition scholarship to one. I have no idea what to say to him when he is so angry and frustrated. He won't switch psychiatrists because he says he finally found one he can talk to but then he also says he doesn't think he knows what he's doing.

It's been 6 months. I know these things can take time but shouldn't he be feeling somewhat better? Any advice?

Sorry if this rambles...I am becoming brain dead with all the meds, doctors, etc. I teach 52 Kindergarten students and I'm a single mom so it's been really hard. Thanks!

there are no meds for anger. one-on-one talk therapy may help. cognitive behavioral therapy could help with the panic attacks and depression.

panic attacks are uncomfortable, but not dangerous. retreating when you have a panic attack is counter-productive and makes it more likely that panic will strike again.

it seems a shame to waste a full-tuition scholarship by waiting out a year.

I don't want more meds for the anger. I wonder if the Pristiq could be causing the anger because while he's always had a bit of a short temper it has never been to the point that he was angry all the time. Or perhaps, coming off the Pristiq has caused it. I don't understand all these medications which is why I was asking for advice.

He is seeing a therapist but so far hasn't been able to trust him enough to do anything more than barely listen. He says he wants to get better but then he says his "fight or flight" kicks in when he gets there so he wants to just leave. I don't let him but he doesn't really participate fully.

There's no way he could accept the scholarship given that the school is 2 hours away. He has never been on his own and can't even go to regular high school. It is a waste but I'm not sure what I can do about that. That's part of my sadness for him. He's missing so many opportunities because of whatever this is that has a hold on him.

Is there anything I can say to him when he's having a panic attack that will help him push through rather than retreat? I've tried being tough and I've tried letting him vent away to no avail.

you can remind him to take SLOW deep breaths and that the anxious feelings will pass in a few minutes. all he has to do is wait. let him know ahead of time that no one has ever died from a panic attack and that retreating is likely to make things worse.

it also might help if he got some relaxation CD's and practiced conscious relaxation, either through visualizing a pleasant place, muscle relaxation, or deep breathing, or all three. if he becomes practiced and good at it, he can use it to do battle when panic strikes.

So, I think part of the problem might be the rather rapid switching around of meds. First of all they take awhile to work, but I see some switches taking place after just a week or two. Secondly, some of those have WITHDRAWL side effects. Pristiq in particular. Many doctors don't acknowledge it, but Pristiq has serious cessation side effects for some people. Both myself and my father I law had a horrible time reducing doses and coming off it, I can't imagine going cold turkey or switching quickly to something else. My doc said that you should never go right from something like Prozac to Pristiq, or vise versa with out a plan to ween from one onto the other. Don't know if your dOctor developeD A plan like that for your son or not.

Just my two cents.

When I have "anxiety," I tell myself that it is random firing of my wonky autonomic nervous system and that it is not related to any real danger. I remind myself that it becomes "anxiety" or "panic" only when I cognitively label it as such. That seems to help me.

Wow, it seems like you are going through so much with your son right now. Can't even imagine it!! ! First off, I'm just so impressed by how well your son managed to do up to now! Just last year, he was doing awesome! I would continue to remind him of that and tell him how he will get back there and that you have confidence that he will be in that place again (don't tell him how he is throwing it all away, I'm sure he understands this already). I don't know anything about drugs but I can imagine that the withdrawal from them must be really tough. Have you ever tried B-complex? I know that my first phychology professor in college told us that she wished more doctor's would prescribe B-complex before they start prescribing stress drugs as sometimes stress is caused by an deficit in those vitamins. I know it's probably something you already do, lol. but it may help to try it if you haven't and on the bright side, no bad side effects. Secondly, your son has some months to get it together but if he just can't and really needs a year off, I'll give you the advice a Cell-Biology professor just gave us last week, contact the scholarship association and ask if it's possible to extend the scholarship till the following year. They may be understanding and say it's okay for your son to take a year off and start fresh the following year without losing the scholarship. You never know, it doesn't hurt to ask and broaden your options a bit. Hope it all turns out ok!

Could he try punching pillows/cushions for releasing some anger? Are there any activities that encourage yelling (there is a martial arts type dance called Capoiera where they really yell!) which might release some frustration.

You could suggest he writes a list of what is annoying him and then burn it to let it all go.

What an awful time with all those medications. I take SSRI (Zoloft) and when they increased my dosage I started getting panic attacks and high anxiety, when I checked the instructions for what the side-effects were...you guessed it, for an anti-anxiety/anti-depressant medication one of the side effects is anxiety (and panic)!

Sounds also to me like your son might be under an awful lot of pressure: could some of it be related to his courseload and his perception of needing to be "gifted" and keep his rank in the National Merit Scholar program? Could you have a conversation about what is causing his stress - maybe have him make a list of everything that he perceives to be stressful and have him rank it from highest to lowest?

There is depression and depression - meaning that sometimes depression has to do with how you are wired and respond to your environment generally, and sometimes it has to do with your response to specific things that are happening to you. I'm not a doctor, but in our family's experience the latter type of depression (representing a specific need) tends to be less responsive to medication.

I also agree with prior posters, it sounds like the meds are being cycled through or changed awfully quickly - can you find another psychiatrist and get a second opinion on how to approach medication?