Gifted Issues Discussion homepage Forums Twice Exceptional Prozac and Abilify

DS12, with ASD, anxiety and low self-esteem issues, has been on 10mg Prozac since May. When he started having issues in school this year, we upped it to 20mg (around Sept. 1).

Since upping the Prozac, he has been even more emotionally unstable, manic at times, refusing to go to class, and getting suspended. He has been defiant at school and at home. He has always been a straight A student, but his grades are slipping a bit (most likely due to missing class). I understand that Prozac can make anxiety worse, especially in the short term.

Talked to the psychiatrist today and he wants to add 2 mg of Abilify to the mix.

I'm not crazy about adding even more drugs at this point, though I do understand that medications often require trial and error.

Has anyone else been down this path and if so do you have any advice?

Thanks.

Sounds like you need a new psychiatrist...(we have been there and the doctor, quite frankly, had a mind of her own and any input we gave about side effects was completely disregarded).

It sounds like you have given it a chance and it's not working. We haven't used Prozac but it seems like after a month, you shouldn't see side effects like that.

Is he taking the Prozac regularly? When is he taking it? I would ask to try a different version as Prozac was the worst of the three SSRIs i have taken. I know nothing about abilify but taking more drugs to offset the effects seems like it should come after determining there isn't a better option.

He has been taking 10mg Prozac regularly since May, and we upped it to 20mg at the beginning of the month. We upped it because his in-school behavior was not improving. After we upped it, his behavior has been getting worse. I'm not 100% convinced it is all the fault of the Prozac, but it looks like it is not helping.

Did the psychiatrist discuss whether the behavior might be associated with the Prozac?

I have previously taken SSRIs and had bad experiences with them. I found CBT and similar approaches much more helpful, but that obviously depends on what one needs help with. I think sometimes there is a tendency to dismiss side effects that are worth taking seriously. That type of medication can cause emotional instability, unfortunately.

It is possible to have behavioral changes with media Atkins like that, though, and I think the psychiatrist should discuss them seriously with you. It sounds as though your concerns are reasonable. Other SSRIs may do the same thing or they may not.

I think it is very fair to want to discuss this more and feel confident about the decision about what to do next.

If his behavior hasn't improved at best and has deteriorated at worst, maybe you and his doctor should consider withdrawing the drug and seeing how he does.

Is the psychiatrist responsive to your input? IMO, it would be reasonable to try a different SSRI before adding a second medication to one that might be causing mood lability. It's not unusual at all to have to monkey around with medication--many people have to try different antidepressants before finding one that helps without causing intolerable side effects. I'd be careful and ask for the rationale. Monotherapy is preferable, when possible.

Does your DS take other medication (e.g. stimulant, etc.)? DS here had a really rough year last year with medication for ADHD and my opinion is it was changing body chemistry because of hormonal changes.

Sorry things aren't going well. We had to discontinue SSRI for DS. It wasn't causing the same problems you're describing but was problematic nonetheless. I explained to the psychiatrist we couldn't afford to experiment like this right now, and he was okay with it.

If you aren't comfortable with the physician's approach, do you have other options?

Thanks everyone. The psychiatrist is not convinced that Prozac is the cause of DS's increased anxiety, but I definitely have seen a correlation when he went from 10mg to 20mg. When he started 10mg he was fine, but 10-20 has been very difficult.

As of today, we are dropping him back to 10mg Prozac and adding Abilify. We'll see if that can get us through to the next appointment. I understand that upping the Prozac can cause short-term problems for a few weeks. But in the meantime, DS is suffering - depressed / manic, crying over little things and missing school. This is ridiculous and my wife and I can't just let this go.

I'm tempted to put the plug on meds, but we put him on them because we had a similar episode (though not as intense) when he was off meds this Spring.

I'm very concerned. Ugh.

FWIW DS' psychiatrist said one potential downside to Prozac, specifically, is that it is sometimes too activating. I'd be inclined to trust your instincts on this one.

Sending tons of support to you, your wife, and your DS. This is so trying. It can get better--endeavor to persevere, I guess. Awful watching your child suffer.

Thanks Eco, we will do our best. This is very hard, especially since he was refusing to go to school today. I managed to talk him into it, but I'm waiting for the other shoe to drop. I hope it doesn't.

After spending way too much time reading about various meds, I have concluded that any of them might work, might do nothing, or might have negative side effects including making the thing you are taking them for worse.

It is such a crapshoot. That's why I was so excited about the DNA thing I posted in another of your threads.

I hope the new combination helps your DS. It's no wonder he's resistant to going to school when the year has been so overwhelming for him so far. I know you've said he has a therapist--I hope that person can help. We don't have the "perfectionism" piece in DS, but I have a super anxious gifted perfectionistic DD and she is WAY more difficult to manage than her brother (ironically). Is your DS open to things like affirmations, breathing exercises, etc.? It would be helpful for him to internalize that it's okay for him to struggle, it won't always be this way, one day at a time, etc. Anxiety is really treatable, but not a quick or easy road.

A scientific explanation to your DS about the neurology of anxiety might be helpful, too, since he is a logic oriented type. Beginning to identify--"oh, my limbic system is hyperaroused because the fight/flight/freeze mechanism has been activated" might help him a little. I know that sounds goofy, but it is really helpful for some people to understand what's happening to their actual physical body, and can reduce some of the anxiety that results from anxiety. If that makes sense.

There are probably good videos on YouTube or explanations of the anatomy of anxiety/panic--wonder if any of that would help. DS' therapist is educating him about "helpful vs. unhelpful worries" as part of his CBT. Helpful worries lead to positive behavioral change while unhelpful ones lead to avoidance, withdrawal, meltdown, etc. using this framework.

I think with brainy kids, sometimes you gain better access via cognition and you might get more buy-in from your DS if he understands the physiology of his experiences.

Eco,

This is a great idea. He is resistant to discussing his anxiety and feeling, but a Youtube video might just work. He is very science oriented, though all logic and reason flies out the window when he is under stress.

We are seeing a therapist as well as the psych. Therapist appt is today and psych is next week. Too bad these meds take so long to settle in, as he needs more immediate relief.

Thanks Emma, we're just trying our best one day at a time. DS has been very sad lately and is regressing in age - moaning, dropping his head, falling on the floor, etc. He also hasn't been sleeping well.

We have an IEP meeting Tuesday to discuss things with the school, because the staff has not been terribly helpful with keeping him up to speed on assignments, or specifying homework.

I strongly endorse this view.

The human body is a complex system that isn't well understood, and there are many causes that can present the same sets of symptoms. Additionally, many investigative options are cost-prohibitive, and/or have the potential to cause additional issues. So, sometimes one of the best diagnostic tools available is drug therapy, through trial and observation.

In this particular case, it appears the drug has been given a thorough trial, and observation has revealed no change at a 10mg dose, and a negative effect at a 20mg dose. The data is in, and unless there are valid reasons to expect that a different SSRI may have a different result, it's time to eliminate the mechanism this class of drugs affect as a possible cause altogether, and move on to other potential causes.

This is basic science, and unfortunately, this isn't the first medical professional I've encountered who doesn't know how to (or can't be bothered to) science correctly.

Adding another drug to the mix to counteract the negative effects of the drug that's clearly not working is not an acceptable response.

This is the unfortunate piece of the SSRI puzzle: there are valid reasons to expect that a different SSRI may have a different result, although that is not guaranteed. Mechanism of action is largely unknown. Some people who can't tolerate one have life-changing results from another.

How are things going, BSM?

Okay. We have the IEP meeting Tuesday. As usual, he has a crud-ton of homework, some of it because he hasn't been in class, other is normal homework.

He is fragile and emotional, and needs us to help him through the process. One of us is sitting with him while he works for encouragement. We let him skip a shower and brushing teeth so that he could focus on homework

I'm seriously thinking of homeschooling. That's basically what we're doing now because the school environment with its rigid rules and forced march does not line up well with DS's learning style. He is very curious and exploratory, wanting to be thorough, which apparently is not encouraged. But until my wife is on board, homeschooling is not an option for us.

Anyway, it has been a good day so far, aside from a couple of minor outbursts when he got stressed.

As for the meds, I took him down to 10mg Prozac and we did start Abilify. Fingers crossed.

Obviously, YMMV, but a word of encouragement on the medication: we attempted a very short trial of Prozac and OMG. DS did not become agitated by it, but sedated-ish. During that one week at school--he failed a science quiz and scored a 78/100 on an easy math test--and forgot multiple assignments, etc. He was in a reeeeaaaalllllly good mood (:O) but could not function. Really could not.

Two weeks later, next math test is 100%, he's even writing without too much pressure, grades are all at least 85, he's using his planner, requiring a *bit* less help (i.e. coercion) at home and just all around better.

I see you are at the "thinking of homeschooling" phase of your 2E journey. Been there, too. I understand your thinking. I hope, though, that if you ultimately make that decision, it's an empowered one v. a helpless one.

I am hoping this is your family's Year From Hell and will improve soon. I hope he find some relief with the new medication regimen. Lots of love, encouragement, support, courage, strength your way.

My wife used to be a teacher, and I'm pretty good at math, history, and writing. We could do it. She is the more rational one and is waiting to see if changing up the IEP is going to work. But DS is refusing to do work in class for some teachers, and the school is starting to look at this as a punishable offense, rather than a cry for help.

DS is a *very* enthusiastic learner given the right environment and right approach. I don't want the public schools to destroy his enthusiasm.

Thanks for the support! We really need it. We're two exhausted parents on most days. I feel like I need infinite patience to get from morning to night.

But let me give you an example of what a great and observant kid DS12 can be, despite ASD, anxiety, etc. This was a dialog from yesterday:

DS: "Why are you tucking your shirt into your shorts?"
Me: "Because I'm going biking and it is cold out."
DS: "It looks wrong."
Me: "Biking is not a fashion contest."
DS: "You'll never get a woman that way."
Me: "In case you didn't notice, I got your mom a long time ago."
DS: "I'll bet you didn't tuck your shirt into your shorts back then."

This made my day.

FWIW, I'm so not anti-homeschool. If DS would have considered it, we'd probably doing that right now, for now.