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Don't know if this is off topic but here goes....

DS12 is ASD with anxiety, self-esteem and perfectionism issues. His behavior was fine for the summer, but has taken a turn for the worse once school started. Many assignments are stressful for him as is the school day.

He is in an accelerated program for exceptionally gifted kids, so the workload is high and he gets a significant amount of homework.

He has been acting out in school quite a bit and yesterday was angry and aggressive for a couple of periods. Overall, his emotions have been going up and down like an elevator in an office building. One moment he is happy, the next he is in tears or defiant. Today the assistant principal will be talking with him.

About two weeks ago, we spoke with his psychiatrist and agreed to up his dose of Prozac from 10mg daily to 20mg. The doctor did not tell us but I did my own research online to find that upping a Prozac dose can actually increase anxiety and depression for 2-4 weeks before it fully kicks in.

Has anyone dealt with a similar issue?

It really takes some weeks to settle in with that class of medications. I'd suggest helping your DS be kind to himself and seeing if it settles before giving up on it.

At the same time, call your prescribing doc and keep them informed of what you're seeing.

My DS will begin SSRI treatment tomorrow. Psychiatrist said give it a 1-2 weeks to adjust to the serotonin effects, and four to assess efficacy on anxiety/mood. I imagine the same timeframe would be appropriate for a dosage increase.

I don't think it specifically causes an increase in anxiety/depression but can be activating (could present as agitation) so the result may look similar.

Different-but-related (and exciting) note: DS' new physician said that there are now saliva tests to identify specific genes (he gave a very complicated explanation) that can help prescribers make better decisions about which medications to prescribe. They don't currently do this unless a child has "failed" several meds (which means the med didn't work properly) but it is really promising. Their clinic sends DNA sample to Mayo Clinic--this isn't quackery! They can also now measure blood levels of SSRI, SNRI, etc., a commonplace practice in neurology but cutting edge for psychiatry. Different bodies metabolize medication differently and there are complex mechanism-of-action considerations.

I know that is just a little bit OT, but I was so encouraged that I wanted to share with you. This physician is convinced--and was convincing--that there is a huge genetic component in ASD/ADHD and that targeting the right neurobiological component for treatment is the key for optimizing treatment.

A link:

http://genetics.testcatalog.org/show/HTTO

Eco,

Thanks for this. There definitely seems to be a genetic link with ASD. Research going back to the 40's shows evidence of this. In our house, I'm pretty sure that my wife and I are both mildly on the spectrum, but highly-functioning, as they say.

I'll be discussing this testing with our psychiatrist.

I think we are ASD-central at my home, too. It's so much easier as an adult when you can self-select your friends and peers.

I hope your DS feels a lot better, soon. His program sounds stressful--no wonder he's off-kilter. Good luck to you and yours!

Oh, one more tidbit: the psychiatrist said that this testing is inexpensive! He said even when insurance won't cover a dime--it's only 300-ish dollars. So if your doctor isn't familiar, you might be able to have this done independently. Not sure how that sort of thing works.

That is cheap! (Compared to other tests at least...)

Thanks again. We'll see if he knows about it.

Be careful about the genetic testing. It is interesting to do and gives information about how you may metabolize medications such as painkillers, ADHD medications, SSRIs, etc. It provides info on whether you are likely to metabolize specific medications too quickly (resulting in lower than expected levels) or too slowly (resulting in higher than expected levels). However, there are many more factors than that that determine how an individual may respond to medications. While the out of pocket amount may be relatively low, even without insurance, they will attempt to have the insurance pay a much larger amount and this may affect different people in different ways (depending on coverage). For those with a limited amount of lab work coverage per year, it may consume quite a bit of the coverage.

I actually had this testing because I always respond very strongly to medications and was interested to know the genetics of my liver enzymes for that reason. I am also a science nerd.

However, it is really hard to know how helpful this testing is at this point (I think this sort of testing will become increasingly valuable as more is learned).

I found this article to be a helpful summary. It focuses on one specific company, although others also do similar testing.

www.thecarlatreport.com/free_articles/genesight-genetic-test-review-evidence-free-article

Going back to the original post, there can be many effects to increasing the medication. I took Prozac myself many years ago and remember it well (and not fondly). I hope that things settle down soon and that it is just related to adjustment to the higher dose.

Thank you for sharing that! I was excited about the genetic testing info in a kind of future-oriented way, too--it makes me think that treatment is (at some point, anyhow) going to be more specific and efficient, which is a comforting prospect in thinking about our children.

The psychiatrist also mentioned that there are some newer medications that behave differently (and have the potential for fewer side effects), but they are expensive and insurance often balks at paying.

The frustrating thing about psychotropic medication is that so much of it is just a crap-shoot, and it can take a long time to find an optimal medication. If I understood correctly, the genetic testing is promising because it can help prescribers make better predictions.

BSM, I hope you don't feel hijacked! I was thinking about your DS and your concerns about his medication when I interjected the information I'd just learned. Using these medications is so stressful for parents, all the way around--and even more so when you see your child suffering and can't be sure of the cause.

One more thought: puberty. My DS12 showed signs of puberty on the early side, and was in full blown hormonal mess all of last year (sixth grade). We saw a lot of mood swings and negativity and he experienced his first (and second) depressive episode. Things seem to have settled down a bit now. Could hormonal changes be affecting your DS? I don't know if there's much a parent can do about that, other than making sure the kid has information and emotional support.

Hi guys,

No hijacking issue here, I'm happy to see the discussion.

We did visit the psychiatrist today and he was nice enough to discuss these tests for about 15 minutes. He does not believe that there is enough evidence yet that the results of these tests have clinically proven efficacy. He indicated that there are some drugs for which genetic testing is highly recommended, due to some peoples' reactions, but it is too new for SSRIs still.

And to make things even more entertaining, DS had a wonderful day at school on Thursday, and apparently had a good day today as well. I'm thrilled about that, though these ups and downs are taking years off my life

And yes, we're probably having puberty issues as well. At this point we take it one day at a time.