Gifted Issues Discussion homepage Forums Twice Exceptional Coming off Prozac

Eco,

I'd be interested in hearing how your son does with this type of diagnosis. As I may have mentioned before, our psych said that this research is very cutting edge and does not have any reputable results just yet. Still, I think about how much we might learn if we took a large number of 2e and neuro-typical kids under an fMRI and sequenced their DNA.

Anyway DS12 is doing a little better containing himself in school. He's been off Prozac for over 5 weeks. 2 weeks ago he had a major meltdown and this weekend he had issues but otherwise I'm seeing small improvements.

Nurse called and gave me some preliminary information, will have full report Friday.

I can't quote, specifics but here is the little bit I took (poor) notes about during quick phone call.

1--Something about COMT gene, more than one issue, associated with attention, mood, anxiety, etc.
2--Something else about sensitivity to SSRI drugs--"intermediate" metabolizer, quick google search reveals this is not worst case scenario, but not best, either.
3--Non-stimulant meds for ADHD recommended, non SSRI/SNRI for mood stuff.

Ready for this, BSM? Psychiatrist is recommending Abilify, because it stabilizes mood and has antidepressant qualities. I've asked question, why Abilify instead of Lamictal (just because, am nervous about it), but haven't heard answer yet.

Psych recommends staying on current stimulant for now, but may change to Wellbutrin later (not stimulant but acts on dopamine. Somehow).

I asked nurse if there was anything about the MTHFR gene and she said not in his notes, which probably means that is not an issue, or he'd have prescribed Deplin.

Anyhow, will update more as this unfolds...

Interesting. The thing to watch with Abilify is weight gain. We've kept the dose small because of that. We're not on a stimulant yet, as DS is not ADHD, thought with all of his EF problems I'd think one might help him focus.

The genetic testing is very new and it's important not to read too much into it. Intermediate metabolizer means it isn't broken down too quickly (meaning the dose may be too small) or too slowly (meaning the dose may be too large). It is mostly just telling you how the liver metabolizes things, which is only one part of the picture. Many other things affect how someone responds to different medications. I have done the genetic testing just because I wanted to have the information on liver enzymes out of curiosity. The results didn't match my experience with the different medications (I don't take any now but had previously). Amusingly, I also had the gene variant associated with lower risk of OCD when I used to have that severely. That's just my experience and doesn't mean the testing isn't useful, but it just isn't clear enough yet what some of the results mean and it just isn't enough to know which medications to choose even though it may help. There is a good review of the data that I can dig up again if anyone is interested (I posted it on another thread when this was discussed before). I'm glad I had it done, but there really isn't enough data to know how useful it will be and it concerns me that it seems to be getting promoted as able to do more than it can at this point.

DS psychiatrist allowed me to choose and so we're going with Lamictal for now--better SE profile and generic. Downside is it takes much longer to titrate and see if it's effective.

apm--I agree with your take it with a grain of salt attitude about this. My son has had a really difficult time with side effects on stimulants and his one SSRI attempt was short/unsuccessful, so I'm going with "what can it hurt?" The biggest risk I see, at this point, is if the physician relies on this technology alone.

DS' doctor said that one advantage of being a young psychiatrist is they are required to learn a lot about this in medical school. He didn't seem to be saying there's any magic here, just that it helps narrow the crapshoot a bit.

BSM--DS doesn't fully meet ADHD diagnostic criteria, either, but his impulsivity has been an ongoing issue, and he has pretty much zero EF. I don't think the stimulant really helps with some aspects of EF but it does help with *something*. I'll be interested to see if he has a positive response to the new medication, and if his anxiety is addressed, what that looks like.