Gifted Issues Discussion homepage Forums Age or Ability Specific Forums Pre-school Psychotropic drug, slightly OT

Hi. I need intelligent, thoughtful responses to this, so posting here...

DS2:8 has asthma, he is on multiple high-dose meds for it. We started one 4 mos ago, and the effect was significant, we could see obvious improvement in daily functioning, and he has not been hospitalized since he went on it (down from a lifetime avg of 4x/allergy season). We also saw immediate, negative mood effects. The drug is proven to produce depression and suicidal ideation in a significant (statistically, yes, but also just to my mind) proportion of seniors who take it, there are reports in younger populations, but I could find no decent studies in younger age groups. There is a family history of depresson on both sides. I have a complex history of bad side-effects and drug resistence, both asthma meds, and other drugs.

We took him off the new med on a trial basis three days ago.I though I saw an improvement in his mood. I didn't get a chance to talk to DH about it. His uncle came over last night and, before getting his coat off, he said "oh, are you trying the other drug, [kid] seems more like himself?" He didn't even know we had an appt comming up, let alone that we had gotten clearence to switch, only that we'd said, three mos ago, that we might try sometime in the winter if the Resp. though it was a good idea. Basically, I don't think that was wishful thinking, I think he really saw something. DH isn't sure he's seen an improvement, but he HAS commented on DS's good behavior 4 or 5 times a day since. So I'm not convinced he really isn't seeing something, he just hasn't clued in yet. When I pointed that out, he said "yeah, I have been saying that a lot, haven't I?" and got all thoughtful.

There is an alternate drug, but it addresses the problems less directly. It is unlikely to work as well, but it will probably work. We won't know 'till he's in the hospital if it will work well enough to keep him off the heavy drugs (oral corticosteriods). Every hospitalization has the potential to become life-threatening, because DS's asthma becomes very severe very quickly, and in the past he has consistently needed max doses of multiple drugs to get out of an exascerbation.

We will continue the trial of the replacement drug for at least 11 days, under the circumstances, we will likely go longer. How would you approach the problem of deciding between the two drugs by mid February (the latest safe date to switch back to the original drug) if it were your kid?

Thanks, sorry for being off topic, I just need the kind of thinking I won't get most other places, and I need it from people who don't know us personally.

-Mich

What a difficult dilemma, having to decide between supporting physical and mental health! I know that this must be heart wrenching for you. I would bear in mind as you consider your alternatives that depression is also a life-threatening condition, and you know that the old med, while it was very effective for the asthma, definitely caused serious mood disruption. You don't know how well the new medication will control the asthma long-term, (remember, it might be fine!), but you do know that you are already seeing benefits in the mental health domain. As someone who has experienced both life-threatening asthma and psychological side effects from prescription meds, I personally would be more willing to deal with less-than-optimal control of asthma (though not at the hospitalized-every-month level) than with uncontrollable mood and mental changes that make me feel not myself.

Have you looked into anti-inflammatory dietary changes at all, and have you ever considered acupuncture as an adjunctive treatment? (Acupuncture has been repeatedly demonstrated to help control inflammation.) Both have been very helpful for me in reducing the frequency and severity of asthma attacks, to the point that my only current medication is a rescue inhaler that is used perhaps once or twice a year, if that.

This is precicely what I'm worried about. and what most people are ignoring, including the respirologist.

And, I, like you, have chosen/would choose to cope with imperfecty controlled asthma rather than suffer certain side effects. I've also used "alternative" control methods with good results.

And if DS is smart, especially if his talents run in the same vein as mine, he will be prone to depression, I think. That Dabrowski guy seems to have met me, anyway. Ugh.

But how do you effectively monitor a 2 yr old (for mood OR for Asthma)? esp. one who is increasingly spending time away from parents. Esp when we're looking at his lil brother's first spat with the same, and possibly going down the crazy getting-treatment-for-an-infant misery soon. arg.

-Mich the really, genuinely worried right now.

Are you followed by a good pediatric allergist? I'm a doctor, and I have seen how our allergist in my group makes a huge difference for kids with allergies. Very few children need to be on oral prednisone, which is probably the drug that you are describing which is triggering depression in your son.

My older son had terrifying asthma, so I feel for you. Nothing quite like going from fine to blue lips in a couple of minutes or standing in a warm shower at 2 AM hitting your child n the back with a cupped hand trying to break up a mucous plug!

There are several preventative drugs, so I'd be hard pressed to keep my child on something that is causing a mood alteration. Have you talked with your pharmacist to find out what other drugs are available that may be in a different family of drugs? I have found the pharmacists to be a valuable resource so that i can speak with the docgor and share what ive learned and what I'd like to try.

My son was on Advair, and it helped a lot. We went from several ER visits a year to none. My younger is on Singulair. Since using the preventative drugs, we haven't had to use prednisone except one three-day burst last summer.

Hi, Michaela,

I've been lurking around this forum for months, but never actually posted before. �I'm curious to know which medicines you're talking about, but if you don't want to say, I understand. �Also, is the feb deadline due to the start of spring allergies, or something to do with your medicine access?�
I've also got an asthmatic ds (3yr 3mos) who worries the heck out of me. He also has environmental and food allergies. �We started this fall with inhaled steroids in addition to the allegra he's been on for a yr. I had initially tried doing the inhaled steroids only at the start of a cold, which our peds allergist suggested I could try, but after 2 absolute failures and subsequent oral steroid courses, I realized this wasn't working.�I hate throwing these drugs at my kid, and have struggled a lot with it. I also finally found a new home for my cat, which I feel very guilty for not doing sooner, and we're in the process of getting rid of all the carpet in the house to help with allergies/dust, etc. We've also got air purifiers, which I'm not at all sure have helped. But enough of me.
My suggestion would be to make up some sort of asthma symptom chart and run it for the next month or two. Theoretically, you should be able to get a good feel for his control short of 'did he end up in the hospital'. I think i understand that you're using the alternate drug right now? If you still think the behavior is better, then I'd suggest starting your trial with this one. I'd make a calendar and chart each day that your ds has to use his rescue inhaler/nebulizer, any wheezing symptoms that you treat with alternative methods, any night that he wakes up coughing, or any longer-lasting dry/hacky cough during the day. Then look back and add it up or take it to his doctor. If you've got really good control, like 2 or less daytime issues (cough, wheeze, rescue meds) per month, and 1 or less nighttime coughing spell, and you didn't wind up in an emergency room, then you're probably good to go with the less mood-altering drug. I wouldn't restart the other one if you can get this good of control with the alternative.
If his symptoms are much more frequent than this, you may need to consider a low dose of the drug you feel worked but caused mood issues, or a different one. There are a few controller options out there, but not as many as one might hope. You may be able to get away with a lower dose of the first drug if you continue the alternative one. That's more meds, but may be a preferable option. Remember, poorly controlled asthma in kids can cause long term issues with lower lung function over time, so it's more than just staying out of the hospital. If you can find an acceptable med plan that still keeps your son controlled, that's where you want to be.
You can also make a behavior chart of some sort, but this may be more tedious than it's worth. If you think his mood is better on the other drug, it probably is. �
I'm not sure this is terribly helpful for you, or answered your question, but just my thoughts. This stuff is no fun. Hang in there!

We tried a ton of things and combinations for our son's asthma and environmental allergies and eczema. We had a failed attempt at S.ingulair at one point, and then, as he got older, his sensitivities to medications lessened, and he now tolerates it well. We also tried various inhalers, and none of them were effective, and all of them caused behavioral issues.

In terms of antihistamines, he was on all of the major OTC meds, and finally ended up on X.yzal. The combination of the two meds has made a world of difference for him.

The real key though, was finally putting the pieces together and finding soap and lotion that don't contain his allergens.

so, I dont have great advice about the monitoring, except to say that in our experience, we were able to determine his behavioral reactions well based on our and his daycare providers observations. I spent a lot of time late at night listening to his lungs for wheezing, too.

Have you tried alternative/natural methods?

Do you know what trigger his asthma? Have your DS done allergy testing?

Hang in there!

We covered the mattresses and pillows with a dust mite blocker, and I noticed a huge difference.

Good luck!
Grinity

Jack'smom: we're trying to avoid pred & dex.

He's on a very high dose of inhailed steriod (not flovent) as well as a leukotrine inhibitor. The leukotrine inhibitor was the problem. The alternative is an antihistamine.

His asthma is following the same course as mine, which is to say excellant controle most of the time with very serious, regular exacerbations. We both tend to skip the wheezing phase and go strait to completely blocked, which makes it a wee bit hard to get triaged properly... gotta take his shirt off the moment you're in the door & demand that they check his oxygen levels, & usually ask then to try that machine over there if they think the first one's just broken. <sigh> Anyway, he typically needs a course of the full dose of Dex + Pred once he's had to have ventolin once. This fall with the extra med, we got away with just ventolin, but did not avoid ventolin. I was on oral steriods (and worse, actually) for years as a kid. (But that was before leukotrine inhibitors and long-acting beta antagonists)

He has only one allergy, not IgE mediated (no evidence of any IgE issues of any kind), to something not reasonably avoidable (why not just peanuts and milk, kid? that would be sooooooo much easier!!!!).

We did the thrice-to-emerg routine with the 5 wk old since I wrote last. Ventolin is holding, but barely. They don't want to presc. inhailed steriods for 2 wks because they don't work "on a population level." We only got the vetolin presc. b/c we started him on it w/out med advice and it worked like a dream despite what the population level evidence suggests. F$@*.

Someone do a longditudinal study: what % of kids subsequentlt diagnosed with asthma saw benefit from asthma meds in infancy? Could those kids have been roughly id'd by family history?

Mom of 1: he's on singulair + an antihistamine? And he seems to require both together?

Hospitalmom: the deadline is to beat the asthma season, so it's soft.

-Mich. the tired. Oh, did I mention *I've* been on vent every 3 hrs, too. Sh@!!# week.)