Psycho-Babble Medication Thread 204120

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SSRI poop out in teenager - Need help now!

Posted by Abby7 on February 26, 2003, at 19:03:37

7 mos. ago my 14 yr. old's depression returned & so far, nothing has worked & I don't know what to do! A summary, briefly as possible: Age 11 1/2 was first onset of depression. Rec'd Adderall, then ritalin from pediatrician. Result - rages (never happened before) that went away when stimulants stopped. He was left more profoundly depressed than before. Then 20mg Paxil from same Dr. Result: extreme fatigue, loss of inhibilition, more depression. Finally refr'd to psychiatrist, Paxil reduced to 5mg & 150mg wellbutrin added. Much improved. Feeling the SSRI was not needed, eventually tried discontinuing Paxil (with aid of Prozac for discontinuation symptoms. Depression returned when Prozac was stopped. Maintained on 5mg Prozac & 150 wellbutrin & did very well for 1 yr. Depression returned. Tried raising wellbutrin (no help, also can't tolerate over 175mg); tried raising Prozac to 10mg(apathy, emotional lability,insomnia, still depressed); tried switch to Celexa (odd pattern of increase dose, 4 days nothing, then 3-4 very good days, then depression returns, becoming more sad with each dosage increase - stopped at 15mg); Switched to 25 mg Zoloft while titrating down Celexa. Felt best in mos. but has deteriorated in days since Celexa has ended. Increased Zoloft to 37.5 but so far still depressed (fatigued, isolated, no enjoyment, irritable, serious; normal personality is happy, joking, enthusiastic). Dr. has discussed Effexor (I'm worred about discontinuation probs) or tricyclic (I'm worried about side effects - he's been so sensitive to SSRI side effects). What are we missing? Is there possibly a theraputic synergy when small doses of 2 SSRI's are combined (like the Celexa/Zoloft experience)? Why would he previously respond to SSRI's but not now? Any other ideas? His life is falling apart & I can't seem to help him. Welcome any ideas.

 

Re: SSRI poop out in teenager - Need help now! Abby7

Posted by ace on February 26, 2003, at 19:18:44

In reply to SSRI poop out in teenager - Need help now!, posted by Abby7 on February 26, 2003, at 19:03:37

> 7 mos. ago my 14 yr. old's depression returned & so far, nothing has worked & I don't know what to do! A summary, briefly as possible: Age 11 1/2 was first onset of depression. Rec'd Adderall, then ritalin from pediatrician. Result - rages (never happened before) that went away when stimulants stopped. He was left more profoundly depressed than before. Then 20mg Paxil from same Dr. Result: extreme fatigue, loss of inhibilition, more depression. Finally refr'd to psychiatrist, Paxil reduced to 5mg & 150mg wellbutrin added. Much improved. Feeling the SSRI was not needed, eventually tried discontinuing Paxil (with aid of Prozac for discontinuation symptoms. Depression returned when Prozac was stopped. Maintained on 5mg Prozac & 150 wellbutrin & did very well for 1 yr. Depression returned. Tried raising wellbutrin (no help, also can't tolerate over 175mg); tried raising Prozac to 10mg(apathy, emotional lability,insomnia, still depressed); tried switch to Celexa (odd pattern of increase dose, 4 days nothing, then 3-4 very good days, then depression returns, becoming more sad with each dosage increase - stopped at 15mg); Switched to 25 mg Zoloft while titrating down Celexa. Felt best in mos. but has deteriorated in days since Celexa has ended. Increased Zoloft to 37.5 but so far still depressed (fatigued, isolated, no enjoyment, irritable, serious; normal personality is happy, joking, enthusiastic). Dr. has discussed Effexor (I'm worred about discontinuation probs) or tricyclic (I'm worried about side effects - he's been so sensitive to SSRI side effects). What are we missing? Is there possibly a theraputic synergy when small doses of 2 SSRI's are combined (like the Celexa/Zoloft experience)? Why would he previously respond to SSRI's but not now? Any other ideas? His life is falling apart & I can't seem to help him. Welcome any ideas.

I would try a tricyclic or MAOI. They have s/effects but they mostly pass with patience. I would forget the SSRIs. I was on Zoloft a few years, but depressed most of the time! Don't consider 2 SSRis together - a serious condition called serotonin syndome (hyperprexic crises) can ensue. Further more, in MY opinion and from MY experiences keep him away from psychiatrists. There are few brilliant ones but they truly are few and far between. A lot of people on this site have been hurt by psychiatrists, me included. The final one I ever saw (and I never will see one again) said "your friends must think your wierd"

Options for your son...

1. Try NARDIL
2. Try PARNATE
3. Try Elavil
4. Try Effexor (ween slowly off it)
5. Augment Zyprexa with any of the above


I'm sure of forgot some combos but ask me again.

In terms of withdrawal DON'T DO PAXIL!

Take Care,
Ace.


 

Re: SSRI poop out in teenager - Need help now!

Posted by Jaynee on February 26, 2003, at 19:37:49

In reply to SSRI poop out in teenager - Need help now!, posted by Abby7 on February 26, 2003, at 19:03:37

You may want to read this article. Personally I would not give my child an AP, unless it was the absolute last resort.

http://www.psychiatrist.com/supplenet/v62s18/v62s1802.pdf

 

Re: SSRI poop out in teenager - Need help now! Jaynee

Posted by ace on February 26, 2003, at 19:47:08

In reply to Re: SSRI poop out in teenager - Need help now!, posted by Jaynee on February 26, 2003, at 19:37:49

> You may want to read this article. Personally I would not give my child an AP, unless it was the absolute last resort.
>
>
>
> http://www.psychiatrist.com/supplenet/v62s18/v62s1802.pdf

Jaynee, sometimes they are needed. They work very well. If there is any appearance of TD you just lower the dose/and or discontinue. People forget that AP are still plausible. For instance a woman was taking Thorazine low dose for 10 years for panic -- No adverse effects.

Of course, I think a child would do best on low dose. But if he is in a lot of pain and the AD + AP cures him, I say go for it. You agree?

Ace.

 

Re: SSRI poop out in teenager - Need help now!

Posted by Abby7 on February 26, 2003, at 19:53:05

In reply to Re: SSRI poop out in teenager - Need help now! Jaynee, posted by ace on February 26, 2003, at 19:47:08

> > You may want to read this article. Personally I would not give my child an AP, unless it was the absolute last resort.
> >
> >
> >
> > http://www.psychiatrist.com/supplenet/v62s18/v62s1802.pdf
>
> Jaynee, sometimes they are needed. They work very well. If there is any appearance of TD you just lower the dose/and or discontinue. People forget that AP are still plausible. For instance a woman was taking Thorazine low dose for 10 years for panic -- No adverse effects.
>
> Of course, I think a child would do best on low dose. But if he is in a lot of pain and the AD + AP cures him, I say go for it. You agree?
>
> Ace.

Sorry, but could you explain what AP, AD, and TD are? thanks

 

Re: SSRI poop out in teenager - Need help now! Abby7

Posted by ace on February 26, 2003, at 20:22:41

In reply to Re: SSRI poop out in teenager - Need help now!, posted by Abby7 on February 26, 2003, at 19:53:05

> > > You may want to read this article. Personally I would not give my child an AP, unless it was the absolute last resort.
> > >
> > >
> > >
> > > http://www.psychiatrist.com/supplenet/v62s18/v62s1802.pdf
> >
> > Jaynee, sometimes they are needed. They work very well. If there is any appearance of TD you just lower the dose/and or discontinue. People forget that AP are still plausible. For instance a woman was taking Thorazine low dose for 10 years for panic -- No adverse effects.
> >
> > Of course, I think a child would do best on low dose. But if he is in a lot of pain and the AD + AP cures him, I say go for it. You agree?
> >
> > Ace.
>
> Sorry, but could you explain what AP, AD, and TD are? thanks


Certainly.
An AP is an anti-psychotic drug. These drugs are for people with psychotic disorders. But now, especially with the newer AP drugs, they are being used for anxiety, depression and OCD.

An AD is an ant-depressant drug ie Prozac, Nardil, Zoloft.


TD is Tardive Dyskinesia - this is a neurological problem caused by AP drugs which includes lip-smacking, and bodily jerks. It is basically a side-effect. Sometimes it can be reversed, sometimes not. There are always thing you can do while on an AP drug to minimize the occurence of this prob. As I said in my earlier post some people take low doses for years and years with no probs.

Hope this helps, and I hope your boy brightens up.

God Bless,
Ace.

 

Re: SSRI poop out in teenager - Need help now!

Posted by Thomas123 on February 26, 2003, at 21:29:12

In reply to SSRI poop out in teenager - Need help now!, posted by Abby7 on February 26, 2003, at 19:03:37

This is just a suggestion but the dosages used seemed fairly low. For example 300 is about the minimum for Welbutrin. Of course, you know how close to adult weight you child is. What side-effects halted the use of Welbutrin? Some side-effects may be worth bearing to end the depression. Seems like there might have been numerous trials but all on inadequate dosages. Then again the dosages used might be right on target if your child is small.

 

Re: SSRI poop out in teenager - Need help now! Thomas123

Posted by Abby7 on February 27, 2003, at 7:08:22

In reply to Re: SSRI poop out in teenager - Need help now!, posted by Thomas123 on February 26, 2003, at 21:29:12

> This is just a suggestion but the dosages used seemed fairly low. For example 300 is about the minimum for Welbutrin. Of course, you know how close to adult weight you child is. What side-effects halted the use of Welbutrin? Some side-effects may be worth bearing to end the depression. Seems like there might have been numerous trials but all on inadequate dosages. Then again the dosages used might be right on target if your child is small.
**********
Thanks for the suggestion. Yes, the doses have all been small due to the fact that he has been very sensitive to these kinds of meds & anything above small doses have created intolerable side effects with no benefit. He is a good size kid though, probably about 180 lb. Wellbutrin @ 200mg made him very agitated/angry. A dose of 150 or 175 is ok. Prozac @ 10mg created insomnia, emotional lability, apathy, an overall "drugged" feeling with no ability to concentrate while a dose of 5mg worked well for about 1 year. An increase in a current trial of Zoloft which took him from 25 mg to 37.5mg seems has added a more irritable quality to his depression plus he has more energy & is up longer at night. I have attributed this to the fact that I've read Zoloft has an impact on dopamine so it seems like its increasing dopamine but not serotonin. This RX sensitivity has made me afraid to try trycilics which I have heard are even more problematic with side effects. I would like to find a way to increase serotonin that he can tolerate. I wonder if there is anything that can be done to make SSRI effective once again? Thanks in advance for any suggestions & for everyone that has replied.
Abby7

 

Fish oil

Posted by linkadge on February 27, 2003, at 14:25:15

In reply to Re: SSRI poop out in teenager - Need help now! Thomas123, posted by Abby7 on February 27, 2003, at 7:08:22

Fish oil is a powerful antidepressant, and
has few side effects (fishy breath) while
it may not be as effective as the drugs
he takes, it can dramatically improve mood.

I am now 18 and have been experiencing depression
since about 12 yrs. While SSRI's helped, I really turned around upon starting fish oil. Many of the people here can attest to its help.

Good Luck

 

Re: SSRI poop out in teenager - Need help now!

Posted by Thomas123 on February 27, 2003, at 14:43:44

In reply to Re: SSRI poop out in teenager - Need help now! Thomas123, posted by Abby7 on February 27, 2003, at 7:08:22

I suggest psychotherapy. There is no point in another antidepressant trial at an inadequate dosage. However, you may simply be describing the depression in terms of drug side-effects. Assuming this is possibility pick the drug which seemed to work best and have your son take it at an adequate dosage for two months. And see what happens.

 

Re: Fish oil linkadge

Posted by Jack Smith on February 27, 2003, at 16:39:18

In reply to Fish oil, posted by linkadge on February 27, 2003, at 14:25:15

What type of fish oil do you take? Cod liver or regular? Liquid or capsules? What brand? What AD(s) are you on?

Lots of questions but I think you can handle them. Thanks,

JACK

 

Ace - Yes I agree, but only as a last resort(nm)

Posted by Jaynee on February 27, 2003, at 17:30:04

In reply to Re: SSRI poop out in teenager - Need help now! Jaynee, posted by ace on February 26, 2003, at 19:47:08

nm

 

ADs a bit different than most drugs - dosage wise

Posted by Thomas123 on February 28, 2003, at 6:11:10

In reply to Re: SSRI poop out in teenager - Need help now! Thomas123, posted by Abby7 on February 27, 2003, at 7:08:22

One last point about ADs. With certain drug classes one is going to get a gradual response. With APs one will notice the action of a little of the drug and with more of the drug one will get more of a response. This holds for benzos too.

The story however is I think different for ADs. A little doesn't produce any antidepressant effect. A threshold must be reached before one gets any antidepressant response. 10 milligrams of Zolfot by and large has no antidepressant action whatsoever whereas 50 milligrams of Zoloft can end depression.

 

Re: Fish oil linkadge

Posted by Abby7 on February 28, 2003, at 12:50:13

In reply to Fish oil, posted by linkadge on February 27, 2003, at 14:25:15

> Fish oil is a powerful antidepressant, and
> has few side effects (fishy breath) while
> it may not be as effective as the drugs
> he takes, it can dramatically improve mood.
>
> I am now 18 and have been experiencing depression
> since about 12 yrs. While SSRI's helped, I really turned around upon starting fish oil. Many of the people here can attest to its help.
>
> Good Luck
**********************
Thanks for reply. Actually I have tried adding omega 3 fatty acids after reading a study conducted by Andrew Stoll. Based on the study, I've been trying to add 3 to 4 grams of the EPA component of the omega 3's each day which amounts to quite a few capsules. We only started a couple of weeks ago & have missed some days here and there. Could you share what exactly you tried, in what amount, & how long before a response? thanks.......
Also, relative to psychotherapy, we've been doing that for the past few years also, along with medication. It's been helpful for coping skills but the root of the problem is the biochemical imbalance.
A particular problem is, I believe, his sensitivity to these meds. I know many people are helped by the 50 mg level of zoloft, but when we've gone from 25mg to 37.5 in the past week, I'm seeing what I believe is zoloft's impact on dopamine (more irritable, on edge, up later at night) but no impact on serotonin as his mood his still poor. Based on this, I'm afraid that going to 50mg would only result in more irritability

abby7

 

Re: Fish oil

Posted by noa on March 1, 2003, at 14:23:08

In reply to Re: Fish oil linkadge, posted by Abby7 on February 28, 2003, at 12:50:13

Re: many capsules, and fishy breath:

I like the liquid fish oil Iam taking, made by Carlson's (Norway)-- it doesn't taste like fish at all. It has a lemony flavor (added) and otherwise fairly bland. No fishy burps. Also, it seems to me to be a raltively cost effective way to get the most EPA. One teaspoonful contains 800 mg EPA. The bottle contains 40 teaspoonfuls and costs 15.99. I know there are gelcaps that are more cost effective than the Carlsons, even with having to take multiple gelcaps, but with the advantages I describe here, it seems like a pretty inexpensive route. The only problem is that it is not very portable. It needs to be refrigerated after opening, or else it starts to smell fishy and can become rancid.

When I told my pdoc I'd started taking it, about 1 to 2 tsp per day (800-1600 mg EPA), and had noticed better mood, he told me to add one or two more doses per day. I have been doing that, but because I am now trying to take fish oil several times a day, I started looking for something more portable that I can take to work for the lunchtime dose. I did find something, (besides the gelcaps, which I would prefer to stay away from because of beef/pork gelatin and those fishy burps). I just sampled, from local health food store, this orange flavored cream that comes in little foil packets (like what ketchup and mayo come in when you order from a deli or cafeteria, etc.). The health food store manager told me it is marketed to be palatable to kids. It's called Coromega, made by ERBL. (www.coromega.com) The taste was ok, kind of like Tang or those Good Humor orange creamsicles, and no fishy taste, but I noticed that if I got it on my fingertips there was a very slight fishy smell. Another downside, perhaps, is that the stuff has a lot of other ingredients that may or may not be what people want (including egg yolk). And it is expensive. 90 packets costs 27.99. Each packet has 360 mg EPA, so as you can see it is a far more costly than the liquid, to get the needed EPA. But I decided to try it for a while anyway, because I do need to spread out my fish oil doses. (I can get the bigger doses at dinner time, and in the morning, if I have my act together enough. But at lunch, I will use the packets (and breakfast too, if eating on the run).

I found some effect from fish oil starting at about 1 week or so. I also have been feeling better since increasing the amount I take per day, per pdoc's suggestion.

 

Re: ADs a bit different than most drugs - dosage wise Thomas123

Posted by HIBA on March 1, 2003, at 23:35:56

In reply to ADs a bit different than most drugs - dosage wise, posted by Thomas123 on February 28, 2003, at 6:11:10

This should not necessarily be true in all cases. Evidently there are people getting sufficient antidepressant response from lower than manufacturer recommended doses of antidepressants. Prozac is available in 10 to 20 mg capsules, and the manufacturer recommendation for depression is 20 mg daily, but I have heard
success stories on as low as 5 mg of prozac. 25 mg of Zoloft is also effective in some cases of depression. Of course it is related to the severity of depression. But mild to moderate depression will definitely respond to small amounts of antidepressants.
HIBA


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