Scoop Essentials: The Good Doc Is In
Now, Talan is back to answer your questions about treating anxiety, handling stress and whether or not medication is the answer.
My 4-year-old son is autistic. He also takes a steroid for his Duchenne muscular dystrophy. This causes him to be very active and anxiety is a daily problem. It is unclear if the autism is the sole reason for his anxiety or if the steroid plays a role also. He has tried BP medication to slow him down — Adderall, Risperdal and Strattera — all of which increase his anxiety. Do you have any recommendations for medication? Behavior modification seems to be helpful but I wish there was something that could help him. — Addy, 34
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Dr. Ken Talan: It seems as though your child has been through a range of different medications, all used to address anxiety and hyperactivity, except for a selective serotonin reuptake inhibitor (SSRI) like Prozac, which is used for anxiety. Since behavior modification is helpful, and is without side effects as well as having long-term benefits regarding his overall development, I encourage you to continue putting as much effort as possible into that path. Medication responsiveness in a young child is unpredictable, particularly in a complex situation. His responsiveness to the medications already tried may change as he gets older.
My 18-year-old son has autism, anxiety and limited communication ability. Since puberty he has had behavior difficulties (screaming, throwing and hitting). He is currently taking Depakote 1500, Seroquel 50, Abilify 10, Lexapro 10 and Neurontin 800mg. He still has a lot of anxiety and doesn’t seem to be able to relax. He follows me around pressuring for “car ride” and at school he is clingy to his teacher. He had paradoxical reactions to Klonopin and Versed, and many other drugs have not helped or made him worse. We began giving him medication when he was 8-years-old and very hyperactive. In addition to meds, we have worked constantly on his behavior but he still struggles. For the past year I have not been able to take him anywhere alone because he is bigger than me and I can’t control or restrain him. I wonder sometimes if he would have been better off with no meds. Is it crazy to consider taking him off all his meds? Should we assume that where he is will be as good as it gets? I can’t imagine him (or me) living the rest of our lives like this. — Cindy Sager, 50
Dr. Ken Talan: I assume you are working with a child psychiatrist/psychiatrist familiar with all those medications and other ways to address anxiety in addition to medications. If not, I think a consultation with one would be appropriate in such a pharmacologically complex situation. To address your question directly: considering or thinking about going off medications isn’t a problem, and in fact it’s quite reasonable, but going off medications is. Any changes should be done very slowly — one medication at a time with a specific behavior or state to be watched. You can then use whether the behavior/state gets worse, better or stays the same as a guide for each subsequent medication change. Depakote, Seroquel and Abilify are more often used for mood stability whereas Lexapro is used for anxiety, as is Neurontin. Sometimes Lexapro can work against the mood stabilizing medications. I would not assume that his current state is as good as it can get.
My 16-year-old daughter is in an approved private school for high functioning kids on the spectrum. Nika is hormonal and O/D (which is most likely related to her anxiety, I’m told). Our latest neurological evaluation doctor told me “her executive functions aren’t working (a.k.a. a stroke victim) and we just have to “deal with this.” Obviously he doesn’t live with this day in and day out. Needless to say, this is an exercise in futility. We tried Ritalin when she was five and she slowed down so we stopped. So now I’m thinking the anxiety is the culprit and we need to seriously address this. There’s a lot at stake here, at home. I have four teenagers and her siblings are fed up tap dancing around to not set her off and frankly, we’re just plain tired of the stress her anxiety projects on the family. — Lisa Kownurko, 50, North Wales, Pa.
Dr. Ken Talan: If your daughter is responsive to individual support at school, then individual psychotherapy or cognitive behavioral therapy may be an option to help her with the situation. And, as daunting as it may seem, some family therapy with everyone to talk and think about ways to better address the strains and stresses inherent in a family with four teenagers could be quite helpful. I have a chapter in my book (Help Your Child or Teen Get Back on Track: What Parents and Professionals Can Do for Childhood Emotional and Behavioral Problems) discussing the different kinds of psychotherapy and their interaction with medication that may be helpful. On the medication track, sometimes an SSRI, like Prozac, can be helpful if anxiety (fear) is a driving force for behavioral outbursts, a short fuse and emotional sensitivity. Caution is necessary, however, because sometimes that group of medicines can make things worse. Individuals with executive function difficulties associated with an organic insult, like a stroke, may benefit from a stimulant, like Ritalin, as it helps them to manage their lives better. Your daughter’s unsuccessful trial at the age of five doesn’t necessarily rule out trying it again at the age of 16. Particularly so, if the main problem was that it simply slowed her down at that age. She might have been physiologically too young and too small to tolerate that dosage when she was five and is in a different place at the age of 16.
My child has been diagnosed with ADHD and anxiety. We have tried many medications — most stimulants, the non-stimulant Strattera, the patch-Daytrana and Guanfacine for sleep (not all at once of course!). There is still an element of anxiety in my son that I am concerned about. We are lucky enough to have a child certified psychiatrist we are working with. I have heard a great deal about Risperdal for use with children with autism and, more recently, I have heard it performed miracles for an elderly person in my family. What can you tell me about this medication and its uses? — Carol Gill Kral, 43, Mobile, Ala.
Dr. Ken Talan: Anxiety occurs along with ADHD at a greater than expected frequency than is found in non-ADHD children. Sometimes medication that helps ADHD, like a stimulant, can increase anxiety. Risperidone/Risperidal, while occasionally helpful in decreasing anxiety, is more often used in autism for aggressiveness and agitation. Risperidone has the potential for a number of unwanted and sometimes very concerning side effects. Your child psychiatrist and you can work together to weigh the beneficial and adverse responses to this medication. The chapter on medication treatment in my book has a lot of clear information about the benefits and side effects for the medicines you mentioned, as well as others. Behavioral therapy and lots of daily physical activity can have a helpful and moderating effect on anxiety too.
Talan is the author of Help Your Child or Teen Get Back on Track: What Parents and Professionals Can Do for Childhood Emotional and Behavioral Problems.