Zoloft for a language delay?!?

[TracyP]

My 10 yo had a check-up with his regular doctor yesterday. We were discussing his language delay - he has been diagnosed with MERLD - and my doctor suggested we try a low dose of Zoloft. The doctor thinks that some of my ds's language issues could stem from anxiety. I kind of understand. DS is very shy and will not easily engage in conversation with people he doesn't know. He bites his nails very low, which I get could be an anxiety thing.

 

But... I don't know. I'm not really buying it. DS had a psych eval this spring where we also discussed the possibility of him suffering from some anxiety. She prescribed daily exercise... She did not suggest that his possible anxiety had any connection to his language issues.

 

I told my family doctor I would consider it, though, so here I am. Could there be anything to the idea that Zoloft could help a language issue? Should I give this a try? FWIW, I really do not like this idea.

[kbutton]

Well, I think there might be an association, but it could just as easily go the other way--the MERLD might cause his anxiety. 

 

I think you should think on the idea and watch to see if it has merit, but I would want to be sure I was actually treating anxiety because I felt it needed to be treated, not treating it hoping a language issue would improve. Improved language would be a good side benefit, but I think I would be uneasy with it as the reason for taking the anxiety meds. I would want to see more evidence of anxiety. Did the psych tell you why she thinks he might be anxious? If there are a dozen red flags vs. just nail biting and language, that's another story.

 

Do you think anxiety is causing the language issue, or do you think the relationship is more complicated or different? (Rhetorical question...)

[coastalfam]

My son has a different dx, he has Down syndrome, and is 11. He was diagnosed as having generalized anxiety disorder by a psychologist. We put him on Zoloft about a year ago, and it has made an enormous difference in his quality of life. I cannot speak at all to whether Zoloft would have the desired effect your doctor suspects, but I can tell you for us it was not as big of a deal as I thought. He is on a low dose, and experiences no side effects. Aside from anxiety relief, his cognition improved, such as recalling information, and committing new information to memory, and processing speed with reading. Others have commented that he is speaking much more clearly and fluidly, but it's hard for me to tell as I have always understood him, and hard to know if time and maturity are not the culprits. I just know anxiety can really gum-up the works in a person's brain. My son experienced relief from his anxiety beginning about three weeks after he started taking it. He still has anxiety, but it is so much better that working through it is a conversation we can even have, whereas before if his anxiety kicked in, there was no chance of working through it and we basically had to just take him home. So, I realize that does not speak to your specific situation very much, but FWIW, it is one family's experience with using Zoloft with a child.

[PeterPan]

I think, given the significant nature of his anxiety, I would try it in a heartbeat. Unless you have an alternative that you try and find works just as well, I would try it. SAM-e is a precursor in that process (serotonin uptake, blah blah) and can work for some people. I guess you could try CBT and some counseling. I'm quite reticent on the meds, but I think in that scenario I'd at least do a trial. You won't know what it can do for him till you try.

 

This will seem like a total rabbit trail here, but you could also read about methylation. If he's an under methylator, SAM-e is a methyl donor. So there you'd be bumping the anxiety *and* maybe working at the underlying cause, if low methyls were the cause. 

Edited August 20, 2017 by OhElizabeth

[TracyP]

I would medicate in a heartbeat if I thought anxiety was a huge problem in his day to day life. I'm just not convinced it is. The psych who evaluated him felt the same way. Like maybe there is some anxiety there, but he is happy, sleeps well, eats well and doesn't seem to be too affected by it. She did feel the places where he was feeling the most anxiety were situations where he couldn't express himself, i.e. the language delay making him feel anxious not the other way around.

 

OTOH, anxiety could be a bigger deal than I can tell. His language delay makes expressing his feelings so difficult.

 

Coastalfam, thanks for sharing your experience. The doctor made it clear that I should expect no negative side effects and that giving Zoloft a try was no big deal. It feels like a big deal, though, so hearing your story is helpful.

 

If we tried this does anybody know what a fair trial period would look like. 6 months? More? Less?

[geodob]

Zoloft takes about 5 to 15 days to have an effect.  

So that it could be well worth doing a trial for perhaps 2 months. Which would give you enough time to observe whether it makes a difference or not?

Importantly, this will help identify whether anxiety is effecting his MERLD or not?  

As well as the degree of effect?

So initially, it could be used to diagnose whether anxiety is a factor or not?

 

But their are 2 basic types of anxiety.  One being GAD General Anxiety Disorder, and the other is Anxiety associated with particular activities.

You wrote: "Like maybe there is some anxiety there, but he is happy, sleeps well, eats well and doesn't seem to be too affected by it."

Which suggests that he doesn't have General Anxiety.

That it is associated with MERLD activities.

 

In this regard. If Zoloft enables him to relax and express his feelings, and feel less shy?

Then Zoloft could be used temporarily, to develop a more relaxed feeling, when expressing himself. 

Where the Zoloft could then be slowly withdrawn.

 

It might be helpful to understand how Zoloft works? 

Which effects something called:'Serotonin'.

 

Our nerve cells and neurons, sends signals back and forth to each other.

At a basic level, a signal is sent from one cell, to cause another cell to act in some way.

The other cell, carries out the action.

Then sends a signal back, telling the first cell that the action was done.

 

When the first cell recieves the return signal, an enzyme puts a molecule of Serotonin on the nerve.

Which blocks the signal from being sent.

 

But the Serotonin molecule needs to be left in place, until the full activity is completed.

Another enzyme, later removes the Serotonin molecule, and stores it away for re-use.

 

Though a problem that can occur, is that the enzyme can remove the Serotonin to quickly!

Causing the signal to be resent.

When this happens with signals sent to muscles?

It can cause the muscles to go into 'spasms'.

 

Then coming back to Zoloft?  It is defined as a 'Serotonin Re-uptake Inhibitor'?

What this actually means, iby Inhibition?

Is that it slows down the enzyme from removing the Serotonin.

Leaving it in place for longer. 

Which basically inhibits the signals that create anxiety.

 

So that with Zoloft, you will find out whether leaving Serotonin in place longer,  will reduce his anxiety when expressing himself?

 

One notable side effect to look out for, is the effect on his appetite?  

 

Though OhE mentioned SAMe,  which increase general levels of Serotonin.

But this raises a crucial issue about Serotonin, where too much Serotonin can be toxic and cause Serotonin Syndrome.

Which can have serious side effects, and also be fatal.

So that if you choose to try Zoloft, then you need to be cautious to not use any medications or supplements that increase Serotonin levels. 

St Johns Wort, is a concern in this regard.  

 

[TracyP]

Thank you, geodob. That is very helpful.

[Crimson Wife]

According to my Communicative Disorders coursework, there is evidence that anxiety treatment can be effective for stuttering and selective mutism. I have never run across evidence that anxiety treatment is effective for expressive language delay. Not saying that it isn't possible anxiety treatment might help an individual child's language delay. Just that it isn't something that would be considered Evidence-Based Practice the way it is for stuttering and selective mutism.

[Crimson Wife]

 This will seem like a total rabbit trail here, but you could also read about methylation. If he's an under methylator, SAM-e is a methyl donor. So there you'd be bumping the anxiety *and* maybe working at the underlying cause, if low methyls were the cause. 

 

Methylation seems to be an issue for my DD (we're still waiting on the whole exome sequencing results). We haven't tried SAM-e, but we did see gains in expressive language with both DMG and methyl B12 injections.

 

[Terabith]

When we started medicating for anxiety, my daughter began learning again and the autistic tendencies decreased dramatically. We definitely had anxiety issues, but I was shocked by the difference it made in those seemingly unrelated.

[PeterPan]

Methylation seems to be an issue for my DD (we're still waiting on the whole exome sequencing results). We haven't tried SAM-e, but we did see gains in expressive language with both DMG and methyl B12 injections.

 

 

Now the flip side is that if you put someone on a methyl donor and they are the inverse, over-methyl, you get really awful symptoms. Geodob mentioned this with the over-high serotonin, but same gig for methyls. But that's a whole rabbit trail.

 

I'm just saying it's not quite as pat as saying all anxiety is low serotonin and going to respond well to an SSRI. But clearly the odds are in favor of it. 

 

The op can look at half-life of each option to help her decide too.

Edited August 20, 2017 by OhElizabeth

[seema]

we have tried Zoloft with my dd since 2 mos and she seems to be able to express better, in giving specifics and also spontaneous speech, I do think controlling anxiety has helped her with language.

[Lecka]

I think there is a way to look at it, where -- maybe he didn't start out with anxiety. Maybe the underlying issue really truly is the language delay.

 

But if he has had a period of time where he has felt anxiety going into a situation where in the past he has felt anxious -- like when he wants to use expressive language -- my understanding is this still counts as anxiety.

 

I think it is still in the realm of "consider anxiety medicine" even if it really is about expressive language and not something where he separately has anxiety independent of the language delay.

 

Now I'm not sure but I think it is a question to ask.

 

Bc that is my understanding of something that can happen when anxiety develops even when there is a known root cause.

 

And then -- even if he isn't anxious overall, if he is just around expressive language, it could still be something where it could benefit.

 

But I am going to be honest.

 

I think they mention this stuff a few years before they think it might really be needed.

 

Then it percolates in your mind a while.

 

And then if in 2-3 years it seems more like it would be good to try, it is not a new suggestion then. It is a familiar situation and you have gotten over your initial response of "no drugs for my child." Even if you personally wouldn't be like that if you were seeing it more.

 

The person might not know you to know what you are like -- but might think that there is some percent chance that in 2-3 years it will be more of a "yes try it" situation and so wants to give you time to get used to the idea.

 

I see this all the time. And maybe you don't need 2-3 years. But a lot of parents do, so it leads to stuff being gone ahead and mentioned.

 

Because I think it is known to come on more at this age and so they may just mention it more thinking maybe your kid is one of the whatever percent where it will seem more pronounced in 6 months or a year.

 

Not like I think they mean it would be a bad idea now, but if it seems kind-of "why are they bringing it up now?" I have found this to be a reason.

 

Bc for a lot of parents it just times to get used to a new idea or to start noticing. And sometimes you get caught in the same net.

 

I do better with the advanced notice, so it is helpful to me, if it makes you feel any better. It is at least helpful to some parents!

[Ottakee]

I can't really speak to the Zoloft but Lithium has greatly improved stuttering for my DD. It is amazing.

[Janeway]

No. Just NO.

 

Also, google Zoloft and children. Seriously. That doctor needs to be better educated. He needs to stick to his specialty which includes things like sinus infections and strep throat.