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Help me help my daughter (Mental Health Related - Anxiety Attacks)


Xuzi
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I'm not sure what to do. Earlier this year my daughter admitted to feelings of depression, social anxiety, and two incidents of self-harming. A few weeks later she had a couple of brief panic attacks (lasting minutes). She's been seeing a therapist weekly for a couple of months now, who's been working with her on how to handle the depression and panic attacks, and just this Friday started on a low-dose of Lexapro. Before starting the medication she spent a week at an over-night summer camp where she said she had a panic attack each day for the last 3 days. When she came home she had a several-hours-long panic attack (feeling a strong sense of anxiety, rapid breathing, and shivering). When it finally stopped I gave her her first dose of Lexapro. That was Friday. Saturday she continued to have several panic attacks, and hasn't left her bed much at all. She's still shivering, and feeling anxious.

If the panic attacks had started *after* she started the Lexapro I'd been tempted to call the doctor about immediately discontinuing it. She had fun at camp, and says absolutely nothing bad happened while she was there (no abuse, bullying, etc). But maybe the constant socialization was too much? Is her body just working through that constant barrage of socialization, or could this be a sign of something more serious? Should I take her to the ER? What would they do to/for her if I did? I will for sure be bringing this up with her therapist this week, and her physician at her next appointment in early August.

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I would not take her to the ER. I would call Monday morning for an appointment with an M.D. who is a "Board Certified" Psychiatrist so she can be properly diagnosed and (hopefully) gotten onto the best medicine for her and the best dosage for her. A Psych8iatrist is qualified to look for Physical things which might be causing Mental issues. Sometimes they are related (cause and effect).    Good luck to her!

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No experience with Lexapro, but I know for Prozac it takes 4-6 weeks for it to be fully in your system and take effect.

I google how long for Lexapro to start working and found this 
"How Long Does It Take For Escitalopram To Work?

Sleep, energy, or appetite may show some improvement within the first 1-2 weeks.  Improvement in these physical symptoms can be an important early signal that the medication is working.  Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve." from here https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Escitalopram-(Lexapro)

I'd definitely call the doctor early Monday morning with my concerns. 

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She's 13. She had her first panic attack about a month ago. The ones at camp were only for a few minutes each time. These long-lasting ones just started two days ago. The rapidly increasing intensity of them is what's most worrying to me.

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She doesn't feel ill. She had a regular check up a couple of weeks ago and had her heart listened to, but nothing checked in regards to her thyroid. I could bring that up at her follow-up appointment.

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18 minutes ago, Xuzi said:

She doesn't feel ill. She had a regular check up a couple of weeks ago and had her heart listened to, but nothing checked in regards to her thyroid. I could bring that up at her follow-up appointment.

Yes, that's an important thing to check. Hyperthyroidism can cause anxiety, panic attacks, racing heartbeat, etc. It should be ruled out, and she should have some lab work to check vitamin D, iron, B12, etc at the same time. 

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I agree with calling the prescribing doctor in the morning. IME it takes a couple of weeks for Lexapro to start helping, so as the others said she may need something to help in the interim. There's nothing at all wrong with seeing a psychiatrist as Lanny suggested, and indeed that may be the best route. But around here the wait time to get in with a psych who works with adolescents runs around four to six months.

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Have you heard of PANS or PANDAS?  My daughter has PANS which was triggered by coxsackievirus and influenza.  PANDAS is triggered by strep.   It causes anxiety, OCD, anorexia-like behavior or disordered eating, tics, and a bunch other random and bizarre symptoms that are uncharacteristic of the child. Kids present in different ways; at my daughter's first onset, it was just anxiety.  Later on that year (months later) she presented with a few more symptoms, then after she got the flu a few more months later she had the full list of symptoms.  The main clue that it is PANS or PANDAS related is that these things are uncharacteristic and come on suddenly.  Oh, and psych meds do not help these children, and can often make symptoms worse.  My daughter was successfully treated with ibuprofen and antibiotics.  Here is some info, I can give you more if you suspect at all that this might be the case with your daughter.

https://kids.iocdf.org/what-is-ocd/pandas/ 

 

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No artificial sweeteners, no recent illnesses. The depression has been around since April. The anxiety attacks started before the first dose of Lexapro.

I'll call in the morning and see about a thyroid check and some anxiety meds.

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For breakthrough anxiety until the meds are in her system well, she may need a PRN (when necessary).  Truthfully, she may need one once the meds do kick in as well.  At her age it isn't likely to be a benzo like Xanax, often it is a beta blocker.  Both my daughters have meds for breakthrough anxiety. Guanfacine is the one that is working ish for youngest.  Clonidine made her tired.

Also did you get the Genesite test done for the most effective antidepressant meds for her?  The first one is often not the right one otherwise, sad to say.  Effexor is really good for depression as well as anxiety for whatever that's worth.

I hope you are able to help her.  ((Hugs))

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Her doctor recommended she go down to a half-dose of her antidepressent, and her therapist recommended she put together a "fidget bag" of things like squishy balls and fidget cubes to help her distract herself during anxiety attacks. She's much improved in the past couple of days, and isn't hiding out so much. She *loves* her fidget bag.

We also have a referral for a child psychiatrist. However long that takes.

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When I had my first panic attacks, I had some of the same symptoms. Sometimes my attacks would last for 30 minutes. It's so awful and I wouldnt wish it on anyone. I'm so sorry she is going through this.

Probably the most helpful coping mechanism I learned when it all started was to play 5 Things. It sounds silly but it gets you out of your head and off the panic thoughts. 

Basically, you name 5 things you see, 5 things you hear, and 5 things you feel. So, I see the doorknob. I hear the tv in the other room. I feel a breeze from the fan. (The feel things need to be external. You dont want to focus on your heart racing or feeling cold because it will perpetuate the panic.) Anyway, you name five of each thing, then four, then three, then two, then one. Usually, by the time you finish, the panic is gone. If not, rinse and repeat. As she gets better, she won't have to do a full cycle.

I know it's not a cure, but hopefully it will help while you're looking for the root cause/waiting to see if the meds will help.

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The "5 things" can be modified as grounding techniques as well. Other ways to do this is to look for something red, green, blue - whatever colors she chooses. Some people like to close their eyes and tell someone what they are smelling and hearing. All these methods force the prefrontal cortex to take over. It has proven to be very helpful with many people even though some initially think it sounds silly. 

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12 hours ago, Thatboyofmine said:

Xuxi, we have a private group for parents of kids with mental health issues.  It’s fairly active and is a good place if you need to talk more privately in the future.  I’ll send you an invite if you’re interested.  Feel free to ignore this, though.  No pressure. 

That would be great! Thanks. :)

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On 7/4/2018 at 9:04 PM, Thatboyofmine said:

Xuxi, we have a private group for parents of kids with mental health issues.  It’s fairly active and is a good place if you need to talk more privately in the future.  I’ll send you an invite if you’re interested.  Feel free to ignore this, though.  No pressure. 

Could I be added as well please? I’ve got two who are struggling. Thank you 

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On 7/4/2018 at 9:04 PM, Thatboyofmine said:

Xuxi, we have a private group for parents of kids with mental health issues.  It’s fairly active and is a good place if you need to talk more privately in the future.  I’ll send you an invite if you’re interested.  Feel free to ignore this, though.  No pressure. 

Could you please add me?

Thanks.

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On 7/4/2018 at 8:04 PM, Thatboyofmine said:

Xuxi, we have a private group for parents of kids with mental health issues.  It’s fairly active and is a good place if you need to talk more privately in the future.  I’ll send you an invite if you’re interested.  Feel free to ignore this, though.  No pressure. 

Could you please add me?  Thanks!

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On 7/4/2018 at 9:04 PM, Thatboyofmine said:

Xuxi, we have a private group for parents of kids with mental health issues.  It’s fairly active and is a good place if you need to talk more privately in the future.  I’ll send you an invite if you’re interested.  Feel free to ignore this, though.  No pressure. 

 

I'd like to join too.  I need some ideas on how to deal with my dd who is experiencing anxiety, depression, and a few panic attacks. 

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