Kid needs to take meds for anxiety, but won't take med because of anxiety – what to do?

[Quarter Note]

(Please don't quote for my son's privacy.)  

My son's anxiety is pulling our whole family down. He's so anxious and angry, and his verbal attacks on me make me want to cry every day. We know that he is self-medicating with computer time (and hogging the computer from all of us!). But he reads about all the potential side effects and is sure that every side effect will happen to him, so he's too scared to start his meds. We have tried every non-pharmaceutical intervention we can think of. We desperately need him to give meds a chance.

The psychiatrist recommended that we don't tie computer time with taking meds, but honestly, I can't think of anything else that would be high-incentive enough. Somehow, we need to break his screen addiction, too.  Any thoughts?

And please don't worry if I don't reply quickly, but I'll sneak in some time to read the thread - I don't get much computer time with my kids on the computer so much!

(The medication in question is Lexapro, by the way, if anyone has any encouragement about that one.)

[happi duck]

You can ask about something to help with the new med anxiety.  I think they can prescribe something like hydroxyzine to take the edge off.

Trying to find the right med for anxiety is hard.  Lexapro wasn't a good fit here but is for others.

Many (hugs)

[Drama Llama]

How old is he? 

[itsheresomewhere]

Is this a teen or younger kid?

[bolt.]

It depends on the age of the kid I think. And I'm glad you've brought this here because there's a lot of wisdom in this pool of brilliant brainstormers!

For myself, I agree with the professional that told you not to tie it to screen time. If screen time is a source of the feeling of "safety" that matters. If you threaten to withhold "safety" in order to make him do something else that feels legitimately "risky" to him -- that's like threatening a kid with a crocodile in order to make him cross an unsafe rope bridge over a canyon. Both 'options' are terrifying, and a kid could really have a crisis.

What to do instead? I don't really know. I'm wondering if there might be any potential in giving him some amount of money that seems like 'a lot' to him? If he's young enough, $5 per day is a small price, but would probably do the trick. If he's a teenager... not so much.

Or maybe what about not threatening 'all screen activities' but making just his very favorite one contingent? (While letting him do the other ones, so he doesn't get feeling like he has no safety at all)?

Lastly, I'd really put the idea of decreasing his screen addiction on the very backest of back burners. For a good long time. That can be addressed once his mental health is stable. Right now there are very few things that matter less than him being on the computer a lot -- especially if it is a form of 'functional' (but not very healthy) coping. His symptoms are very real with his anxiety, and his screen addiction is probably real too. A kid can't be expected to overcome both anxiety and a low-harm addiction simultaneously. That's not reasonable for him, or for you. It's not an overnight project: let it be one step at a time. (Therefore: quit stressing yourself out with screen guilt. Let it go for now. Pick it up again when you both have the bandwidth for it.)

[Arcadia]

Does anyone in your family has scary side effects from medication? My aunt nearly died in hospital from penicillin. It makes me even more aware of keeping track of drug sensitivities. What has helped was taking the new medication at the clinic/hospital with a relative/friend accompanying, and staying there for half to an hour before leaving. When DS17 reacted to Pfizer, he felt too nauseous and dizzy to stand up and get help. The nurses heard me asking him what’s wrong and came over to check on him. 

[Katy]

I have nursing experience so I’d probably ask for something to inject. But in absence of that, call the doctor. 

[MercyA]

.

Edited July 14, 2022 by MercyA

[ScoutTN]

Has he had genetic testing for the psych med? We got it, a saliva test from a company called Tempus, for Ds before beginning stimulant ADHD meds. The psychiatrist ordered it and it was about $100. It gave us a 4 page report on how Ds would react to/process all major psych meds. 
 

This might reassure your Ds snd help eliminate any chance of scary side effects from a drug that is a mis-match for him.

[Bambam]

I'd try to find someway to convince him to try it for x weeks (long enough to take effect). But you need some sort of metric for determining if it is helping him or not - preferably something that he could agree on.  I know it is hard. Can the prescribing doctor offer any useful advice about how to make this practically happen? Would the child listen more to the doctor? 

 

[athena1277]

I would talk to him about trying it for a day or 2 to see if there are side effects.  Let him know it’s ok to not take it again if he has any serious side effects.  If he’s ok in a day or 2, talk to him then about staying on it for a month to see if it makes a difference.  

[happi duck]

Before they start taking it make sure you have instructions for stopping.  After a certain time I think you need to taper off not just stop

[Guest]

I’m so sorry - that sounds really difficult. 

I agree with suggestions to set a specific time-based trial, and tie some specific metrics and incentives to it. 

The tough thing is that SSRI’s can take up to 4 weeks to show effect. So perhaps you want to set a short term time-trial and a longer term time-trial. The shorter term one could be for 1-2 weeks, to see if there are any negative side effects. (Negative enough to warrant stopping). The longer trial could be 4-5 weeks to see if there are positive effects. 

I don’t know what the dynamic is like in your family, but I tie a lot of things to screen time for my son (also ADHD, anxiety). He doesn’t get screen time until he’s done with school and unless he exercised at least an hour the previous day. Maybe I shouldn’t do that, but it’s the only carrot I have.

[Guest]

2 minutes ago, happi duck said:

Before they start taking it make sure you have instructions for stopping.  After a certain time I think you need to taper off not just stop

Yes, you cannot stop SSRI’s cold turkey. They must be tapered. SO discuss that with the psych and with your child in advance so he knows what to expect.

[Drama Llama]

It's hard to answer without knowing how old the child is.  It's possible my suggestion will be too young, or just wrong for your family culture.  But, I've had a lot of experience with getting kids to do things that are scary to them, even terrifying, including medical things.  

The thing that usually worked in the end was to first of all let the kid know that this is a decision for me to make as the parent/adult, that I did my research and I'm confident it's worth the risk, and that they don't need to decide.  And then I tell them that it's what's gong to happen next, and that I can keep them company, and be with them, but that it needs to happen next and that we can't do other things until we get past this thing.

And then we wait.  Together.  I don't present it as do this or you can't . . . or do this and then you can . . .  I just say "now we're going to do this, I understand you're scared and I can wait."  and then we wait together.  I've waited what seems like a really long time, with kids who wait silently, and kids who cry, and kids who tantrum, and eventually we do the thing together.  And then, regardless of what happened while we waited, I thank them and it's over till we need to do it again, and there's no anger or consequences or discussion.  

I'm probably not explaining it well.  

[Tap]

I would talk to the doctor about something with a short half life to get him over the worst of his anxiety and work from there on a long term med. Something like Lorazepam or Alprazolam. Some doctors would be ok with this plan, and others would never go for it, but I would talk to them about it anyways. By getting the worst of it managed, he may be able to build some strategies to work on the parts that are still difficult, but not horrible

When dd15 tries to refuse meds, I tell her that she can't live in my house without her psych meds. That helps to keep her motivated to take them but I don't think this is a healthy option for most people. 

[KSera]

4 hours ago, happi duck said:

You can ask about something to help with the new med anxiety.  I think they can prescribe something like hydroxyzine to take the edge off.

I was thinking the same. Hydroxyzine is a good option that he might feel more comfortable about because it’s an antihistamine, not an SSRI— if he’s ever taken Benadryl or Claritin or Allegra or anything like that, you could tell him it’s in the same type of medications, but it turns out that it also works well for anxiety. It’s one that can be taken as needed and doesn’t need to be weaned off of or anything. The only side effect he’s likely to feel is drowsiness, which makes it great for taking at night to help with sleep. You could start with that for a couple days and once comfortable with it add the Lexapro. You can let him know that once he has the Lexapro working, then he can stop the hydroxyzine again. Obviously, a doctor would need to agree with and prescribe this, but mine was totally fine with it when I requested it for my kid.  

[kiwik]

10 hours ago, Bambam said:

I'd try to find someway to convince him to try it for x weeks (long enough to take effect). But you need some sort of metric for determining if it is helping him or not - preferably something that he could agree on.  I know it is hard. Can the prescribing doctor offer any useful advice about how to make this practically happen? Would the child listen more to the doctor? 

 

Yes you just need to get him to take it for a month.  Can you appeal to logic? Say try for a month, keep a record to discuss with a doctor and if doesn't work after a month or the side reflects are bad look for another option.  Sort of treat it like an experiment   Let him know though that likely other people will notice improvement before he does.

[Quarter Note]

Hi friends.  Slipping back on while I can.  Sorry I forgot to include his age:  he's eleven.

I'll talk to the doc about hydroxyzine, but I don't think that he'll take anything right now if I can't guarantee no side effects.  (He will ask me one hundred times "Are you sure it's okay?" and I will answer him one hundred times, "Yes, 100% sure", but he still won't do it.  He won't even take Motrin anymore.  We can't get him to try the Lexapro even once, much less trying it for a month.  (I know that it takes a while to take effect.)  He was also really burned by stimulants (we tried two different ones), which worked fine during the day, but turned him aggressive and violent at night.

I should also add that this isn't situational anxiety.  The kid is anxious all the time.  He won't eat homemade food anymore, only things that come out of a can or a wrapper, because he's too scared of germs or mold.  He's getting to the point he doesn't want to leave the house.  He's depressed.  It's all tied together.

@ScoutTN, thank you for the idea of genetic testing!  That might really help to assure him, and us, too, that we're not just guessing and that it will work!  I'll bring that up with the doc at our next appointment.

You have all been so kind and encouraging, but I want to say a special thanks for @bolt. and @Baseballandhockey for sharing your really wise advice.

 

[Carrie12345]

How self-aware is he? By that, I mean does he recognize his experience with anxiety as restricting and uncomfortable?  I’m asking because I imagine it is/would be so much more difficult if he doesn’t recognize the benefits of “normalcy”, so to speak.

[Ottakee]

Have you ruled out PANDAS 

[Quarter Note]

3 minutes ago, Carrie12345 said:

How self-aware is he? By that, I mean does he recognize his experience with anxiety as restricting and uncomfortable?  I’m asking because I imagine it is/would be so much more difficult if he doesn’t recognize the benefits of “normalcy”, so to speak.

It's hard to tell.  He's so upset about always being "worked on" that he won't talk about much.  But, I need him to calm down so he doesn't take his anger our on me all the time.  

Need to sign off now - the kid has been over my shoulder for the past half-hour asking if I'm done.  It's hard to get privacy for typing on the forum!

Thank you all!

[Quarter Note]

On 7/8/2022 at 7:09 AM, Ottakee said:

Have you ruled out PANDAS 

No, but we can ask about it at the next doc visit.  My understanding is that PANDAS has a definite start with a strep infection, but there hasn't been any "start" to this.  He's always been hard.

Thanks for suggesting this.  We will follow up everything we can.

[ScoutTN]

Adding that the genetic test also reveals the MTHFR mutations, if present. 

[itsheresomewhere]

1 hour ago, Quarter Note said:

No, but we can ask about it at the next doc visit.  My understanding is that PANDAS has a definite start with a strep infection, but there hasn't been any "start" to this.  He's always been hard.

Thanks for suggesting this.  We will follow up everything we can.

You can have PANDAS without having an obvious strep infection.  

[Storygirl]

I have a teen on Lexapro, and he has had no side effects. It works very well for him. It did take two months, I think, for us to see an effect, so it definitely needs time to start working.

He also has hydroxyzine for quick short-term anxiety relief, when he is having a bad moment. This also works well for him. It calms him down a lot and has no side effects for him, other than sometimes making him feel sleepy. But he has taken it at the beginning of school days, so it doesn't make him too sleepy.

DS also takes other medications, and his medications help the entire family, because it makes him easier to live with, so I understand that component of your situation.

I would get counseling for the medication resistance. Other than that, I don't have great advice, because we've been able (usually) to get DS to take his meds, even when he doesn't want to, by saying that it's not negotiable. When he is really worked up and needs the hydroxyzine the most, he is the most likely to refuse it. Sigh.

Once you have gotten him to try the medication (I know that is the big question), I would do what you can to make taking the medication routine -- take it every day at supper, for example. And letting him feel as much control as possible. Perhaps have him fill a weekly pill organizer every week. Perhaps get one with a big enough compartment that he can put a favorite treat in with the pill (a little candy, maybe, like a Hershey's kiss).

 

 

[Storygirl]

Another idea -- we had resistance in another area (doing homework). I made a chart with squares, and DS got to cross off a square every time he did homework. When he filled his chart, he got to pick a special reward. Sometimes he would want to order something from Amazon. Sometimes he would want to pick a restaurant to eat at.

This was surprisingly helpful, even though DS was a teen at the time, and it seems like a strategy for younger kids. He was motivated by the rewards and was willing to earn them.

You could start by giving a reward daily when he takes his medication, then make it a weekly award, then extend it from there to longer periods.

Is he motivated by money at all? Money can be a motivator for some people.

If he is only motivated by computer time, and if he is kind of addicted to computer time, I think I might tie taking the meds to computer time, but not in an all or nothing way. Maybe earn an extra hour of computer time. Or perhaps if he takes the medication at supper, and he refuses, he doesn't get any MORE computer time for that day. If this will make him have an anxiety attack, though, it may be better to choose a different tactic.

[sbgrace]

My son does well with Lexapro. He started at a small dose and worked up.

We tried Luvox first, and he had sleep issues with that one. The plus was it was obvious very quickly, so we were able to just stop. 

My son has medication anxiety too, and really reluctant to try. But we convinced him that we could stop if there were issues (which did happen...) He really wanted some help, but it took a long time until he was willing to try. I think I would try a bribe if you think that would work, along with a lot of reassurance that any side effects that are problems will show up and you can stop. 

Edited July 11, 2022 by sbgrace

[TechWife]

Two ideas -

First - Has  your son talked about this with the psychiatrist? They would know all the info that is available and would be able to help him put potential side effects into the broader context of both studies and real world experience.

Second - Does your son see a counselor? If not, this might be a good time to start. A counselor can address anxiety and try to help him get to a place where he is willing to take the medication, which would further help him manage anxiety. 

[TexasProud]

I cannot stress this enough

GET GENETIC TESTING

And since you are talking about Lexapro, my middle son calls this the drug from the devil because it made me suicidal when I never before.  Did the exact same thing to my oldest.

That said, obviously, it works really well for some people. But the genetic testing ( which the psych did, family practice doc did nothing before he prescribed) showed that my genetics magnify all the bad side effects and negate the good ones for Lexapro.

The other thing is. His concerns are real and valid. All medicines have side effects.  I wonder if acknowledging that but saying that NOT taking anything also has side effects might be helpful.  What won't change is that YOU are there and trying to help him.  So if there is a side effect like x, then you guys will do z.  

[Quarter Note]

On 7/9/2022 at 6:09 PM, Storygirl said:

DS also takes other medications, and his medications help the entire family, because it makes him easier to live with, so I understand that component of your situation.

Storygirl, thank you so much for your understanding and for your suggestions.  He is motivated by so few things now, but we'll try to find something that will work for him.

[Quarter Note]

On 7/11/2022 at 9:10 AM, TechWife said:

Two ideas -

First - Has  your son talked about this with the psychiatrist? They would know all the info that is available and would be able to help him put potential side effects into the broader context of both studies and real world experience.

Second - Does your son see a counselor? If not, this might be a good time to start. A counselor can address anxiety and try to help him get to a place where he is willing to take the medication, which would further help him manage anxiety. 

Hi Techwife.  He won't talk to the psychiatrist.  😞  For our last meeting he ran from the room and never came back.  And no, he doesn't see a counselor, and is really resistant.  I think that he's just so tired of being the problem child that he's hoping everything will just go away and he'll be normal without any more embarrassment.

[Quarter Note]

On 7/11/2022 at 11:15 AM, TexasProud said:

I cannot stress this enough

GET GENETIC TESTING

And since you are talking about Lexapro, my middle son calls this the drug from the devil because it made me suicidal when I never before.  Did the exact same thing to my oldest.

That said, obviously, it works really well for some people. But the genetic testing ( which the psych did, family practice doc did nothing before he prescribed) showed that my genetics magnify all the bad side effects and negate the good ones for Lexapro.

The other thing is. His concerns are real and valid. All medicines have side effects.  I wonder if acknowledging that but saying that NOT taking anything also has side effects might be helpful.  What won't change is that YOU are there and trying to help him.  So if there is a side effect like x, then you guys will do z.  

Hi TexasProud.  He has absolutely refused to get the genetic testing.  I don't know if he has anxiety over what the test will involve, or if he's just tired of being "worked on".  We'll keep trying, though.

[Quarter Note]

Thank you, everyone.  The update is that he is still refusing any sort of intervention.  In the meantime, he has developed even more food issues (he's scared to eat more foods all the time.).  And he's so addicted to the computer.  My husband and I get almost no computer time ourselves because our kids hog it so much.  (We're looking for a family counselor to help us with more reasonable boundaries with the kids, because we shouldn't have to beg our kids to use our own computer!)  If he's not on the computer, he's usually lying in my bed.  

It's so hard to see a child you love depressed and he doesn't want any help.  😞 

[TexasProud]

3 minutes ago, Quarter Note said:

Hi TexasProud.  He has absolutely refused to get the genetic testing.  I don't know if he has anxiety over what the test will involve, or if he's just tired of being "worked on".  We'll keep trying, though.

I'm sorry, but I guess at 11 how is he even getting to choose???????????  

[TexasProud]

nm not helpful

Edited July 28, 2022 by TexasProud

[Quarter Note]

4 minutes ago, TexasProud said:

Ok, I just do not understand this at all. Just turn off the computer and tell him he can't get on....  YOU ARE THE PARENT.

Well, yes... But giving him computer time is easier than him breaking expensive or sentimental things, or screaming all the time.  It's just not that easy.  But we're working with him all the time on these issues.  

[livetoread]

It sounds like maybe he is developing some OCD symptoms. It also sounds like he is getting worse overall. Has the psychiatrist discussed hospitalization with you? You might want to ask him about it.

I'm so sorry you are having to deal with this. There are no quick and easy answers when a kid is that ill as I'm sure you know. It is so very stressful.

[Drama Llama]

I have liked the things I read about the SPACE program, which focuses on training parents in how to respond to childhood anxiety.  My anxious kids therapists suggest a lot of the same techniques.

I will also add that something can have a parenting solution that doesn’t mean that the problem came from the parenting.  Kids with special needs, regardless of etiology, need specialized things and those things need to be taught.

Having said that, if you are at the point where you are worried about property damage each time you set a limit and can’t force cooperation with something like a blood test, it may be time to consider an inpatient stay.

[TexasProud]

1 minute ago, Baseballandhockey said:

I have liked the things I read about the SPACE program, which focuses on training parents in how to respond to childhood anxiety.  My anxious kids therapists suggest a lot of the same techniques.

I will also add that something can have a parenting solution that doesn’t mean that the problem came from the parenting.  Kids with special needs, regardless of etiology, need specialized things and those things need to be taught.

Having said that, if you are at the point where you are worried about property damage each time you set a limit and can’t force cooperation with something like a blood test, it may be time to consider an inpatient stay.

YES.  Absolutely.  He needs to receive help.  However, forgot she was going through breast cancer.  Totally get being overwhelmed, but it really sounds like he needs to be hospitalized so he can receive help.

[Quarter Note]

2 minutes ago, Baseballandhockey said:

I will also add that something can have a parenting solution that doesn’t mean that the problem came from the parenting.  Kids with special needs, regardless of etiology, need specialized things and those things need to be taught.

Bless you, baseballandhockey.  Every night I cry, "How can someone who tried so hard to be a good mother have failed so terribly?"  I'll look into the SPACE program.

[TexasProud]

1 minute ago, Quarter Note said:

Bless you, baseballandhockey.  Every night I cry, "How can someone who tried so hard to be a good mother have failed so terribly?"  I'll look into the SPACE program.

Oh sweetie.  Not your fault. 

[Drama Llama]

Just now, Quarter Note said:

Bless you, baseballandhockey.  Every night I cry, "How can someone who tried so hard to be a good mother have failed so terribly?"  I'll look into the SPACE program.

You didn’t fail.  He has a disability.

As a parent, I have needed to go to classes to learn to program a communication device, and gotten lessons from PT’s about how to put on AFO’s and from RT’s on how to trouble shoot ventilators and so many other things.  No one ever made me feel like my lack of knowledge about these things, before I was taught, was the reason my kid had issues.  They just accepted that my kid needed things outside of “normal” parenting.

But God forbid I need similar instruction because of a mental health issue in one of my kids.  That, people are happy to judge!  

[livetoread]

2 minutes ago, Quarter Note said:

Bless you, baseballandhockey.  Every night I cry, "How can someone who tried so hard to be a good mother have failed so terribly?"  I'll look into the SPACE program.

It's a huge lie that we parents have tons of control over the mental health of our kids. We need to be good enough parents which isn't a super high bar, and then we need to figure out as best we can how to deal with their illness, but their mental wellness is not a measure of our parenting. Big hugs to you.

[Quarter Note]

1 minute ago, Baseballandhockey said:

But God forbid I need similar instruction because of a mental health issue in one of my kids.  That, people are happy to judge!  

Yep.  One problem is that he's just been under the radar for so long that we haven't been able to get anyone to take us seriously, and I think we are going to switch psychiatrists as well, for the same reasons.  We've been trying to get him help for years.

We live in a town where it's really hard to get services.

[Quarter Note]

2 minutes ago, livetoread said:

It's a huge lie that we parents have tons of control over the mental health of our kids. We need to be good enough parents which isn't a super high bar, and then we need to figure out as best we can how to deal with their illness, but their mental wellness is not a measure of our parenting. Big hugs to you.

Thank you, thank you, thank you!  

[ScoutTN]

1 hour ago, Quarter Note said:

Thank you, everyone.  The update is that he is still refusing any sort of intervention.  In the meantime, he has developed even more food issues (he's scared to eat more foods all the time.).  And he's so addicted to the computer.  My husband and I get almost no computer time ourselves because our kids hog it so much.  (We're looking for a family counselor to help us with more reasonable boundaries with the kids, because we shouldn't have to beg our kids to use our own computer!)  If he's not on the computer, he's usually lying in my bed.  

It's so hard to see a child you love depressed and he doesn't want any help.  😞 

Put parental control software like Bark on your computer. It will be the bad guy for you snd eliminate much of the power struggle in that sphere. Absolutely worth the money. Takes maybe 30-45 minutes to install and set up kids’ accounts.

[ScoutTN]

1 hour ago, TexasProud said:

Oh sweetie.  Not your fault. 

This!!! 

[bolt.]

1 hour ago, TexasProud said:

Ok, I just do not understand this at all. Just turn off the computer and tell him he can't get on....  YOU ARE THE PARENT.

Perhaps the way that you have noticed that you don't actually understand how a situation like this develops or functions... might serve to deter you from shouting oversimplified 'solutions' at suffering people.

Advice given from the place of ignorance, however well intended, rarely actually solves problems.

I'm sure you didn't mean to make anyone feel ashamed or stupid, but that can be quite an easy line to cross when a person reacts in this way.

[TexasProud]

nm not helpful

Edited July 28, 2022 by TexasProud