Help! Prozac for 6yo who is anxious and out of control. Thank you all - encouraging initial results!

[Lecka]

The doctor you are seeing sounds good!

[mindinggaps]

27 minutes ago, Lecka said:

The doctor you are seeing sounds good!

Yes, we feel incredibly fortunate. She is a psychiatrist who only treats children and you can she tell is a true expert. She has been incredibly patient with us throughout the process and is always available to answer questions. We were very hesitant with the medication, but it never felt like she pushed us uncomfortably - she always acknowledged and addressed concerns in a reassuring manner. We do trust her a lot. At one point during the process I asked if Prozac was really safe and if she'd treated many children with it. She smiled and said she'd treated "thousands" of children with Prozac over the years. It was a subtle moment that did make us feel like she really knows what she is doing. 

[mindinggaps]

I must say thanks again to everyone for the support. After increasing her dose from 5mg to 10mg, there is no doubt the Prozac is helping her! We are amazed, excited, relieved and for the first time in what feels like forever, optimistic. She is much more clam and relaxed, has been actively engaged in healthy play throughout the day. She asked about visiting friends today, something she would never even previously consider. Overall, she seems happier and not on the verge of a meltdown at every moment of the day.

She is definitely is more active and energized, which the psych said could happen as we increase the Prozac. But so far, I see this as mostly positive and no side effects to worry about. 

A couple of days ago I was crying because I thought giving her Prozac was a bad thing, but today I was crying with happiness. We'll see how things go, but for now, it does seem we are on the right track. My mind has certainly flipped on the concept of medication...I'm already feeling foolish for being so resistant to the concept.

Edit - I should also mention, as some have asked - we are still doing various other kinds of therapy and will actively pursue a balanced treatment. But I do see the value of medication in a totally new way.

Edited February 18, 2023 by mindinggaps

[thatfirstsip]

Yay for modern medicine! Imo, consulting a doctor for an illness and at least trying what they recommend is the right way to go, whether the issue is in the brain or the lungs or the foot. I'm so glad you did that, and that the first med they tried is working!

[mindinggaps]

3 hours ago, thatfirstsip said:

Yay for modern medicine! Imo, consulting a doctor for an illness and at least trying what they recommend is the right way to go, whether the issue is in the brain or the lungs or the foot. I'm so glad you did that, and that the first med they tried is working!

Yes, and to be honest, I need to do some self-reflection - I resisted medication for far too long due to my own uninformed thoughts and biases. It is easy now to see that I should have been listening to the suggestions of a trusted psychiatrists and I hope to continue to learn and do better.

Unfortunately, despite the success we're seeing, my husband is still very lukewarm. He feels she should not be on the Prozac for very long as he is convinced it will impact her development. I am hoping he comes around and uses the evidence in front of us to get past his preconceived notions.

[Ottakee]

The meds can make her able to be successful in learning the therapy techniques and allow her to respond to your parenting, etc.

[wendyroo]

42 minutes ago, mindinggaps said:

He feels she should not be on the Prozac for very long as he is convinced it will impact her development.

It probably will impact her development - but that is the goal! It is an example of The Matthew effect: "the tendency of individuals to accrue social or economic success in proportion to their initial level of popularity, friends, wealth, etc. ie "the rich get richer and the poor get poorer"".

Kids who can't manage activities, friends, challenges, etc, never get the opportunity to develop those skills, to experience success, to learn from mistakes, etc. That is what can really delay their development - they are not gaining all the life experiences that children naturally learn from. Just as troubling, kids who have persistent behavioral challenges can internalize a damaging self-image which can impact their mental health and behaviors for the rest of their lives.

For our kids with anxiety, I firmly believe that functioning begets functioning; regulation begets regulation; engagement begets engagement, etc. And I am willing to medicate if that is what is required to maintain those positive feedback loops. 

[mindinggaps]

27 minutes ago, wendyroo said:

It probably will impact her development - but that is the goal! It is an example of The Matthew effect: "the tendency of individuals to accrue social or economic success in proportion to their initial level of popularity, friends, wealth, etc. ie "the rich get richer and the poor get poorer"".

Kids who can't manage activities, friends, challenges, etc, never get the opportunity to develop those skills, to experience success, to learn from mistakes, etc. That is what can really delay their development - they are not gaining all the life experiences that children naturally learn from. Just as troubling, kids who have persistent behavioral challenges can internalize a damaging self-image which can impact their mental health and behaviors for the rest of their lives.

For our kids with anxiety, I firmly believe that functioning begets functioning; regulation begets regulation; engagement begets engagement, etc. And I am willing to medicate if that is what is required to maintain those positive feedback loops. 

Thank you so much for sharing this. From our initial results, I fully agree with everything here and ultimately our goal was to impact her development in a positive way.  Framing the impact on her development in this manner is helpful and something I hope my husband can see.

@wendyroo You seem to have a wealth of experience and I have a couple questions based on your posts in this thread if you don't mind me asking (if you'd prefer not to share, totally understand).

1. You mentioned your eldest ended up on 30mg and has been able to stay on this dose for a while. Given that he responded well to the Prozac, during the original process how did you know that 30mg was the best fit? We're very much in the process of trying to figure out what dose is optimal. Our psychiatrist wants to get her to a level where meltdowns aren't happening and I think she'd rather push slightly higher with the hope that we can avoid tinkering in the future.
2. Would you mind shooting me a PM to discuss the private support group? For some reason I cannot message you - perhaps because my account is new?

[wendyroo]

2 hours ago, mindinggaps said:

Thank you so much for sharing this. From our initial results, I fully agree with everything here and ultimately our goal was to impact her development in a positive way.  Framing the impact on her development in this manner is helpful and something I hope my husband can see.

@wendyroo You seem to have a wealth of experience and I have a couple questions based on your posts in this thread if you don't mind me asking (if you'd prefer not to share, totally understand).

1. You mentioned your eldest ended up on 30mg and has been able to stay on this dose for a while. Given that he responded well to the Prozac, during the original process how did you know that 30mg was the best fit? We're very much in the process of trying to figure out what dose is optimal. Our psychiatrist wants to get her to a level where meltdowns aren't happening and I think she'd rather push slightly higher with the hope that we can avoid tinkering in the future.
2. Would you mind shooting me a PM to discuss the private support group? For some reason I cannot message you - perhaps because my account is new?

When medicating my kids, I am always looking for the point of diminishing returns. I never want to needlessly overmedicate them, so my goal is to improve their functioning and quality of life as much as possible with as few meds as possible. So when each of my kids started Prozac, they typically began on 5mg for a week or two and then upped to 10mg. After about a month we assessed if there were still anxiety symptoms that were negatively impacting them - there always were, so we increased to 20 for a month. For three of my kids, 20mg worked substantially better than 10, so we knew it was worth it. In fact, for all of them the jump up to 30mg still offered a significant improvement, so we knew that was a net benefit as well.

But for one of my kids, the jump from 10mg to 20mg didn't really offer much improvement. His anxiety was always less severe than his siblings', and while the first 10mg made a huge difference in his ability to function and enjoy new experiences, the move from 10 to 20 didn't offer many more improvements, so we dropped back down to 10mg.

In the last decade plus of managing my kids' mental health, one thing that I have found disconcerting and hard to get used to is just how much control I have over their medications. I have found this to be very different (and scarier) than other types of health care. When my oldest broke his arm two weeks ago, the doctors didn't ask me whether we should put a cast on it - they just x-rayed and announced that was the plan. But over the years I have accepted that many mental health choices will be largely left up to me, and just like with most of the day to day, minute to minute decisions I have to make when parenting special needs kids, sticking my head in the sand isn't a choice. No doctor asks me what dosage of antibiotics I want prescribed to a child, but our psychiatrist always gives me a wide variety of choices so that I can address the problems that I see as most limiting for a child. And on one hand, if definitely freaks me out that on my say so, all of my children are now prescribed "off-label" medications and dosages. But on the other hand, I have a long trusting relationship with our psychiatrist, and by this point I have been around the block enough to see the good, the bad and the ugly, so the unknown doesn't scare me as much...the years have made me haggard, but more self-confident.

As for the private support group, I will happily send you a message, but I have to warn you that it is a pretty dead group right now. You are certainly welcome to post, and I expect you will get some replies, but don't expect a bustling support group.

[mindinggaps]

11 hours ago, wendyroo said:

In the last decade plus of managing my kids' mental health, one thing that I have found disconcerting and hard to get used to is just how much control I have over their medications. I have found this to be very different (and scarier) than other types of health care. When my oldest broke his arm two weeks ago, the doctors didn't ask me whether we should put a cast on it - they just x-rayed and announced that was the plan. But over the years I have accepted that many mental health choices will be largely left up to me, and just like with most of the day to day, minute to minute decisions I have to make when parenting special needs kids, sticking my head in the sand isn't a choice. No doctor asks me what dosage of antibiotics I want prescribed to a child, but our psychiatrist always gives me a wide variety of choices so that I can address the problems that I see as most limiting for a child. And on one hand, if definitely freaks me out that on my say so, all of my children are now prescribed "off-label" medications and dosages. But on the other hand, I have a long trusting relationship with our psychiatrist, and by this point I have been around the block enough to see the good, the bad and the ugly, so the unknown doesn't scare me as much...the years have made me haggard, but more self-confident.

@wendyroo Your thoughts and insights are so valuable as we embark on this journey and I cannot thank you enough for sharing. It is point this that you mention, the fact that as parents we seem to have a distinct influence into the psychiatric treatment that has terrified me from the start. Fortunately, our psychiatrist is quite good at synthesizing information and making a strong recommendation one way or the other. However, I am acutely aware that the information I am providing is guiding the decision making in a way that doesn't happen in other forms of healthcare. As you say, if she has a broken arm, my observations on the treatment are far less relevant.

Even the framing of things is unique. At the end of our last appointment, the psychiatrist mentioned that as a next step we will decide whether to increase from 10 to 20mg. The notion that it is a collaborative decision does weigh on me. But already I am learning and understanding more about how the process is managed. The gradual step by step adjustment and observation does seem to make finding a balance achievable.

But I also see the stress of tough decisions coming and realize this is part of it. My husband wants to keep her dose low and is already thinking about how/when she can come off. The psychiatrist recommends at least 1 year at a steady dosage, ideally longer before we try a taper. I just want to take it one day at a time.