Child on 5mg

[Shellfish]

Hi,

I would really appreciate any advise any one can offer
My son (10) who has Autism has suffered from pretty severe anxiety for the past few years but it is escalating as he gets older. At it's worst, he self-harms (rubbing his face/body until he gets welts and ulcers in his mouth) and bad OCD particularly at night.
We tried strattera and unfortunately, it didn't do much so after a year or so, we opted for Prozac.
He is currently on 5mg and has been for 3 weeks. He seems happier in himself and the OCD, sleeplessness and self harming is reduced but he is now extremely overactive - he literally can't sit still.
He also has ADHD (hence the Strattera and two birds with one stone) but this is extreme even for him. His ADHD is inattentive so he withdraws and can't focus but he was never disruptive, moving and talking constantly as he is now.
Is it possible that the dosage is too high for him?
I am at my wits-end at the moment. I was so sure that this would work for him but he can't carry-on like this and hope to be able to function at school - where he struggles at the best of times.
The Doctor advised waiting til week 4 and advise how we are going but I was hoping someone out there could advise in the meantime.
Is the medication not right for him and if not, what then??

I am aware that it can take several weeks two reach it's full capacity but the hyperactivity is not showing any signs of stopping or even slowing.

TIA

[panic_down_under]

Hi,

Welcome to No More Panic,

Is it possible that the dosage is too high for him?

...Is the medication not right for him and if not, what then??

This is obviously a complicated situation and I'm not about to second guess your son's doctors. But a couple of observations.

I don't think the dose if too high, per se. It is only half the usual dose for a child your son's age. Whether there are specific factors that might necessitate a lower dose in your son's case I can't say, but my guess is dose is not the problem.

Fluoxetine is generally the most stimulating of the SSRIs which can be a positive for many with ADHD, but a negative for others. This is something only his doctor/s can judge and it may be too early to make that call.

Fluoxetine has a very long half-life, which is not a bad thing, but it means it takes quite a while for plasma levels to stabilize to a steady-state, about a month for the primary med, several for its active metabolite which actually does much of the work, and the side-effects tend to be worse while levels are on the roller-coaster. Therefore, I wouldn't necessarily be judging the med by what is happening now.

Antidepressants typically take 3-12 weeks to kick-in and, again because of the long half-life, fluoxetine is more likely to do so at the high than the low end of this range.

I suspect the hyperactivity will ease as fluoxetine takes effect, but I'm wondering whether a low sedative dose would help until then. Not a benzodiazepine, but the antidepressant mirtazapine (Remeron) which is a more potent sedating antihistamine than antidepressant. The lowest dose tablet is 15mg, but I'm thinking just a quarter of that, maybe less (it comes in an oral solution which can be diluted to allow 1 mg dosing, if necessary), might just be enough to take the edge off.

[Shellfish]

I suspect the hyperactivity will ease as fluoxetine takes effect, but I'm wondering whether a low sedative dose would help until then. Not a benzodiazepine, but the antidepressant mirtazapine (Remeron) which is a more potent sedating antihistamine than antidepressant. The lowest dose tablet is 15mg, but I'm thinking just a quarter of that, maybe less (it comes in an oral solution which can be diluted to allow 1 mg dosing, if necessary), might just be enough to take the edge off.

Thanks so much, Panic_down_under.
I will keep an eye on it and mention this as a possible option to my son's paediatrician.

Are you a chemist? Do you have any idea about combining Prozac with Vyvanse or dexamphetamine? These are options that his doctor mentioned before but I have read some unsettling information online about combining them.

Thanks again, really appreciate your help

[panic_down_under]

Are you a chemist? Do you have any idea about combining Prozac with Vyvanse or dexamphetamine?

No and no. Sorry. I know a little about the meds commonly prescribed for anxiety and depression, but this is way outside my limited knowledge. My only advice is to get a second opinion on everything, even a third if you still have doubts about something. Two/three minds are usually better than one. As a taxpayer I'll think my money is being well spent!