My son was in a state (as he has been for the past several days) in which he paced and perseverated endlessly. The perfect to meet up with a specialist. Full on detached mode, as it were. At the appointment, attempts were made to converse with my son but with no success. So we spoke about the situation and I shared my observations. He pondered my son and was puzzled. He has seen this sort of behavior before - it's just that he never has seen it develop suddenly. Rather, kids who behave like this have always behaved like this. The most significant takeaway was that my son was in a state of high anxiety and that was, in his mind, the prevailing and overarching issue. He said the approach taken thus far was reasonable and what he would have suggested but now is the time to "fish in a different pond" - pharmacologically. He thinks the SNRI medication is a good place to be although he seemed to prefer Cymbalta to Effexor and was bemused at the pharmacist's reaction to it.
Although he said he needs to think about the sequence and priority, he suggested the following:
1. Increasing Effexor to at least 150mg/day before abandoning it
2. Trying Remeron
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