My Special Child: Meeting with a Specialist

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

3. Trying trazedone - primarily to address sleeplessness
4. Trying neurontin

He thought it was curious that we have these lucid periods. I noted the recent connection I observed to ramping up or down on medications. He said that might mean that

1. My son is sensitive to lower (much lower doses) of these medications
2. My son is reacting to the metabolizers rather the primary active ingredient of these drugs
3. There is something unrelated and neurological going on that is turning on and off at random

He noted that in the case of anxiety-related issues most drugs reveal their reactions more quickly than they do for treating depression and even OCD. He also noted that higher levels of medications associated with treating OCD often have adverse effects when anxiety is the main actor. This is consistent with what we saw with my son when the Prozac level was increased to the "standard OCD" dose. We also saw this to a certain extent with fluvoxamine which is considered the "go to" drug for OCD.

We're still on 2 x 37.5mg Effexor. He's been stable at pacing and perseverating and non-communicative since the last lucid day this past Friday.

My Special Child

Thursday, October 27, 2011

Meeting with a Specialist

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