Steady - That's About It

We've been at 45mg of Remeron and 300mg of Neurontin twice a day and things are pretty much the same.  A few words every few days.  Little else.  Still anxious and agitated.  No real conversation or communication.  Still perseverating.

I'm thinking about 2 things. 

1. Going back to check if very low doses of things we have already tried can help.  Specifically Prozac, Seroquel, Effexor and Geodon saw short periods of "awakening" as we either tailed off or built up.
2. Schedule an MRI.  I mean why not?  If there are structural problems in his brain there's nothing we'll be able to do but, I suppose, at least we'll know.

Worser

From moments of quiet conversation to sudden violent or near violent outbursts featuring screaming, tantrums, throwing objects and - if people are present - grabbing.  That has been the cycle of the day.  The outbursts are directed at a teaching aide (whom he no longer has) who told him (9 months ago) that all people die eventually.  Her declaration of human mortality was and is too much for him to handle.  He "hates her", he want to "hit her" and "flip her off".  He has threatened to send her "an email telling her she's stupid".  I tell him he already did all these things (although he did not) and he says, "I did?"  I assure him that he did and he calms down some until the next time.

It seems that the lower dose of Prozac that remains in his bloodstream has allowed him to reflect openly on the root cause of his distress.  That he has eaten from the Tree of Wisdom and was turned mortal.

Meltdown

It's been about 8 days with no Prozac.  While generally things have seemed pretty good, tonight was as near a nightmare as I have experienced.  During the day, my son was lethargic and uninterested.  He slept pretty much the whole day.  Ate a lot when he was up.  Asked a lot of questions about death.  I got him to leave the house with me for some errand running for a couple of hours but that was as engaged as I could get him.

It seems though that there's something about nighttime that emphasizes the awful.  He started having tantrums.  Loud, near violent ones.  He was throwing pillows and hitting the walls. He broke a lampshade.  When I got near he would grab me and grip my arms or legs and squeeze. I was able to shake him off (but not calm him). I couldn't get him to answer why he was so upset.  I couldn't even get him to acknowledge that I had asked a question.  He was going on about how he was mad at some teacher who told him that everyone was mortal and going to die (about 8 months ago).

I had to lock him in his room.  He is calm right now but I feel like he could explode at any moment.  At some point, he will fall asleep.  I hope.

On The Downside

We are now working our way down to near trace amounts of Prozac in my son's bloodstream.  I have noticed something that is emerging as a pattern of sorts.  When we ramped down the Seroquel and, now, that we are ramping down the Prozac, as we approach very low levels - very very low levels,, my son seems a little brighter.  Still obsessing, but brighter.  He can converse, sometimes, even about new and different topics.  He behaves more predictably.  He carries himself a little bit better.  He can focus a little more.  He's not back to the old way.  But the fog has lifted a wee tiny bit.

The odd thing is that this happens "on the way down", as the drug is eliminated, but not "on the way up" as the drug is introduced.  I also recall seeing it with Seroquel and now Prozac but not the others. I wonder if this means that we don't (or didn't) give these drugs enough time as we ramped up or if we started too high a dosage or if there is some other pharmacological mechanism at play.

I do recall, though, that in my frustration at my son's sleepless nights, at one point, I gave him 25mg of Seroquel (half the dose he started on - when he was on it).  All that did for him was make him sleepy but seemingly had no other effect.  Maybe that was too high?

Upping Prozac

The new strategy was to raise the dosage of Prozac to a level that has shown success in dealing with obsessive compulsive tendencies.  Seemed like a good strategy.  So we started off down that new path.  We knew that the effect of any new dosage level would take about 10 days to reveal itself.  As always, we remained hopeful.

Sure enough within 10 days - pretty much as expected - we saw the new outcome.  And it wasn't pretty.  The behavior showed distinct similarities to those of my son's reactions while on the anti-psychotics.  The total self-involvement, the persiverating, the sleeplessness.  So we brought the level back down.  While the behaviors subsided somewhat they did not return to even the manageable level of madness previously experienced.

New and exciting obsessions started, constant bathing, for instance.  Constant clothes changing. 

It was therefore decided to get off the Prozac entirely.  And so another set of bottles of various dosages of a drugs goes into storage.

That basically brings us to now.  We are letting the Prozac go, waiting for it to subside in the bloodstream.  The plan is to switch to Fluvoxamine - a drug more typically associated with treatment of OCD and depression but specifically OCD.

Prozac, Not Really Listening

When we learned that Zoloft was not having any helpful effect, it was decided to switch over to Prozac.  Prozac is well documented in the literature in its use on teenagers.  It also has more "headroom' than Zoloft on that larger doses can be given.
The switch involved tapering off of Zoloft while increasing the dosage of Prozac over the course of a couple of weeks.  This also meant that there would be a time where the amount of anti-depressant in my son's bloodstream was minimal.

It was also during this time that we decided to cease giving my son his daily Concerta which he had been taking for his fleeting attention span and somewhat impulsive behavior.  Since Concerta is an amphetamine and my son was already quite "amped up", it was felt that it served no useful purpose and perhaps masked the effectiveness of the anti-depressant.  What I did notice though is that his behavior since the cessation has been more impulsive and his attention more fleeting.

Back to Prozac.  The tapering partially occurred while we were away at a family weekend.  Perhaps owing to the wider audience but perhaps owing to the change of medication, my son put on quite a show.  He was oppositional and had frequent tantrums.  He would tell others that we didn't care about him and wanted him to die.  He would say that we weren't willing to help him.  He did, however, get it together enough to participate in a few activities but, for the most part he was in pretty bad shape.  What's odd, is that when we got back home, he told our neighbors that he had a great time.

As we slowly ramped up the Prozac, we again saw very little if any difference in his behavior.  This led to an attempt to use a class of drugs known as anti-psychotics.  These drugs are used in tandem with anti-depressants because they are thought to have an amplifying effect on them.  Apparently, this amplification is selective and amplifies "the good things" and not "the bad things" of the anti-depressants.