Medication for J

[InsaneCdn]

I'm not familiar with using Strattera so young, so I don't know what a "low dose" is in that context.
For teens and adults, we're told that it really isn't effective below 60 mg. But... J is no where NEAR that size or state of development.

Some adults only need 60 mg... permanently. That level of baseline help is enough to make the difference.
Our psychiatrist knows some who are on double that.

 

[Malika]

The lowest available dose is 10mg, which is what he is on.
Today was the first day. No nausea, stomach ache or loss of appetite which are classic side effects of Strattera. However, he was very drowsy all time - another classic side effect - particularly in the afternoon, and quite "nasty". What worried me most was that his usual moments of aggression/opposition were worse - he actually bit me at one point (he usually stops short of actually hurting me) and in the evening, when I said he had to come in for the night he was raging for a full 15 minutes, saying things like "I want to kill you". He is not usually this bad.
This worries me. The drowsiness I can live with on his behalf and it will presumably pass but this increased aggression and violence? He had exactly the same reaction on the stimulant. Can anyone shed light on this?

 

[BusynMember]

That's why I told you to be careful. I have read about that reaction from Straterra on a lot of threads. But since it is a "build it up" drug you have to wait to see the full affect. If he gets meaner, more hyper and more aggressive, by all means, think about keeping him unmediated. ADHD is not so serious that the kids HAVE to be on medications, especially if they don't react well to them. Use your mom gut. You have a good one

Jumper did not like ADD medications. She insisted on compensating for her Learning Disability (LD) and ADD without medication and she actually worked so hard at it that her grades are way up now. At J's age though she struggled a lot. She did not learn to read until she was eight, but she caught up.

 

[InsaneCdn]

We were told the worst effects for Strattera were the first couple of weeks. Then, another few days after each increase.

 

[svengandhi]

Before we put oldest boy on ADHD medications, H, who is severely undiagnosed ADHD himself, was very opposed. The doctor said, if your son had diabetes, would you refuse him insulin? If he had cancer, would you decline chemotherapy? It's a hard road, my son was 7, a little older than J is now, when we began the medications. He is 23 now and made it through HS, though not college because as he got older, he refused the medications. He is an adult, it is his choice. I hope the medications work for J. When they work, it's like taking a blindfold off and letting someone see where they are standing.

 

[Malika]

Okay, day two. He has still been sleepy, but less so than yesterday.
But the nastiness, hostility and aggression... continue. I will try to speak to the psychiatrist tomorrow morning. It is actually very hard to keep going in these circumstances, to keep giving him these pills that are making his already aggressive tendencies worse. I feel I have to keep on with it for the experiment to make sense, for at least a month or so, but it goes against all intuition, somehow.
Is the aggressiveness a side effect that is going to disappear?? No noticeable positive benefit yet, but I know that is to expected with Strattera.

 

[trinityroyal]

Malika, if the medications are making J's negative behaviour worse then that might very well be a good reason to stop.

Years ago my difficult child was prescribed an SSRI (paroxitine) for anxiety. He experienced akathesia, extreme disregulation, impulsivity and other destructive symptoms that led directly to a major run-in with the law, and other consequences.

If the medication isn't working for J, talk to your doctor as soon as possible about making a change, whether it's lowering him to a less-than-therapeutic dose, switching to another non-stimulant medication, or something else entirely. The whole purpose of medications is to make things better for J and for you. If the medications aren't doing that, then they're not working.

Trinity

 

[Malika]

Thanks, Trinity. J is on the lowest available dose and there is NO other medicine available for ADHD here in Morocco.
Of course if the aggressiveness were to continue like this, we will stop it, no question at all. But the uncertain factor (for me) is whether this is a side effect that could disappear. I need to talk to the psychiatrist, I guess.

 

[SuZir]

It's not an allergic reaction so I would give it two or three weeks if it is at all manageable. Side-effects do tend to diminish with these type of drugs. And let's face it. Two days is quite a lousy sample size to begin with.

By the way, just an idea: Have you asked him if he is feeling anyway unwell. Aggressiveness could be a side-effect of an side-effect in the way. I do know, that I tend to be irritable when I feel drowsy or have a stomach or head ache for example. Of course that doesn't make any difference if aggressiveness continues with this medication. But I would give it a fair chance and see if it gets better in few weeks.

 

[BusynMember]

Malika, since I had been on medication myself, before Sonic was given any, I was well aware that medications are necessary for SOME people (I am one, Sonic is not, J is a ???). But I also knew it could take YEARS before the right medication combination could be found and that medications can make things worse if the person is given the wrong medication. And you are right. It's not an exact science. Neither is any sort of diagnosing. J. may not even have ADHD. He may have something else. Until there are blood tests, it's just the diagnostician's best guess. And, as you probably noticed, diagnostic standards are different even country-to-country.

It is never a good sign if medications make somebody more irritable or aggressive whether it is the first day on the medications or the twentieth. My own personal experience is that if a medication amped me up the first day, by the second week I was usually a manic mess or even near toxicity. There were medications I could not even trial because they were so bad for me that I couldn't handle their effects...some of my side effects included hallucinations.

If you want to keep J. on Straterra for a month, go for it. Now if you see him getting worse and worse, I would consider that it is not good for him. Although this is hardly scientific, I have been on this board for years and only remember hearing of one or two cases where Straterra seemed to be helpful. Please do chime in if you have had a good experience with Straterra! In real life, I know of many, many kids diagnosed with ADHD and none doing well on Straterra. I could be WAY wrong, but in my limited experience I have not heard about it being affective. If any child has a predisposition to a mood problem, both stimulants and antdepressants can make the child meaner and worse, ADHD or no ADHD. J. is kind of young for you to know if he is prone to depression or another mood disorder, but he may be and that could make him overly sensitive to these medications.

I don't really believe that any medication alone changes behavior. It has to be coupled with other interventions. The medications I am currently on changed my life for the much, much better and it took about ten years to find them. However, I still have setbacks and need regular therapy to remind me how to control my tendency toward negative thinking and my tendancy toward getting overly emotional. Usually you have to attack these issues on more than one front.

I think you are a very good mother to this cute little boy. I trust that whatever you do it will be in his very best interests.

 

[Malika]

Hi MWM. Your input is appreciated One thing is fairly certain - J has ADHD. He has been diagnosed by four doctors now and really he is a textbook case. Whether he has other things too... that could be, though the new psychiatrist says he has no other conditions in his judgement.

I agree with much of what you say. I can really see how medication is only part of a whole treatment system, including therapy, etc. There are no magic pills... I think I really have accepted that now!

I do want to continue with this experiment because if I don't I will never know whether Strattera could maybe have helped him. If it doesn't, and the aggression just continues, well - I will know we gave it a good shot. As to whether there are good experiences with Strattera and children: I've read a lot about it on the net. People's anedoctal experiences would seem to be about two-thirds negative, one third positive - and the positives are very positive. J could be in the minority group, it is possible.

As I remain basically someone who doesn't want to be putting toxic substances into a child (but who has got to the point of being willing to try it because of all the ways in which my son is handicapped by his disorder), I can very well imagine returning to life without drugs. But I owe it to him to try and see, because I now see that ADHD is a neuro-biological condition that can be helped with medications. As long as the side effects are a price worth paying.

SuZir, yes, I have asked him through the day how he feels. And, truly, he would be the very first to let me know if he had pain or discomfort of ANY description...

 

[InsaneCdn]

As long as the side effects are a price worth paying.

Well said!
That is the fine-line of balancing for all medications... sometimes, even with some pretty serious side effects, medications are still worth it due to the severity of the non-medicated behavior. But... the positives must outweigh the negatives. It's no different with any other type of therapy, really.

 

[Malika]

Thanks Sharon. This is what I am confused about! Generic Strattera is not available in the States - and yet one can buy it online in the States...! Can anyone explain this?

Neither of those two other drugs are available here in Morocco and, to be honest, I would be less comfortable about trying them rather than Strattera which is specifically for ADHD.

Okay I have my answer! http://www.drugs.com/availability/generic-strattera.html The online Strattera is apparently illegal. Clears that avenue up anyway.

The doctor has prescribed 10mg for one week, moving up after a week to 20mg. However, I have read that Strattera should be titrated very slowly. I am wondering whether I should just keep him on 10mg (we haven't started yet, am due to pick up the pills, which have to be ordered specially, this afternoon) for the time being.

 

[BusynMember]

Malika, I knew you'd make a good decision. Yes, it is worth a try.

 

[TeDo]

Here's my two cents and you're free to ignore me. LOL He's normally a very active boy. Now he's sleepy earlier in the day. This is a new feeling for him. He doesn't know how to handle it, could be blaming you for it (you gave him the medication), is just plain frustrated with the feeling/change, or all of the above. Personally, if you can stick it out, I'd go for it.... unless it gets even worse. If he's reacting to the medication (he shouldn't be quite yet), you'll know. If it's just an adjustment/change for his sense of normal, it will get better.

I still give you a lot of credit. This was a hard decision and I know how you feel. been there done that I wish you had to options for medications we have here in the States. That medication might end up not being the one for him and I feel for you both if that turns out to be the case. Another case of "one size fits all". It's just not fair.

Crossing all crossable body parts that the Strattera ends up being as much of a help for J as it has been for us. {{{HUGS}}}

 

[Malika]

You have long experience with Strattera, TeDo, and I certainly wouldn't ignore your opinion! I'm not sure how much J connects taking the pill in the morning to his feeling sleepy.... not much, I think. The psychiatrist did tell him he was going to give him a pill that would help him at school and help him make friends (and also that would help him "listen to mummy without complaining" - I wasn't so keen on that one; I don't want J to take a pill to make him good...)

A little confused, though, when you say he wouldn't be feeling the effects of the medication yet - the sleepiness is an effect of the medication, so could he not be experiencing other effects as well? I am willing to see it through for a few weeks, though next week is a school holiday and he is going to stay with his father and family for some days. My ex-husband is not in favour of his taking medications and doesn't want to talk about his having ADHD, though I think deep down he knows it is real and that J is "different". I have told him he is going to try a medication for it, and he will doubtless agree to giving him the pill in the morning.

by the way, how is Buddy? Are you still in contact with her? She doesn't seem to post on the board any more - would love to have news of her.

 

[InsaneCdn]

Unfortunately, with medications that have to build up in your system, the side effects kick in before the positive effects do...

 

[Malika]

Yes, I did realise that, IC My questioning was really whether the aggressiveness could not also be a side effect that was manifesting early, just like the sleepiness.

Well, day three... also sleepy during the day - at lunchtime he didn't insist on going out to play with his friends down the road but stayed on the sofa with me, listening to stories. I asked his school principal how school had been that day and she said "fine". Apparently they are having tests at the moment and he got full marks in science and maths. Tomorrow will be Arabic and French, so that won't be so impressive. Not that I mind about any of that - I just want him to fulfil his potential, whatever it is.

Meantime he has developed tiny little raised bumps on one of his feet, which he is constantly itching. Another usual side effect, apparently. I didn't ring the psychiatrist in the end. Will wait a bit.

 

[TeDo]

Yes, Malika, it would be an effect. What I meant was that you won't know if it's just an initial reaction that will go away or a long-term reaction that will stay or even get worse because it isn't "leveled" in his system yet. I would be watchful of the intensity and frequency of the aggressiveness. difficult child 1's aggressiveness and defiance progressively got worse on Prozac and Risperdal. Those were my cues that the medication was not a good one for him. I have heard that this can also be true for some kids on Strattera but it's not as often the case.

I will PM you about Buddy. She and Q are doing well.

 

[Malika]

Thanks, TeDo. Well, we just have to stay the course, I guess, with no knowledge of the outcome. Day four and he seems less sleepy, less aggressive - though he is still talking, in a chatty, pleasant voice, about killing people and shooting them (that sounds worse than it was; you'd have to have witnessed it, really - more like Cowboys and Indians stuff). No noticeable changes in concentration, yet, although he has twice now told me that he "wanted" to take the lighter from the kitchen (but didn't). A while back he took the lighter without my knowing - it is now hidden except for times like this lunchtime when the maid is here cooking lunch - and set fire to brush wood and a tree with it.... It's probably because a big deal was made of this little bonfire and he remembers that. So the jury is out. I really want to titrate up very slowly, though, more slowly than the psychiatrist has prescribed.