We have been talking a lot about medications here on ADHD Central lately. Part of the reason for this is that so many of you write in with questions about medications and you are wanting to know things such as whether or not certain medications are effective. These are always difficult questions to answer particularly because these types of questions are always best answered by the prescribing doctor or your pharmacist. But what we can give to you are resources on how to find your own answers.
Another thing that I can personally offer is my experience as a caregiver in witnessing how particular medications affect my son. In a previous post I talked about our experience with Risperidone or Risperdal. In this post I am going to give an update on how the Risperdal is working for my son. I am also going to talk about the process of adding Celexa, an antidepressant, to my son's medication treatment plan.
Note of precaution: I always feel the need to include a small disclaimer any time we do discuss medications. None of us here are medical doctors or pharmacists. This post and others like it are written from my perspective as a parent. The decision to use medication to treat your child's symptoms is a very personal one. You need to do your own research, talk to your child's doctors, and reach your own conclusions. What works for one person will not work for another. If you do use medication as a part of your child's treatment plan you will need to find the right medication(s), at the right dosage for it to be effective. Unfortunately nobody can tell you which medication will be most effective for your child's symptoms. At most, your child's doctor can give you an educated guess.
Some background: My son is fifteen. He has always had extreme symptoms of ADHD but his primary diagnosis is autism. I personally never wanted him to use any medication to treat his symptoms and we have always tried to exhaust other treatment methods first. Adolescence hit my son hard and he began to have crying jags which increased in frequency along with general agitation and trouble sleeping. At this point we decided that medication might ease his suffering.
When he was 12 we made an appointment with a pediatric neurologist recommended by my son's pediatrician. It took nearly six months to get the initial appointment and so he was nearly 13 when we put him on a very small dose of Prozac. The Prozac worked wonderfully for about 18 months. He was no longer fearful of so many things (previously he was just about agoraphobic and didn't want to leave the house) and his crying spells diminished and finally he was sleeping well at night. But shortly after his 14th birthday things changed for the worse. The crying spells came back despite no change in his environment. In addition to the crying he was also becoming extremely anxious and agitated. The mood swings combined with testosterone cumulated into behaviors we had never seen before, namely aggression.
At that point we sought advice from my son's neurologist, who suggested we try Clonidine, which is a blood pressure medication sometimes used off-label to treat the symptoms of ADHD and/or autism including angry outbursts and aggression. Let's just say this was a disaster for my son and I will write amore full report on our experience with Clonidine in a subsequent post.
Which brings us to the beginning of this year, when we made the decision to try Risperdal.
In my previous post I detailed the positive improvements I had seen in my son while taking this medication. However, in about 4-5 weeks we noticed a re-emergence of some negative behaviors we had seen prior to him taking Risperdal. It seemed that there were certain "witching hours" of morning times and early evening when the medication seemed less effective. I became concerned about this and we went back to the neurologist for some further guidance. Risperdal has some potentially very serious side effects and I did not want to take this amount of risk for a drug which was seemingly losing effectiveness.
My son's neurologist had a lot of suggestions for us to try. My son's current dosage at that time was 1 ml (we are using the liquid form of risperdal) in the morning around 7:30 am and then 1 ml in the evening around 7:30 pm.
Possible changes to dosage and schedule of administration of Risperdal suggested by my son's doctor:
- Increase the dosage to 2ml for both morning and evening. We were not comfortable with this increase as it would seem to me that we would also be increasing the potential for adverse side effects to occur. The neurologist's answer to this was that the side effects are either going to be there or not regardless of dosage. I was personally wondered about the accuracy of her answer.
- Divide up the total dose into three as in we could give one part in the morning, one part at noon and one part in the evening.
- Divide up the amount of the total dosage between morning and evening. For example we could give 1.25 ml in the morning and .75 ml in the evening.
Basically our doctor told us that parents know best about which dosage works best for their child. Whereas I wanted exactness the doctor was providing too many variables to contemplate. I felt overwhelmed and confused. I wanted to hear about other choices than messing around with the Risperdal dosage.
Back to the drawing board and the addition of an antidepressant
The other suggestion our pediatric neurologist made was to replace the seemingly ineffective Prozac my son was still taking at this point with another one. In the past she suggested Wellbutrin. But this time she made a recommendation for Celexa. Her reason was that Celexa is of the same antidepressant family as Prozac, as it is an SSRI. My son had tolerated Prozac very well and so she thought that he would also tolerate Celexa just as well. I can tell you that I researched both Wellbutrin and Celexa for days. There were many articles pointing to a study claiming that Celexa does not help kids with autism. Yet when you read it carefully, they are talking specifically about treating the symptom of repetitive behaviors. This is very different from using Celexa to treat symptoms of anxiety and mood disorder.
Then I looked at Wellbutrin. A conversation with a friend was very enlightening about the differences between Wellbutrin and Celexa. My friend suffers from both depression and anxiety. She described that when she took Wellbutrin for her depression, it worked great for decreasing her symptoms of depression. However, for her, the Wellbutrin caused her to feel so much anxiety that she had to stop taking it. This conversation was the inspiration for me to dig further into which medications can cause anxiety symptoms and indeed Wellbutrin lists anxiety symptoms as a possible side effect including nervousness, agitation, restlessness, irritability, and panic attacks. My son suffers from mood swings but also extreme anxiety. The last thing I wanted to do was to add to his anxiety so we decided to try the Celexa.
Is the Risperdal and Celexa combination working for my son?
I am going to give a tentative and hopeful yet emphatic YES for now. My son is now taking his usual 1ml of Risperdal in the morning and 1ml in the evening. We made no changes to his dosage or when we give him this medication. We cross tapered the Prozac with Celexa which means we gradually weaned him from 10mg of Prozac as we were gradually introducing Celexa. This process has taken four weeks. He is now taking no Prozac and is taking 10 ml of Celexa (we are using the liquid form). There was some mild sedation at the beginning where he would take an afternoon nap. But this is tapering off and he is getting a solid ten hours of sleep at night. His appetite has increased with the Risperdal. He has definitely put on some weight but he was underweight to begin with so he is simply within the normal range of weight for his height now.
His mood has improved dramatically. Before he began the Celexa we would have him report his moods using this visual emotion checklist and he would frequently report that he felt sad. Now he is reporting that he is happy most days of the week. Overall we are very happy about the changes we are seeing.
Here is a summary of the positive and negative effects we are seeing presently with the Risperdal/Celexa combo.
- We saw some drooling as a side effect to the Risperdal early on but this has not been seen again in later weeks.
- Now and then he will have some nighttime wetting of the bed because he is in such a deep sleep but this has greatly diminished upon simply reminding him to use the bathroom before bed.
- There are times when the medications are kicking in where he will seem a little off-balance. He rests for a few minutes and this seems to pass.
- He has a healthy appetite but he is not over-eating. For some children who take Risperdal the potential weight gain can be a deal breaker. This has not happened with my son.
- There is some sedation at times. He will sometimes nap in the afternoons but this is diminishing with time. He gets in a good 10 or more hours of solid sleep at night. He is a teen and they do need more sleep.
- My son's mood has dramatically improved. He no longer has crying jags, meltdowns, or constant mood changes. He appears happy and he laughs more and is definitely enjoying life a whole lot more.
- I am surely going to jinx myself here but my son's aggression has decreased to zero episodes each week. There are no more angry outbursts, tantrums, yelling, making threats, throwing objects, hitting, pushing, etc.
- My son's anxiety is not completely gone. We still see some ritualistic behavior daily. But these episodes seem limited more to the morning hours right before he gets his medication and about an hour after he gets it. But overall his fears and phobias seem greatly improved. Talking about emotions seems to really help and to teach him alternative strategies for when he does feel anxious.
- My son's tolerance for frustration has increased dramatically. Things that normally would have ignited him before to an outburst are now handled in a calm manner. He is finally able to show some patience.
- We are seeing a difference in temperament in that now he wants to socialize. Celexa is also a medication used to treat Social Anxiety Disorder and some patients say it really helps.
- My son seems far more motivated to do learn, complete his lessons, and shows a marked improvement in being able to concentrate and pay attention. He is now actually asking to do more work. This is a huge difference from his behavior before where he would avoid tasks, chores, and lessons.
Overall we have been very pleased with the Risperdal and Celexa medication combination for our son. Time will tell, however, if these changes will remain or whether there will be future problems. I will update you all through the weeks and months how this is all going. Please don't hesitate to share your experiences about medications here with us. We can all learn a lot from one another. Thank you for your participation on our site. We couldn't do it without you