Give Zoloft/Sertraline AM or PM (alon... - CHADD's ADHD Pare...

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Give Zoloft/Sertraline AM or PM (along w/ Intuniv)

missbonafide profile image
20 Replies

For those with a child that takes Intuniv and Zoloft do you give both in the morning?

My son already takes Intuniv/Guanfacine extended release in the morning (3mg) and we are debating on adding Zoloft to help w some anxiety and also aggression which I feel is anxiety masked by anger. A pediatric psychiatrist recommended low dose Zoloft (sertraline) but left it up to us at what time to give it. And I’m not sure yet. Is AM better for Zoloft or PM?

My son has also been having a lot of anxiety w sleep and wakes up in the middle of the night. 😕

Any advice? We have the 25mg Zoloft prescription that we haven’t started yet. But we’re thinking of starting it at a 12.5mg dose by cutting it in half. Thx in advance for your help.

My son is 6yo. He also gets weekly therapy and has IEP at school. His diagnosis is severe ADHD + Level 1 ASD.

Thank you!

20 Replies
SecretAgentIEP profile image

Perhaps do a genetic test, which may show Zoloft would not be good for your child. If you have any doubts, try that first. Or do they have sensory sensitivities or defensiveness to sensory overload, demand avoidance. Is the school avoiding their triggers, building connection? Perhaps also try occupational therapy first to see if you get progress from OT.

missbonafide profile image
missbonafide in reply to SecretAgentIEP

Yeah my son already gets OT a few times a week at school and she address both fine motor and sensory integration. Now the school and are they avoiding the triggers - more than likely they are NOT catching those triggers and NOT connecting which is probably part of what may lead him to feel angry and annoyed.... it's NYC DOE so anything is possible!

Onthemove1971 profile image

Thanks for sharing. For us it was so helpful that our son had the medication to help him feel good and help with mood, focus, impulse control, etc. Since your care professional told you to give it him when best. I would give it when you feel best. I would try am and see what happens ( this might help with sleep since it is much earlier in the am).

We started in the am ( with Initiv) then had to add a second dose at night.

For us maturity helped so much as our son got older and he was also able to discuss what was happening. When he was younger he was unable to control himself and describe why he did things.

Sorry I do not have experience with Zoloft, but know when the medication is all dialed in, learning and growth happens.

One last thing, I worried so much that our son would in the future not be successful because he was a certain way when he was young. That did not happen.

We are always here for you and hope my advice is helpful.

missbonafide profile image
missbonafide in reply to Onthemove1971

Thank you so so much :) - i always love your responses. I'm holding on to the hope that the maturity will really improve things over time!!!!

Onthemove1971 profile image
Onthemove1971 in reply to missbonafide

We will be thinking about you!!. We are all in this together. Please update us so we know things are getting better for you guys

Gimgim1 profile image

Hi, my son is is on both guanfacine and sertraline for just about the same reasons your son is! My son takes the guanfacine in the morning and the sertraline at night. We like this a lot and have seen successful results. It has been four months with this routine.

We are also getting a genetic test done to see how he metabolizes medicine and which kinds will work best for him. His doctor wants to increase the sertraline, but I’m not too sure yet.

I would cut the sertaline in half to start. We did that too and didn’t increase until after a month. I wish you the best of luck. It sounds like you are doing all the right things for your son. You are not alone.

missbonafide profile image
missbonafide in reply to Gimgim1

Yay so glad the combo has been working for your child :). Was your son aggressive? My son stil does not have skills to cope when he does not get his way (probably stems from the ASD diagnosis - very rigid) or when is being told what to do and b/c he's not able to cope w those feelings he releases them feelings w/ aggression. He also goes to weekly therapy and he's finally opening up to the therapist so I hope w that he's able to learn from a 3rd party coping skills. We really hope the Sertraline can support him in calming down that frustration which I really think stems from anxiety in the moment...we'll see. Yes we'll definitely split it in half so start at 12.5MG first.... thanks so so much again for your comment!

Gimgim1 profile image
Gimgim1 in reply to missbonafide

hi, so yes he was a bit aggressive especially when he disagreed with something (game, asked this to get ready for bed, interrupted play time, share something, etc)… this stopped after taking guanfacine. I also learned how to approach telling him the next task by giving him a 5 min warning and then a 2 min warning before we moved to the next thing (get ready for bed, leave for school, etc.). I think the weekly therapy is good and learning coping skills takes time. Your are doing all of the right things! My son has not been diagnosed with ASD, but is going to be re- evaluated because they they he might have it. He is also rigid in his thinking, like your son. You are definitely not alone!

missbonafide profile image
missbonafide in reply to Gimgim1

often it feels we are the only ones but coming to these forums really helps me feel a little better in the long journey of learning and supporting....thanks again for the insight

StellarMom profile image

My kids both take Zoloft & one takes Guanfacine and the other Strattera. They both take the full 25mg at night & the other medication in the morning. Zoloft makes them a little sleepy so night works well. Also- don’t split the 25mg- they’re supposed to take it all at once.

Zoloft has mad a huge difference in reducing the frequency and magnitude of meltdowns.

Hope this helps!

missbonafide profile image
missbonafide in reply to StellarMom

very helpful thank you!! the 25mg pill we got has a line in the middle and it is coated so that leads me to believe that I can cut it in half if we choose to....

StellarMom profile image
StellarMom in reply to missbonafide

I used to give half (12.5mg) when my son was younger because that was his full dose at the time. But if 25mg is the full dose then it should be taken all at one time

Elijah1 profile image

Zoloft is usually taken once daily. The doctor is correct that the time is up to you. We were always told that if taken in the morning and causes tiredness, then switch to evening. If taken in the evening and increases energy to a mild degree, then switch to the morning.

Also, if it is a noncoated tablet (which it is), it can be cut in half with no problems. Tablets that shouldn't be cut are those with a coating and that are time release (unless made to be cut). We learned about cutting pills through years of experience.

Auggie123 profile image

Yes our son has level 1 ASD and adhd, we do guanfacine morning/afternoon and sertraline at bedtime. Sertraline causes him drowsiness so bedtime is better for him.

missbonafide profile image
missbonafide in reply to Auggie123

oh so our kids have same exact diagnosis. did you start guanfacine first and then added sertraline? What changes did you notice w the sertraline? Just curious on his experience....Thx!!!

UncleMuscles profile image

My 7 year old, 42-lb boy takes 1 mg guanfacine in the AM, 1 mg right after school, and 1/2mg right before bed. He takes 15 mg Prozac in the AM. For us the timing of the dose of the SSRI doesn’t seem to affect anything, so we just consistently take it the same time daily.

Consider breaking up the intuniv dose with your med provider. We did it this way after telling ours he was being rambunctious at breakfast time. Good luck.

missbonafide profile image
missbonafide in reply to UncleMuscles

Great thank you...we USED to split the guanfacine ER before we were doing 1mg in AM and 1mg in PM for the extended release but then we started noticing my son kept waking up in the middle of the night so we switched to giving him full dosage just in the AM and now he's up to 3mg. Don't think we'll go back to splitting the dosage between AM and PM anymore b/c I think giving it to him in the PM was messing up his sleep. We look forward to him having some relieve w Zoloft w sleep but also w anxiety/aggression...

Lanego profile image

Hi. My son is 10 years old and started zoloft first and then about a month later began intuniv. We used both in the evening and had no problem. This past month we moved the zoloft to the morning since he has now started adderall xr in the morning, and have left the intuniv for evening. The switch hasn't been a problem so I do'n't think it will make a difference when you give it.

missbonafide profile image
missbonafide in reply to Lanego

So good to know...thx!

missbonafide profile image

Hi fellow parents :) -- I knew this group wouldn't let me down. Really appreciate everyone's insight! My husband and I were worried about adding Sertraline to the mix since our son is 6yo. But sounds like it has worked for some of your kids. I did order that DNA test - waiting for the kit still but my plan is to do that DNA just to confirm that it does not show the SSRI as not recommended for his system.

However not sure we can hold out on waiting for that DNA test b/c his anger/moodiness has gone up in school the last 2 weeks so we may just try it and see how it goes.

Again thank you everyone here for the amazing feedback..good to know we are not alone in all of this!!!!!

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