Hi, I have an ADHD child and and most possibly an ADHD wife. Wife used to be furious most of the daily life. She is taking Sertraline (for depression) now and anger is controlled. My daughter is diagnosed with ADHD. She was on Methylphenidate 36, aripiprazol 10, and fluxetine 200. Her symptoms were almost controlled. She came to uk on this medications. Psychiatrists said we need to change medications based on the UK guidlines. As they were changing medications, lots of symptoms appeared. Finally they stopped all medications and started Atomoxetine 10mg and increased it to 20mg after less than two months. My daughter is not feling ok at all. She is full of anger and fights with us all day long. We do not have even one minute normal communication together. Everyghing is messed up. I do not know what to do.
Her next appointment is for next week. But the psychiqtrist says we would like to keep all medications down. We are struggling.
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Sustaci
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Hi SustaciI can't comment on the changes of medication within the UK guidelines . I live in Australia and paediatricians also minimise medication.
I just wandered if you were able to look at parent education. There is evidence for it's efficacy and is considered a frontline management in our guidelines.
There are some programs available online if that is more accessible for you and your wife.
I understand this is not a quick fix or even all the answer but we have found it very useful.
So sorry your doctors are not being cooperative. We recently added Sertraline to my teenage grandson's meds and it has really gotten his anger under control.. But he is also on Straterra and Guanfacine.He also sees a counselor weekly who tries to walk him through situations and help him decide how he should have reacted.
Thank you Anirush. I have realized that the higher the dose of Stratra, the higher the anger the child experiences.
On the other hand, there is a stock issue with Atomoxetine in the UK. We have been told that your daughter's medication will probably be changed if the stock issue is not sorted.
We have recently started Wellbutrin, with Gufacaine and it is working well. We removed the stimulants becuase we could not get them. It has been a good substitution.
Best of luck in finding what works for your child.
Does her UK psychiatrist have her most recent medical records from her last psychiatrist? Those would probably be very helpful. If he is relying only on the history you have given, have you only said your daughter has ADHD? I’m asking because fluoxetine and aripiprazole are not ADHD medicines. Fluoxetine is an SSRI (antidepressant) and aripiprazole is an antipsychotic medication also used to treat depression and sometimes irritability and anger/aggression in autism. If someone tells a new psychiatrist they have only ADHD and brings no medical records for when and why they are taking those 2 medicines, most psychiatrists everywhere will not refill/re-prescribe those medicines. You will probably need to show documentation from your child’s last psychiatrist of when, what doses, why, and how well she responded to these medicines in order for them to consider continuing them. I hope this helps!
I have done the same as what you said. My daughter was on all thoes three medication for first tew months in here. Then we have been asked "do you agree with some changes on medications?" I said " as long as it helps with my daughter's situation I am very happy". But it was very difficult days.
I would ask for a meeting to discuss what he thinks her diagnoses are and be sure he knows what you’re seeing at home. Sometimes taking a video of her behavior if possible can be useful. I did this with our daughter with autism and intellectual disability for our behavior therapist. Our daughter behaved well at the therapy office. At home she had bad meltdowns several times daily. Finally I got the therapist’s attention with proof on video. Maybe that would help?
I'm sorry to hear you're going through this. Have you considered nutritional supplementation as a option? Low dose lithium orotate (1-2mg) as well as a methylated folate multivitamin (with iron and other B vitamins) has worked wonders for my son's irritability and aggression.
Sure! Lithium is an effective mood stabilizer even in small doses. I tried it for my son based on guidance from the book Finally Focused by James Greenblatt. Greenblatt also has a website including a full discussion of the benefits of lithium - see below.
Why Low-Dose Nutritional Lithium Should Be An Option For ADHD
As for the methylated folate multivitamin, my son has a (fairly common) gene mutation in the MTHFR gene, which makes it more difficult to methylate folate into it's active form (5-MTHF). Folate is critical for neurotransmitter production and if you have this mutation, you can be getting plenty of folate in your diet but you aren't able to use a large percentage of it. I've pasted a figure from a research paper here that shows how methylated folate, along with a number of other vitamins & minerals, is a cofactor in nuerotransmitter production.
The multivitamin my son takes is called EnLyte. It's pricey and I'm not sure if it's available in the UK but other vitamin manufacturers like Pure Encapsulations (Junior Nutrients, pill) or Dr. Mercola (Chewable Multivitamin) have methylfolate in them.
Neurotransmitter production and required cofactors
Greenblatt recommends starting with 1mg per day for children split between morning & night. I give my 10 year old ~2mg per day. The Weyland supplement you found looks good but you probably want to buy a lower dose, then take more if it's not having an affect. I personally take the Pure Encapsulations Lithium Orotate 1mg while my son takes the KAL liquid lithium orotate (both available on Amazon).
As for the Junior Nutrients, they are small pills so they're easy to swallow but they don't smell very good so you may want to refrigerate them and give them to your daughter with juice or a smoothie. The Dr. Mercola chewable multivitamin (also on Amazon) has twice as much methylfolate but they are fairly large, chalky tablets. You have to go with what your daughter can tolerate!
Unless you know that your daughter (and wife) have an MTHFR mutation, I don't think taking methylfolate alone is the best idea or worth your money. ADHD symptoms have been attributed to a suite of vitamin and/or mineral deficiencies including Omega-3s, most of the B vitamins other than folate, vitamin C, vitamin D, magnesium, zinc and iron, among others. (Irritability can also be due to bacterial or yeast overgrowth in the gut.) Taking a multivitamin with methylfolate will cover your daughter's nutritional needs if she's deficient in other things. The only nutrients that a multivitamin won't usually contain are Omega-3s and iron.
If you're serious about a nutritional approach, I recommend asking your doctor for a full nutrient blood panel (Omegas, vitamin D, folate & other B vitamins, zinc, copper, magnesium, lithium, iron) and for genetic testing from a company like Genomind. The sample for the genetic test is just a cheek swab and it provides a lot of information.
Hello Sustaci,I'm sorry you are going thru all that, it is a lot to manage.
I'm in the states so not sure exactly how it works in the UK, but here I would suggest telling the psychiatrist that you strongly disagree with them about "keeping the medications down" you want your daughter back.
If the meds she was on were working tell them you want to get back to that. You tried what they suggested, it isn't working, now fix it.
It really doesn't matter what they want, it is about what is best for your family, and you know better than they do what that looks like.
You may also want to consider counseling for both Mom and daughter for their anger. Even if it is under control with meds for Mom, it would be nice to work on it, figure out where it comes from and what triggers it. Understanding can have a huge impact on reducing those types of symptoms. Often when we are used to a strong emotion being part of our lives we just let it rule us, thinking it's just "part of our personality". It doesn't feel good and often we are hard on ourselves when the emotion takes over. Once you understand where the emotion comes from - emotional disregulation for instance - then you can stop beating yourself up about it. Once the self chastise is reduced you have some bandwidth to look at it and feel less out of control, which leads to a bit more calm. Often with anger, especially ADHD disregulation type, just knowing you are not a bad person, or you are not weak or broken because you can't control it can give relief and reduce resistance. When you understand the emotion it is lessened, less scary, less overwhelming and you are more able to exert control over it. Resistance or feeling "this shouldn't be happening" can actually make things much worse.
Another suggestion is to get your daughter, and you and your wife too, into some sort of high cardio exercise. That is good for her health and can help balance hormones and neurotransmitters which can even out mood. It is recommended to have 30+ minutes most days per week. It isn't a quick fix but after a couple of weeks you should notice changes.
And meditation is another life long gift for the whole family. Depending on your daughter's age you may need to experiment with different types to find a good fit. Many ADHDers don't like the idea of sitting still, there are moving meditations like Tai chi, or simple things like walking and counting your steps up to 10 and starting over.
It could be helpful for you too to give yourself some kindness and quiet to support yourself as you support your family.
I wish you the best, stay strong when dealing with the psychiatrist, you are the expert on you and your daughter, not them.
Good luck,
BLC89
Full disclosure: I am an ADHD Parent Coach. I have been married to ADHD for nearly 30 years and raised two kids who have ADHD
My wife knows that she has a situation (ADHD or...) but she is hiding it from me. She takes Sertraline 150 mg. Her sister, brother, and her dad are super angry people. They are also sensitive to the words of "angry, depression, manic, and..." which makes everything difficult. Apparently, they have not been diagnosed. But you can clearly see all of the symptoms in them.
As you said I keep fighting for my daughter. My daughter has an appointment with the psychiatrist this Friday. As you said, I am going to push the psychiatrist to do something for her. Hope everything goes well.
Hi AgainI saw the psychiatrist on Friday. He was insisting on low doses and saying that these medications are cytotoxic. He says that based on Nice guidelines any child lower than 18 should not take any medications.
He said your daughter's Blood pressure and heart rate are already higher than normal a bit. They were 116/75 and 95.
He said to go for an ECG and it's reported to show me. He said he is not good at cardiac parameters readings.
I say to myself, if it is going to be toxic why I should give it to my child? No idea. Should I get along with this or fight for medication?
Hmmm, I would see if there is a second opinion that may be more sympathetic to your needs or have better hearing. Yes why would you give a toxic material to your child?There are other things to try. I'll type up some stiff and send via messages.
Wishing you luck! I know it’s difficult, especially with some families and/or cultures, but whatever cooperation and information you can get from your daughter’s mom about her own mental health history, diagnosis, and family history, including what medications have been effective, would be very useful for the new psychiatrist. The more information they can get about everything, the better they can help you.
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