SSRI vs SNRI 9 year old with ADHD

[acfowlie]

Hello my now 9 year old son was diagnosed with ADHD when he was 7. We waited until he was 8 to try medicine which was Guanfacine. He went up to taking 2 mg (1mg in AM and 1 in evening) but we noticed anger/frustration with this so weened him down to 1mg per day (.5mg in AM and .5 in evening) He has some really good days but sometimes we think the guanfacine is still causing anger/mood swings. Our pediatrician thinks he could have other co-existing conditions that are being inadequately addressed such as anxiety, OCD, or Autism. She is suggesting additional neuropsych testing to confirm the correct diagnoses and that starting stimulants may actually worsen his anxiety, sleep disturbances, and picky eating and so SSRI therapy (zoloft) or SNRI (strattera or qelbree) may be better options.

Anyone been in a similiar situation and had additional neuropsych testing done or SSRI or SNRI therapy.

Thanks

[Imakecutebabies]

Did you notice any anger or mood swings in your son before he started the guanfacine? I ask because my son was originally prescribed guanfacine to ADDRESS his anger and mood swings.

[acfowlie in reply to Imakecutebabies]

He had a little anger but we feel the guanfacine is making it worse

[Mamamichl]

Stimulants can raise anxiety. It is definitely possible anxiety is there as well. With Guanfacine, its main effects were to lower blood pressure so that people with ADHD dont get heightened emotions. It didn’t work for my family. My partner got light headed and it raised his anxiety, and my stepkid feinted. Both anxiety and OCD are treated with anxiety meds. I tried stimulants and had more anxiety because of it, but my partner does well on Vyvanse. It also made us less likely to act on our emotions but that was only because blood pressure was lowered. We still had our feelings and thoughts that werent able to be addressed while on Guanfacine.

After trying stimulants, I started taking Stratera, and though I feel mildly zombified, I am able to control my emotions for the first time in my life. I still have all of my same interests, but I can control how I show them and choose to take time for the emotions or be more logical in the moment. I was taking Trintellix (2 part SSRI and one part SNRI) for 10 years, but I had a hard time getting off of it and insurance companies werent happy with me.

Most of the time people do well with SSRI OR SNRI. Prozac made me have more emotions and suicidal ideation, so I stopped it in its first month. All I mean by this is keep close eye on whether the med is working or not.

[acfowlie]

Thank you for the information and insight

[Aspen797]

Just wanted to say that it sounds as though you have a great pediatrician. I am impressed! A neuropsych eval can be very helpful in figuring out what might be contributing to behaviors and what treatment options (OT, SLP, behavior, executive functioning, etc.) might help give your child skills to be their best self as well as what school accommodations your child will need while still learning those skills.

Guanfacine works on the prefrontal cortex. It aids working memory and emotional regulation. Our son was very sensitive to this medication and any increase or decrease had to be in super small increments to avoid side effects (night-waking). That said, it was one of the most helpful medications in elementary school and he continues to benefit from taking it now. Anxiety can cause aggression/behavior issues. It can sometimes be hard figuring out what is causing anxiety, but addressing it can be a game changer. You might want to check out Jessica Minahan on the topic. kappanonline.org/skill-buil...

[adoptivemom]

My son is 7 and we have struggled with ADHD, anxiety and PTSD for a while now. We were working with a child psychiatrist who met with us often. We tried a lot of stimulant medications a year or so ago and they all had a terrible rebound effect, which was not sustainable. He eventually was put on Abilify and clonidine with some improvement but not enough - still hyper and distracted easily, angered easily and could not control his emotions. We recently added Prozac and it's been a huge improvement. I didn't realize how impactful the anxiety was on all of his other symptoms. He is much calmer and happier now, but completely himself. It is like he can relax and be fully himself. He still has a lot of struggles - especially at school, and we are going to look into adding back ADHD specific medications (really hoping to find one that won't rebound as harshly).

I just wanted to say that I wish I had pushed for anxiety specific medication earlier. Kindergarten was a nightmare, and last year was better but still severely behind. I am cautiously optimistic that if we can find the right stimulant medication it will be balanced out with this more stablizing medication already in place.

[acfowlie]

Thank for your feedback and sharing

[arrh121]

My son (now 8) was diagnosed with ADHD at 4 with significant mood issues among many other things. He was taking immediate release guanfacine twice per day but had some side effects and subsequently switched to extended release guanfacine once daily, and he also takes atomoxetine. The combination has worked well for him and he is doing well.

We also found it helpful to go to a developmental pediatrician and he now goes to a child psychiatrist who prescribes him his medication. We love his regular pediatrician but wanted to go to specialists who work with far more kids with similar issues to him.

[Littleme2000]

Our child’s psychiatrist recommended Genomind and psychoeducational testing, and I’m so glad we did it. Genomind was covered by insurance and it told us that SNRI’s work better than SSRI’s as well as which stimulants are a good fit.