Prozac increasing impulsivity?

[Chipcookiemom]

My 8 year old son started prozac two months ago. Tried stimulants and guanfacine for awhile that made his anxiety waaaay worse. On prozac, we saw an almost immediate improvement in irritability, rage and major anxiety that was making life unmanageable for everyone. He's soool much happier. Now that his mood has improved, he's that stereotypical adhd kid who is impulsive, getting in trouble at school (last year he was masking/anxious and didn't get in trouble at all, so school is confused) trying to steal from his friends maybe thats just him) and class clown. We're thrilled after two miserable years that he's not miserable and now we are just dealing with obnoxious behavior. But also he can't just start getting in trouble at school because that also doesn't work for functioning well.Did others see unmasking/more impulsive behaviors on prozac or other ssris?

Did anyone find success on stimulants after getting the anxiety under control with an anti anxiety med and trying stimulants again?

Did others find success with other ssris/anxiety meds that also did not result in more impulsivity? Were open to something other than prozac

Thanks

[Speckled_frog]

Oh this sounds sooo much like my son. He’s 7 now, but not too far off 8.

I’m happy to send you a more detailed reply about what our medication journey has been like, but in short

Yes - taking an SSRI caused a massive increase in impulsivity. And psychiatrist says - this is just his baseline without all the anxiety (so the unmasking you speak of). So a much happier child, with significant decrease in the rage you mention. And his ability to participate in his community has improved.

Yes - we have great success on an SSRI & stimulant, but that is just for the 8 hours the stimulant is working. Outside of that, we have an extremely impulsive and distractible boy. So I am extremely grateful for what the medication has helped with, but our mornings and evenings are still intense.

[Speckled_frog in reply to Speckled_frog]

Adding to my 1st reply

SSRI :My boy has Zoloft as his SSRI. Psychiatrist was tossing up Zoloft versus Prozac. Can’t remember why we went Zoloft. But one of the considerations was about a small dosage size & what can be halved, rather than medication itself. I live in different country (& hemisphere) though to most people on this forum - so I know we don’t have access to all same medications as US. Not sure if what dosages are available differ in my country as well. So there might be different considerations at play for me.

Stimulant use: Our very first medication we tried was a long acting stimulant (Vyvanse) at a very low dose (half the recommended starting dose for child). We actually haven’t ever stopped it. When we started with 10mg, we could detect a small improvement in ability to engage in leisure activities, but meltdowns worse in afternoon (due to sleep & food intake issues) & the “crash” of stimulant wearing off. We tried 20mg vyvanse & became clear anxiety was increasing (very controlling, meltdowns & physically reactive over tiny things). We didn’t actually stop the stimulant. We introduced Zoloft (starting at half the usual starting dose), and we saw improvements in anxiety in first few weeks, by time Zoloft reached its full effect (4-6 weeks), the impulsivity was huge. Although happier, his impulsivity (still on 20mg vyvanse mind you) was impacting his ability to complete tasks at school, as he was so loud, impulsive & distractible at school. His teachers were gobsmacked, but thankfully kind, supportive & skilled with managing the student they now had. So we increased the vyvanse to 30mg. We saw definite improvement in ability to engage in school tasks initially, but gradually started seeing too much impulsivity. So we went up to 40mg vyvanse. At 40mg vyvanse, I started seeing some more subtle signs of anxiety (decreased interest in doing range of activities, bit rigid/obsessive about certain tasks, needing certain objects to be with him). However with some other signs the vyvanse wasn’t enough (e.g still calling out/getting off task at school, as well as the stimulant just taking “too long” in morning to help) we upped vyvanse again to 50mg. At 50mg a vyvanse, the anxiety was very clear. So I upped the Zoloft & anxiety has improved. We are in the best place we’ve been. We have just had to keep changing the dosage according to “too much anxiety” or “too impulsive”. Managing appetite & sleep with stimulant can be hard work (particularly each dosage increase), but no signs of medication being too high yet. (No zombie effect you hear about). It sounds like a lot of medication when I write it down like this - but we certainly don’t just rely on medication. But with the medication support, we actually have some success with the strategies we’ve tried for years with very little impact.

School: I am lucky with my child’s current school & teachers. But I also think it’s been really beneficial for teachers to see the very stereotypical ADHD behaviour in my child. (No one could doubt the diagnosis now- when very easily could have before). They now have a far better understanding of his needs & what actually existed under all that anxiety & still exists, though helped greatly by the stimulant (impulsive thoughts, difficulties regulating attention & emotions, planning difficulties, difficulties with motivation for under stimulating tasks etc etc). They have a far better understanding of the strategies he needs to learn effectively too. Unfortunately, the very anxious child can be more pleasing to adults in a school setting (so he doesn’t get as much positive feedback about his behaviour now ), but there’s just no comparison in my child’s well-being & ability to learn!

What my psychiatrist suggests this all means for her working model of understanding my child is that my boy has very high anxiety (that it could mask all that underlying impulsivity so much) and also very significant impulsive ADHD (because ssri is not known to cause impulsivity as a side effect, but rather its showing us his baseline). I agree with her working model of what’s happening for my child (Even if I’d rather not because actually it’s kinda scary that’s what we dealing with- so much anxiety, so impulsive). She suggests that unlike most children with ADHD whose anxiety is result of trying to function with ADHD, my child has Anxiety quite seperate to his ADHD and the anxiety is of biological origin (I.e not caused by environmental factors). She describes the reason the stimulant increases his anxiety is that it gives my boy clarity in his thoughts, so rather than his brain bouncing around & being easily distracted from anxious thoughts, he can really focus and zone in on just how anxious he feels. This has helped me persist on our current medication pathway, because when I’ve seen the anxiety increase with stimulant use, I’ve viewed it as better insight for both him & myself that he still needs more to assist him in getting the anxiety to a manageable level. (Please note - not suggesting this is true for your child/any other child- just I thought It could be useful to share what’s informing the decision we are making currently & why I haven’t abandoned either the stimulant or the SSRI when there have been so many awful/discouraging moments).

I hope you find this helpful. Feel free to ask any questions. Also I have never used the “chat” function in this forum. I’m guessing it’s a private messaging feature. You are also welcome to contact me using that if you’d like.

Also interested to hear what you try & how it goes (whether you try a stimulant or not) since there is so much I relate to in your story & there might be other options for my boy too:

[oldwiseone]

Hi! My daughter is a lot older (16) but we just started her medication journey and did see the same thing with Prozac. My daughter was diagnosed with ADHD at 6 years old but did increasingly better in school through middle school. Apparently, her brain used anxiety as the main coping strategy for her ADHD symptoms. Once she began high school, her anxiety began affecting her functioning and she also developed depression. She started Prozac and was her happy, curious self again. However, I also had glimpses of “my 6 year old little girl” with more impulsivity, distractibility and defiance while she was on Prozac and wondered if Prozac makes ADHD worse. She switched to Wellbutrin now (because she is driving!) and is doing better with ADHD symptoms.

[adoptivemom]

My son (almost 8) is also on Prozac. It helped a lot in the beginning too but now he seems to struggle more with the typical ADHD symptoms you are experiencing. Anger recently has been on the uptick. We tried stimulants but they did not help and the rebound was awful!! We have a RX for Strattera but haven't given it to him. The stimulants were rough so we took a break to get him happy and stable again. I filled the Rx but haven't given it to him yet. Maybe next week. We had the teacher resign and new one start today and a lot of travel and chaos the past few weeks. I have been waiting for a quieter normal time to try it out.

Hope that helps!!

[Mamamichl]

My experience with Prozac was that it gave me suicidal ideation and didnt help my impulsivity. I am so glad you are having success with it. Instead of a stimulant, which can raise anxiety, have you tried the non stimulant route for adhd? I tried 4 stimulants and no success with my anxiety, but When I went to atomoxatine (stratera?), I am having a lot more success (while still taking my anxiety meds).

Stimulants seem to help me with adhd in that it speeds up my brain so I can think the about my decision making things and decide which action to take. This also made me have a lot more thoughts, which raised my anxiety. With the nonstimulant, I almost feel like my brain is slowed down so that I dont have as many thoughts troubling me. I can also identify my emotions better without them being as extreme. I can keep my counseling/therapy in the front of my thoughts better and take those necessary actions, but dont fret on the poor actions as much, and make less of them as well, so I dont perseverate on them in general.

As for anxiety meds, I did well with Citalopram for a while, not well with Prozac, then went to trintellix. Trintellix was great for me, but I became dependent on it and coming off when insurance wouldnt cover it was a horrible time. I am now on Ecitalopram (sister to Citalopram), and I am doing well.