Prozac (fluoxetine) please help

[Chipcookiemom]

My 8 year old has combined adhd and dyslxia. We tried stimulants for over a year and they made him anxious and reactive. In August, his developmental pediatrician decided we should first treat his anxiety and we started 5 mg of prozac. (Prior he was so anxious, he'd gotten to the point of summer school refusal and not leaving house unless we could majorly distract him). Within a week, prozac 5 mg was a miracle drug for him. He was less anxious, thus less angry and engaging and interested in practicing soccer again. In fact, he played fall soccer and was a star goalie.

Fast forward 5 months and something has massively changed with his medication and unleashed a new issue. He in the past 6 weeks (since Thanksgiving) has gotten completely uninhibited and so impulsive with his reactivity. He functioned decently at school prior, but is now cursing at teachers, destroying things, needing tons of help getting regulated, etc. His current IEP doesn't have behavioral supports bc he previously wasn't struggling there.

Our former developmental ped has told us that with time, prozac can become activating for adhd kids, creating more hyperactivity, less inhibition, and almost manic like symptoms. That's what we think we're seeing. However, we also recognize we can't just

So the dilemma on whether to stop prozac is we are in between providers. We had our last appt with our developmental pediatrician last week because we had finally gotten into psychaitry at childrens hospital the following week. She said don't change meds now and let the psychaitry team possibly titrate the prozac and change ssris since they'd be taking over.

Well then snow came and our 2 hour intake at children's got pushed to February.

So we messaged our old provider and she said he's on such a low dose that we could stop the prozac and just start fresh with psychaitry in Feb.

My massive concern is that stopping it will return us to masdive anxiety and depression, which even over three weeks can lead to massive crisis. But, right now we're in a different kind of crisis with out of control impulsivity at home and school.

Please share with any comments on the prozac, medicine experience or just encouragement.

He's already in OT, in behavior therapy outside of school, had a fanily therapist trained by Ross Green, etc

[Missylee]

Hi There, My son is 14 and has ADHD combined, Anxiety, Depression and many LD's. He was diagnosed in gr3. We have tried many medications. And in gr8 he decided he wanted to not take any medication. I was terrified but he actually was much better with his mental health and friendships. However his ADHD was pretty bad and his grades tanked. So in gr 9 we went back to the doctor and my son communicated that Vyvanse helped him the most but a small dose 10mg only because of his anxiety. So the doctor put him on prozac 10mg as well. It seems to be his sweet spot for meds. But after 6 months the meds seem to be kinda wearing off or not working as well. Anyway I hear you and can relate. The prozac was great at first but now it seems to be causing him to kinda regress in some ways. I feel like this is going to be a long journey of trial and error as our kids grow. Personally I try and communicate with my son as much as possible to check in on how he feels and what's working and what's not. I let him be an advocate for himself in some ways when it comes to medication. I will say though Prozac seemed to have helped alot at first. I ask him if he thinks he wants to increase the dose but he doesn't want to and that's OK. Could be hormones, or other stuff going on at school etc. I can't control everything and I need to let him learn on his own in some ways. Anyway I thought I'd reply to your post as I can relate. You're not alone!

[Crazyboymomma]

It’s probably time to add an adhd med to the Prozac, which could really help with a lot of those things. If it were me, I’d be worried about taking him off of it, but just my opinion. My son is also on Prozac along with his adhd med.

[MomNDance]

Thanks for sharing. My 9 year old has ADHD and depression and just started taking Prozac. I'm going to keep an eye on impulsivity!

[JamB11]

Prozac and guanfacine have helped my kiddo. We also do Deplin l-methalfolate for his Mthfr needs.

[Rosie_Audrey]

Hi there,

I’m so sorry you’re experiencing this. We’ve had a similar journey with Prozac causing a massive increase in ADHD impulsivity and lowered inhibition with our (6 year old) daughter. It actually led us to her ADHD diagnosis. She was originally diagnosed with GAD and we started the SSRI at the beginning of the school year.

We were put on a low dose of Prozac and when we increased after a few weeks we saw a huge shift with manic behaviour and basically no impulse control. It was a complete crisis.

She started on a stimulant (biphenten) and that seemed to help quite a bit but she was experiencing some difficult symptoms with the Prozac (talking about death and dying a lot) so we immediately took her off of that.

With only the stimulant we had noticed a lot more executive function skills and focus, but it really suppressed her appetite and made her so incredibly irritable that it became debilitating. She was unable to make it a full day at school and each day between 10am-12pm I’d get calls from school to come and pick her up.

We stopped the stimulant over the holidays as it seemed to cause more harm than good at this point. She’s currently unmedicated until her next appointment. We’re managing ok with physical tools (a wobble stool at school) and body breaks for now. Emotional regulation and executive function are our big hurdles.

We’ll be working with her psychiatrist to help find the best medication for her. Hopefully something that will treat both her Anxiety and ADHD. We are wondering about Guanfacine?It seems on paper as though it could really help her particular situation. But she seems to be so sensitive to medication, I’m quite nervous!

All this to say- you are certainly not alone and this journey to finding the right treatments is such a winding road!

[Lillianmcmcl]

my 9 year old with Adhd and autism takes Prozac and it also seemed to help a lot at first. Recently we added Wellbutrin to help with her ADHD, because after 3 years of stimulants and very little effect on her, we got the psychiatrist to try something different. It has not massively changed her. Honestly I think we just need to keep up the slow work that is supporting her as she grows up and learns from experience. It's very hard. Every task takes a lot of reminders, patience and help. But it seems there's no magic pill. I remember that parenting all kids is hard and it will get better. We are trying another chore and reward chart.

[Alt49]

Unfortunately I can’t help with your questions but your story is helpful to hear. My son is 7 w combined type adhd and is on stimulants (methylphenidate) and guanfacine. Those have done wonders for his hyperactivity, focus, impulsivity, and aggression. Now his anxiety and obsessiveness has gone way up. We are trying therapy first before going to an ssri and unfortunately we cannot stop the stimulants because they are allowing him to stay in school (more pros then cons right now). As others have said a combo could be something that works for your son. And also trying different forms of each could help too ie a different stimulant or ssri. My son definitely had big differences ie they didn’t work when trialing other stimulants. The short acting methylphenidate works great for him aside from needing to change his dose a couple times.

[SunshynnSeas]

You could try switching from Prozac to Lexapro? Lexapro is more calming while Prozac is more activating. I also recommend adding a stimulant back in and possibly guanfacine. I think guanfacine is best for quite hyperactive kiddos and not so much for those more daydreamy kids. My 10 year old takes a stimulant in the morning, guanfacine in the afternoon, and Lexapro before bed. It’s been a good combination for him but we have been on that roller coaster with meds working/not working/dosage changes/adding meds/stopping meds and there always are some side effects. It really comes down to the benefits outweighing those side effects. Good luck to you and your son!

[SurvivorFan]

Yes, my son also had similar reaction to prozac. This was the first ssri we tried. At first, it helped so so much. Then 3 months later, it was like he was taking nothing at all. He was on Focalin, guanfacine, prozac. Behavior sky rocketed at school, had to he put in a hold, swearing, trying to elope. We switched to Celexa and same thing happened. Great at first, then 4 months later repeat. He has now been on zoloft for a year and doing pretty well, much more steady behavior. Mostly good days with some minor off days mixed in. He still takes Focalin and Guanfacine. If one piece of the puzzle is off, it all goes to hell. Having your son/family have to experience 3 more weeks of this sounds unexceptable to me. I would push for a switch now. I know how tough it is..hang in there.

[Elijah1]

If the present behaviors are similar to the anxiety that was initially present, he may need a higher dose. If it is different, then it may be activation. Stopping it will answer the question - if activation, he should be calmer within the week. If higher dose needed, there will be no change and a gradual worsening. Of course, make sure the symptoms are not ADHD.

[Meangreenllamabean]

My child also needs an SSRI to counteract the anxiety created by the stimulants. She's on Zoloft (sertraline) and has had no negative impacts or regression with that. When you are able to get a new provider I would definitely encourage trying a different SSRI. You could also try non stimulants for his ADHD like clonidine or guanfacine. They aren't as powerful in helping focus as stimulants but they do help with impulsivity and hyperactivity and don't tend to come along with the more negative side effects of stimulants.

As for what to do in the meantime I think you need to decide if being anxious and depressed is better or worse than having his behavior problems at school. Obviously neither option is great but your job is to avoid the worse outcome while you're in limbo with providers.

[CatLove25]

Hi! My son is on Prozac as well. It has greatly reduced his anxiety but some is still there. I find it interesting that your doctor mentioned that Prozac can be activating. Some of the symptoms of ADHD is poor impulse control (impulsiveness). Did the dr even suggest increasing the Prozac dosage and suggested adding a 2nd medicine for the impulsivity? This is what my son's psychiatrist suggested. My son started on Prozac 10mg and was increased to 20 mg which has helped a lot. We are now exploring adding a 2nd medicine to help with the ADHD portion which sounds like you may want to explore as well. We are looking at Clonidine which is supposed to help with impulsivity and sleep. Those are the two biggest issues my son have that he wants to have more control over. As we know, ADHD is complex with multitudes of areas that we have to work with and hyperactivity and impulsivity is part of it.

[Chipcookiemom in reply to CatLove25]

Yes, prozac can increase ADHD symptoms of impulsivity/inhibition, however it can also cause manic like symptoms in some children.

[CatLove25 in reply to Chipcookiemom]

This is good to know. I take Prozac as well and have never had anything like that. My son did experience an episode last week suddenly out of the blue and I am beginning to wonder if that's what it is.

[Chipcookiemom]

Thanks for all of the love, support and posts.

For those recommending clonodine or guanfacine, unfortunately we had the very rare side effect of hallucinations with these blood pressure meds. Again rare, but it does happen for some kids and obviously couldn't work for my kid.

It's helpful to hear that others found prozac more stimulating and increasing of impulsivity than other SSRIs. Under the care of a psychiatrist I'm hopeful we can titrate and move to another SSRI like Lexapro to calm him down and then move on to trying stimulants again.

Thanks all and we're just hanging on till he can get seen in a couple weeks. I'll let you know what's next!