My 8 y.o. DS is on a fairly substantial dose of Zoloft for anxiety (75 mg), and we noticed a substantial decrease in his anxiety after the most recent dose increase (roughly a month ago). However, recently we have discovered that he has been having some issues that we weren't aware of. One example...
At school, they have been having problems with kids peeing on the floor in the bathroom. My DS stepped in it near the beginning of the school year, and his shoe was soaked. We just found out that he is going to the office every single day (sometimes more than once per day) to inform them that the bathroom is dirty and needs to be cleaned. It really bothers him, and he says sometimes he can't even go in to pee because his feet might get wet. However, he has also gone and reported pee on the floor when it was just a bit of water from the fountain... When my DH told him he didn't need to go tell the office every single time if the floor was just a bit wet, DS said he was supposed to - the school secretary told him to come tell her so he has to! I think that, in his mind, he is obligated to go and report it.
This is just one example - there are many instances of rigid thinking and misperceiving people's intent, including thinking that people are yelling at him when voices are not raised and no one is angry at anyone... So I think many of these things are not necessarily anxiety-related, but then he has also just started having more anxiety around going to bed again, so I do wonder... I am thinking about it now because we're going in to discuss how the meds are working on Monday, and I had been expecting to report how much better he is doing, but now I am not sure how much of this is anxiety and how much is just... him.
I would appreciate any thoughts to help me try to process all this and decide how to proceed.
Is it possible that with the reduced anxiety (because of the meds) he is better able to articulate what kinds of things cause him anxiety in the first place?
With my DD, anxiety is caused in part by her rigid thinking, but in full on anxiety mode, she doesn't seem to know what is causing the anxiety and cannot articulate it at all. For her, to be calm enough to explain what she is experiencing and how she feels about it is improvement.
but everything has pros and cons
Yes, that is possible. After the first dose increase he actually verbalized way more anxiety than he had previously, which would fit with that theory. But after the most recent dose increase he verbalized far less anxiety, and also showed less obvious signs of anxiety (although certainly we still see signs of it... it just isn't as obvious to others). Then just recently we saw another smaller spike in anxiety, and then became aware of the bathroom issues and a few others which we are wondering if it is anxiety related or not. His anxiety and other symptoms have always waxed and waned quite a bit, so I guess I shouldn't be surprised... and he is generally fairly rigid in his thinking even when he's doing well. I'm just questioning now if the medication is actually helping as much as I thought... We are about to start (restart) CBT/psychotherapy with him, so hopefully that will be helpful now if he is more aware of and able to articulate what is bothering him.