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Location: Grand Rapids, MI
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I personally think after much research that she has more traits of Asperger's, but I am only her Mom and who am I to question a school psychiatrist who can figure it all out in a 15 minute eval?
Here is a summary of my thoughts/experiences with medications for anxiety.
First, if she is having anxiety, possibly contributed to by OCD or Aspergers or whatever, its okay to treat the anxiety without having an exact diagnosis. Among the typical mental health anxiety-related diagnoses, the medications prescribed are going to be the same, pretty much. I wouldn't worry too much about hunting down an exact diagnosis first. You'll want an accurate diagnosis eventually. Sometimes the response to specific medications can actually help figure out the diagnosis.
Most, if not all, anxiety diagnoses can be helped a whole lot by desensitization techniques, behavioral techniques, and/or cognitive therapy. However, if her (and your) quality of life is severly affected by her anxiety, it can be a huge relief to take some of the edge off so that she can focus better and have more successful experiences with anxiety-producing situations. The more practice she has successfully dealing with stressful situations the better she will handle the next stressful situation, and meds can help her get there faster. Once starting meds, combining a medication regime with teaching skills for dealing with anxiety will help her the most and the fastest. As she gains skills in managing her anxiety and overcoming her fears, the meds can be slowly decreased.
Secondly, some meds are better than others in terms of side effects and long-term use.
Here's some common ones that are generally best tolerated and usually have the least side effects:
Anti-depressants commonly used (also used for anxiety particularly if its OCD-related anxiety)
Zoloft (for most people has the least side effects)
Paxil (has some withdrawal issues usually managed by very slowly decreasing the dose) (also isn't that often prescribed anymore)
Mood stabilizers (also often used to treat seizure disorders)
Depakote - can have a calming effect.
Tegretol - similar to Depakote
Lithium - ugh; probably the most dangerous of the lot
Mood stabilizers can cause liver damage and other physical problems - generally not a good choice for anxiety alone
Antipsychotics/ major tranquilizers
Risperidal - most commonly prescribed for children. It just has an overall sedative effect. Almost always causes weight gain. It has the potential of causing some nasty side effects associated with all the antipsychotics (drooling, odd postures, bizarre facial movements) but this is pretty rare. Typical dose for children is .5mg to 1mg. Very commonly prescribed for behavioral issues, particularly aggression.
Anti-anxiety - the drug class specific to anxiety. Its rarely prescribed to children because the ones that work are addictive and the other ones don't work so well.
Buspar - non-addictive. Also hardly ever works.
Benzo's - (ativan, valium, klonopin, etc lorazepam, diazepam) on an as-needed basis only (with at least a few days between each use).
diazepam, etc). Highly addictive and abrupt withdrawal can sometimes cause great discomfort including seizures in some children. If a child has infrequent episodes of anxiety/aggression/agitation that last longer than an hour or so, this type of medication may be a good choice when given on an as-needed basis with at least a few days between each use.
Inderol/Enderol - a blood pressure medication that helps to prevent adrenaline spikes associated with panic-type anxiety or phobias. It has no side effects that I know of and is really safe. But it only is helpful for specific situations, like if you have a fear of public speaking and have to give a presentation. Kind of works, sometimes.
For most of the kids I know with almost continuous anxiety/agitation, a good medication plan might be:
Try the antidepressants also known for effectiveness with OCD first. Might have to try more than one.
If no relief there, try risperidal at a small dose (starting with .25mg is a good choice), with the option to give another .25 to .5mg as needed.
If side effects of risperdal are too problematic (e.g. weight gain, etc) probably go to a mood stabilizer instead of a different anti-psychotic.
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