Hi! My eight year old son has ADHD. He's been diagnosed for at least 3 years. Unfortunately, he has never been able to take any of the stimulants (we've tried concerta and adderrall) because he just whacks out... says his brain is telling him to hit himself, gets very irritated/agitated. Anyway, we've had a lot of success with Tenex treating the hyperactivity. But it does not help the impulsivity and attention. We've been told that to really treat ADHD he needs to be on a stimulant and the doctor wants him try taking an antidepressant with a stimulant to see if that would stop the wierd side effects. Has anyone had experience with taking both at the same time?

I tried Concerta with Prozac for three days and gave up so that doesn't really constitute a fair trial. I know many people use that combination (IE: one of the authors of You Mean I'm Not Lazy, Stupid, or Crazy? says she uses is to good effect).

I've also read about the atypical antidepressant Wellbutrin being effective for some folks, or Effexor. Everyone is so different in their body chemistry. I don't know with his tendency to hit himself how those would work. I have read that as serotonin levels drop self injury risk rises, so an antidepressant working on the serotonin levels might help. If I understand it correctly, when dopamine levels go up, serotonoin go down and so forth, so it can take a bit to get the balance just right for any individual. You'll probably just have to work very carefully with his doctor. I hope it works out well for him.

Scattered

Yes, my daughter is on Focalin (stimulant) and Zoloft (antidepressent). The Zoloft seems to counteract the negativity produced by the stimulant. She was on Adderall alone a while back and her symptoms were as you describe in your son. We took her off Adderall, put her on Zoloft for a while and THEN added the stimulant. The doctor wanted the Zoloft in her body for a while before adding Focalin. It has been two weeks and so far so good. She will increase the Focalin to full dosage next week. But so far we are not seeing the negative side effects that taking only the Adderall produced.

I can empathize a little with you, my daughter say's her brain tells her to do and say bad things-not to herself but others. Although only 5 she has been on prozac for oh about nine months now. Two days ago, I would have said it was helping, but after last night I'm not sure about much. Is this the pediatrition that is giving him the medication? It could be a good thing to seek out a child Psyciatrist in your area, sometimes they know what the Dr's don't. And even though my daughter's on prozac, I'll tell you to watch your son for suicidle thoughts while on anti-depressants. One that was mentioned by Scattered- Wellbutrin has been known to cause suicidle thoughts in young children, and my daughter's Psychiatrist told me that with any anti-depressant to watch my daughter for those thoughts. As Scattered mentioned everyone is differant, and the meds can affect people differantly. I'm not saying don't try it, just to watch him, they could help a great deal, but you have to try it to find out(sometimes you just have to experiment with the meds, it sucks, but when you find the right combination for your son you'll be glad). Hang in there, things are always the darkest just before dawn.

Hi there just been reading yours posts and if i can may i ask why your children are on antidepressants? This is the only thread that has scared the life out of me, only because i put my son on antidepressants when he was about 7 because to me it was like he was depressed, i had been suffering depression for yrs so i know the basic sign's, he was on them up untill i saw the news reporting suicidal tendencies with this medication.

I was horrfied when i spoke to him to then find out if he had felt like this on this medication and he told me that he had took himself off one day and was going to throw himself in front of a train, i knew he was telling me the truth i could see it in his little face, anyway i took him off them straight away, luckily they had helped him cope over the bad periods we were having with him.
Finally he was diagnosed a.d.h.d and put on medication, since then life has improved tremendesly.
He isn't on any antidepressant anymore because i found the root of the depression.

I myself have been on prozac and they made me like a zombie, it just scares the hell out of me what these medicines have in them and the side effects it can have, i put my son on the lowest amount possible that i am able to cope with because at the end of the day do we really know what we or our children are taking?

I went back on Prozac (10 mg) along with my Concerta and at first it was wonderful -- for about three weeks -- then I started getting weird side effects. I'm still not sure if it triggered Tourette type tics or if it was tardive dyskensia. Neither was anything I'm interested in having. I had an almost constant chewing on the inside of my cheek and lower lip and my cheeks sucked in involuntary and left me with a very sore face and jaw in addition I developed an annoying eye twitch. I got on line and found out that I'm not the only one who has experienced this. The book Prozac Backlash by Dr. Glenmullen of Harvard discusses patients he has had and others he has learned of through colleagues that had similar symptoms from Prozac and other SSRI anti depressants. These side effects are well know with the antipsychotic medications like Thorazine and Prozac lists "antipyramidal syndrome" (which means this cluster of tardive dyskensia type tics) as a possibility. Some people have developed such a problem that their tongue involuntarily sticks out or they flap their hands (my GP had a patient with this problem) or have involuntary body movements. Self injury was also reported as a problem with Prozac when they applied to make the new and improved Prozac. The Division of Nephrology at NYU Department of Medicine lists the "use of psychiatric medication, especially antidepresants such as Zoloft, Paxil, Prozac" as risk factors for developing bruxism (teeth grinding that may include damage to the inside of the cheek from biting and chewing, TMJ, and tense facial or jaw muscles).

Each parent has to make their own call, but after my experience I won't be putting my 8 year old daughter on a combination of stimulents and anti depressants. I think anti depressants are especially risky for young developing minds.

I hope things work out for you and your child. I know lots and lots of vigorous exercise has always helped my daughter and I cope with our ADHD and I also find participating in music helps as well -- for me it is a way to focus the mind that my ADD doesn't find too boring!

Take care,
Scattered

Well, we did not have a good experience. Not because of the antidepressant though. He just cannot tolerate the stimulant. He literally took one dose of the adderall XR, ONE dose and he was a basket case. You would have thought he was schizophrenic. He was running through the house like his pants were on fire and, I kid you not, he stayed awake for 38 hours straight!!!! 38!!!!! He was doing headstands in my bed at 4:00am! I had called the pediatrician at 2:00 am and was told to give him a double dose of benedryl, not even that slowed him down. So we are DONE, DONE, DONE with the stimulants... However, my new post is about Provigil. We are going to try that this weekend (he is on antibiotics for some trauma to his nose, long story.. and I want him to be off of that before we introduce anything new)...

Thanks for all your feedback!!!!

Wow -- that's quite a reaction to a stimulent. Has your doctor double checked the diagnosis. Mild bipolar and ADHD are very hard to differentiate in children (actually in the majority of cases if a child has bipolar tendencies he also has ADHD comorbid to that). Wender (early ADHD researcher) writes that when the reaction to stimulent medication is not what is expected it's a good idea to recheck the diagnosis. Stimulents can make bipolar and certain other conditions much worse. Frequently stimulents will make an ADDer sleepy at least initially.

I'm not familiar with Provagil -- I hope you get a positive response on this medication. I know it's the pits going through trials of medication trying to figure out what helps more than it hurts. When we put my daughter on Concerta, her academics improved dramatically but her anger/lashing out also increased. Few easy answers I'm afraid.

Take care,
Scattered

Thanks for the info!

I was told that there is a percentage of children that have that kind of reaction to stimulants. I'm a speech-pathologist... I had my suspicions very early on that he was ADHD (my husband had a harder time, I don't think he was totally convinced til he saw our younger boys getting older and how different they were compared to our oldest son). I definitely never saw bipolar symptoms in him... unless you would consider hyperactivity manic, but he never had any lows. He was always a very happy child. He does have some lows now, I think due to the meds, but very seldomly. It's amazing now that we have the hyperactivity under control, I would definitely say he's ADD. He will actually tell me that he can't help daydreaming. He just spaces off, even when, for example, his taekwondo teacher is talking right in front of him... he's staring out the window.

But the most frustrating part is that he can play his gameboy for hours on end without ever being distracted!!! Grrrr.... But I understand that that is a hallmark of the disorder, they can really focus on one thing when they want to.

Do you find intensity to be a problem? The way I would describe my son is "intense to the nth degree"...if we go to the library and he's into pirates that week, he'll check out every book there on pirates, and won't even entertain the thought of anything else. He can be that way with friends, overpowering, wanting to spend every minute with them... He hasn't touched his gameboy in 6 months, but last week he decided to getback into it. I have to limit him to one hour, because he would literally play all day on it. Self control, self moderation, in anything, is difficult for him.

Up for 38 hours! Wow. That does not sound so good. So, is he on Prozac now? Good luck and I think it is good that you keep trying different meds. All you need is one good one.

Thanks for the info!

I was told that there is a percentage of children that have that kind of reaction to stimulants. I'm a speech-pathologist... I had my suspicions very early on that he was ADHD (my husband had a harder time, I don't think he was totally convinced til he saw our younger boys getting older and how different they were compared to our oldest son). I definitely never saw bipolar symptoms in him... unless you would consider hyperactivity manic, but he never had any lows. He was always a very happy child. He does have some lows now, I think due to the meds, but very seldomly. It's amazing now that we have the hyperactivity under control, I would definitely say he's ADD. He will actually tell me that he can't help daydreaming. He just spaces off, even when, for example, his taekwondo teacher is talking right in front of him... he's staring out the window. That definately does sound very ADD.:) John Ratey says in one of his books (I think it may have been Answers to Distraction) that some folks do well on extremely small doses of medication -- that they have a systems that reacts very dramatically to stimulents and most other meds too. And like you said there are 30 % or so that don't respond well to the current medications.

But the most frustrating part is that he can play his gameboy for hours on end without ever being distracted!!! Grrrr.... But I understand that that is a hallmark of the disorder, they can really focus on one thing when they want to. Yeah -- par for the course!:p Try not to begrudge that hyperfocus ability too much -- By the time I flailed along and got in high school and college and was able to pick more interesting classes, that hyperfocus ability helped me really excel instead of holding up the bottom of the bottom of the bell curve. The trick here is helping him find his passion and then going for it!

Do you find intensity to be a problem? The way I would describe my son is "intense to the nth degree"...if we go to the library and he's into pirates that week, he'll check out every book there on pirates, and won't even entertain the thought of anything else. He can be that way with friends, overpowering, wanting to spend every minute with them... He hasn't touched his gameboy in 6 months, but last week he decided to getback into it. I have to limit him to one hour, because he would literally play all day on it. Self control, self moderation, in anything, is difficult for him.I don't find it a problem -- but my family certainly did!:D Asked to described me in one word my mom said, "INTENSE!" I think a lot of ADDers (and my psychologist who specializes in treating ADD confirms this) have a bit of OCD in the package and once they're hooked on something they're really hook on good andhave difficulty letting go. Tom Brown describes is as a trouble with the gear shifting. They not only have trouble getting started, but of stopping and shifting gears when needed. My daughter is also very intense -- there are no small deals either positive or negative. Samuel Goldstein discusses how when ADD kids get happy they get so happy they're told to, "Calm down!" When they're upset, they get so upset that they are again told to, "Calm down!" Tom Brown in his book Attention Deficit Disorder the Unfocused Mind in Children and Adults does a great job of explaining the emotional dysregulation that is part and parcel of most ADDers standard package.

Hang in there!
Scattered

Not that I'm a child, but I took Adderall and Prozac for 6 years and didn't have any issues.

In fact, Prozac was the least difficult to deal with as far as the 10 different antidepressants I have taken over the years. In other words, Prozac had the least amount of uncomfortable side effects for me.

However, a friend of mine couldn't take Prozac at all! So, everyone is different when it comes to how antidepressants will effect them.

Therefore, it's important not to rule out all antidepressants just because one antidepressant produced some bad side effects! Almost all antidepressants are safe for adults and children, and probably even more safer than taking a stimulant!

Peace :)

Seek - Well, the only reason he started the antidepressant was with the hope that it would raise his seratonin levels and combat the negative effects of the stimulant. Since that didn't work, there's no need for him to be on the anitdepressant.

Scattered - It's good to know that he's not the only one! You know, up til now I haven't even told his school that he has it. Partly, because I didn't want him labeled. There seems to still be such a negative connotation with it. I guess if I could teach them that this is a neurobiological disorder and not a behavioral problem I would feel better about it, but I think the behavioral description gets the most popular vote. But the bigger reason I haven't said anything (even though they know something is not quite 'right') is that I don't want things made 'easier' for him. I don't want shortened spelling lists, more time...etc. I know it sounds really mean coming from his own mother, but what worries me is who is going to do that for him when he's 18??? What college professor is going to do that? What boss if going to say "Oh, it's okay you just do 50% of what every one else is doing." You know what I mean? I'm hard on him, but only because I love him and I want him to succeed. I was hoping that we would get meds figured out and have him on a good path without having to say anything. But this stumbling block of not being able to take a stimulant has really put a monkey-wrench in my theory. I'm contemplating just going to his teacher right off the bat this year and saying "he needs to sit in the front of the room, away from distractions"..etc. Surprisingly he's been holding his own academically. He's smart. But I know as more and more responsibility gets placed on his own shoulders the worse it is going to get. Tests won't be a problem especially the computerized ones (there's no chance of him skipping problems or going out of order on computerized tests!--he has a tendency to skip around instead of going in order on paper, I've actually seen the kid do math problems were he will add the first column of every problem then go back and do the second column..., which is fine if he actually remembers to get back to all of them!)... getting assignments done and handed in when and where they are supposed to, is going to kill him!

I saw a good book in ADDitude magazine called "Learning to Slow Down and Pay Attention". Have you heard of it? It's geared towards 9-12 year olds. Lots of checklists for them to evaluate themselves. I think I may get it for him...

Krista

Is your son going into 3rd or 4th grade? In California, 4th grade is a real step up from 3rd. Lots more homework, etc.

As far as reducing the amount of problem on homework. By the time they are in high school that will not be feasible, but for early elementary it should not be a problem. You are making a trade-off, by reducing the number of problems, you are reducing the frustration level associated with doing homework. In addition, most ADHD kids can learn the stuff without doing all of the problems, they tend to catch on quickly, so it is the tediousness of doing the additional problems that is so frustrating. Their brains get it, so why keep doing the problems. By reducing the number of homework problems for my child, her test scores went up, not down.

OTOH, it is very difficult to reduce the number of spelling words. For that we often do the work verbally, which is much easier than writing the problems down.

My 02.

I saw a good book in ADDitude magazine called "Learning to Slow Down and Pay Attention". Have you heard of it? It's geared towards 9-12 year olds. Lots of checklists for them to evaluate themselves. I think I may get it for him...

KristaI haven't read it but I'll look for it -- sounds like a good one! Thanks!:)

My parents opted to not medicate me as a child -- fortunately I was bright and they were very consistent and patient with me. Some thing that helped me do well academically and in handling responsibilities are as follows:

*Music -- I was heavily involved in piano lesson, band, and played guitar (I think it helped develop my brain -- John Ratey discusses in A Users Guide to the Brain the ways music helps other types of learning and it gave me something to feel good about which developed confidence and helped me develop a peer group with similar interests).

*Exercise -- I started exercising three of more times a day -- Hallowell and Ratey in Delivered from Distraction discuss how that naturally increases the levels of dopamine and serotonin in the brain acting like holistic doses of Prozac and Ritalin. The key is that is has to be vigorous and more than one time a day. The effect can last up to four hours or so in increasing concentration, etc. It also helps keep depression and anxiety at bay.

*Diet -- I know some studies indicate that this isn't a biggy but I know that when I quit eating sugar and refined foods on my own in eighth grade my grades made a significant leap. The book The ADD Nutrition Solution has some interesting information that I found useful.

*Scaffolding -- Tom Brown in Attention Deficit Disorder: The Unfocused Mind of Children and Adults discusses how parent can provide scaffolding to help make up for the organizational, time, and other ADD deficits allowing the ADDer to thrive.

*Spiritual Connections -- for me being actively involved in a faith based community not only helped my focus and emotional anchoring but allowed me to make connections to others and a provided an outlet where I could be useful that proved invaluable. Samuel Goldstein wrote in an article that this type of connection of one of the things shown to help promote resillience in children. He has a great book out called How to Raise Resillient Children.

Please understand that I'm not suggesting any of these things are a cure (or the lack of them the cause) of ADHD. But attending to them may help move a ADDer to the more functional place on the ADD spectrum. Since stimulent medication has proved problematic for your son, I thought I'd pass these things along.

Take care!

Scattered

MGDAD- I'll keep that in mind. I definitely can see that though, he often 'gets it' but can't stand the repetition. However, that doesn't work when it comes to writing. He has to do compositional writing and you can't cut corners on that.

He goes to a small, Catholic school. It's kindergarten to 8th grade, about 360 kids. He's going into 3rd grade. It does seem that the academics are a bit ahead of the public schools (he's been doing power point presentations, report writing, detailed science experiments...since 1st grade). In some ways this is good but it can be more strenuous. But we like that he's in a very loving atmosphere and it being a small school, it is not so overwhelming.

I think we hit most of those categories for helping him. He is in a chancel choir (think Vienna Boy's choir) where the music is difficult (he's had to learn Latin and complicated music forms). It's an old church tradition where they earn vespers. I love that it is all male (boys combined with men's choir) and the director is a well educated music professor at the university here. He's also very 'in your face', very strict. But the boys love him. They make it fun too... 3 hour practice, but they get to play dodgeball, have snacks. They get paid $5 every other week! They go to fun places paid for too... (it's run out of a trust fund--pretty remarkable program.) It's the perfect combination of music discipline and fun. My husband and I both sing in our church choir and have sung since high school, so I am also a big believer in music. I'm in the process of buying a piano as well. My son has shown great interest in that. I learned to play on an organ, but have always wanted a piano.

He's also an avid soccer player, as is my husband. We worship the soccer gods during soccer seasons! :) And I don't worry too much about exercise. He doesn't usually stop moving! I've seen him do 'core training' in our backyard just for fun! (2 laps around the house--we live on an acre, a trip across the monkey bars, 20 skips of jumprope, a little bit of handwieghts--then he gets some water and starts again!) He just started taekwondo. His younger brother has been doing it for over a year and I am amazed at his development with it. It is wonderful for memory skills, self control, balance, and discipline.

Diet- I try to watch sugar with him, but probably could do a better job. Although he would complain!

I am not familiar with scaffolding though, what is that??

Krista

I am not familiar with scaffolding though, what is that??

KristaSounds like you guys are doing an awesome job! I know parenting an ADDer isn't easy (my mom often reminds me of that!;) ). Tom Brown refers to scaffolding in his book Attention Deficit Disorder the Unfocused Mind in Children and Adults -- my guess is that you all are already applying it. It refers to the structure and support parents provide to enable their kids to succeed.

Remember that ADD is developmental and I've read that the preschool years are typically hardest. ADDers lag about 30% developmentally in some areas behind non ADDers according to Russell Barkley in Taking Charge of ADHD. So with a 8 year old you're looking at someone closer to 6 years old developmentally. I know my eight year old does great playing with 5 and 6 year olds. It can be helpful to adjust expectations accordingly.

Scattered