View Full Version : Increased meltdowns, meds related??


JenE
09-04-09, 10:44 PM
My 7yo is taking 40mg Strattera (for about a month, started at 10 and worked up to 40mg so he's been on it about 1.5 months now) and Lexapro. We started the Lexapro in July at 10 and went up to 15mg about 2wks ago. We saw improvement in depression and anxiety the first month with the Lexapro but it didn't totally go away and we saw no added improvement the 2nd month so we upped it to 15mg about 2 wks ago because school was starting and he has major anxiety about school.

School was up and down the first week. Great first day, horrible 2nd and 3rd as he was so anxious he couldn't separate from me and had horrible meltdowns. They sent him home one day and I made them keep him the next. Day 4 was fine and he's had a great week with dropoffs all this week. I do have to get him there just before the bell so he is the 1st one in the class or he freaks out.

Anywho, even tho he's been doing great getting to school and during the day, he's been having meltdowns again in the evenings this week. These can be horrible and he'd not had any in the last month or so. He has had a meltdown of varying degrees almost every day this week. The worst was today at the afterschool program. They were having a relay race and his sister won and he went crazy!! He was screaming, throwing chairs, hitting the counselor and running away. It took me probably 15 minutes to calm him once I got there. He and his sister are having some issues getting along right now and he was screaming that he hated her and that he didn't want to live with her anymore. I've never heard him say anything like this before. The aggressive behaviour isn't new but the feelings he expressed are.

So any ideas? Is it ADHD meds dosage or type? Too much Lexapro? We weren't seeing these meltdowns at the lower dose and I know kids can go the opposite direction with these meds. It was after office hours when this happened and it's a holiday wknd so I'm hard pressed to get advice from the doctor until Tues. I decided on my own to drop his Lexapro back to 10mg starting tonight. Does he need something else to help with the control? Risperadol, Abilify? I don't know these drugs but friends have mentioned them to help him control himself.

It's so frustrating and heartbreaking! And we are dealing with our own emotions. I admit I was embarrassed by his behaviour and even felt angry at him. Sorry so long, I just don't know what to do.

Logic
09-05-09, 06:48 AM
Your post caught my attention, in particular the line that read: "he was screaming that he hated her and that he didn't want to live with her anymore"
I yelled that when I was a little boy too, on several occasions and not just at my sister, I yelled it at my parents too.
However, even as I screamed it at the top of my lungs, my face turning red with anger; I did not mean it. I was just too frustrated and worked up to actually articulate what I really wanted to say, and instead resorted to shouting the most hurtful thing I could think of (which is 'I hate you' when you're that little) which guaranteed a response or at least a shocked look on somebody's face.

Unfortunately, my parents were the obliging type and after about six months of constant fighting, destruction, dangerous impulses, total lack of common sense and violence, they sent me to live at a residential school.
I ran away from there too shouting that I hated it and everyone in it.
After being picked up by the police (after being reported missing from the school) I was deemed 'behaviourally unstable' and sent to a secure school for 'children with behaviour disorders' (think of juvenile prison and you're not far off).

I did not intend for this to happen, and looking back it was a result of my poor communication skills to begin with. If I had been able to say "Scott (an older brother) hung me out of the window by my belt and now I'm angry with him" instead of just getting incredibly frustrated and angry before screaming "I hate Scott" and then "I hate you!" when I was shouted at for yelling at him...

On the subject on medication though, I was switched from Dex onto Methylphenidate, which had more desireable results with regard to my behaviour. Meltdowns still did occasionally take place though, and unfortunately I still suffer the complete and total loss of control which results in a meltdown (I'm 26).

The only other thing I can think that perhaps sets me apart from your son is I was branded 'aggressive' and 'violent' from birth... I was born an XYY Male (google 'criminal syndrome' and see what I've been up against since I could remember). I am 'supposed' to be more aggressive, violent, bigger, stronger, have poor social and communication skills and have wound up in prison by the time I was a teenager... so I guess my 'outbursts' were tolerated more as they were chalked up to that as well as having an ADHD diagnosis on top of that.

Perhaps this was not the definitive answer you were looking for, but it is my own personal take on something that sounds incredibly like the situation you describe. Although, I can probably guess that you're not as intolerant as my parents (the very fact you're out there seeking alternatives and ideas tells me that), but I guess my example shows how quickly it can go wrong when the wrong approach is used.

I hope that you find a strategy that helps both you and your son get through this.

Logic

Trooper Keith
09-05-09, 09:17 AM
While the medication change may have something to do with it, it's also entirely possible that the problem is with adjusting to school and the changes that come with that. Kids under stress tend to meltdown because they can't adequately express their frustrations, insecurities, and anxieties.

Vickie
09-05-09, 11:58 AM
The med thing can be hard and I hope you and the doc can get that situation taylored to best help you son. We went through similar issues with my youngest daugter and maybe you will recognize things in this story that might help in your situation.

My youngest used to suffer from anxiety and would have violent outbursts when she was 8. With diagnosis and treatment things got better. Finding the right med combo can be tough. She was on a stimulant for the ADHD and Guanfacine helped with anxiety. She was on risperdal for a period when the anxiety was really bad.

Part of her anxiety with school was the usual difficulty with classwork but was compounded during 4th and 5th grade with insensitive teachers and difficult social interactions. THe special ed teacher was wonderful and would allow her to spend lunch in the classroom helping out, or set her up to help the kindegardeners with thier lunches. My youngest is very patient with younger children and could interact better with them than with children her own age.

Through this time, we would coach her on better ways to express her anger. She would mostly melt down at home so we made her room the "safe" place for her to be angry and stay until she could calm down and we could address the problem when she was ready. We would then praise her for getting control of the anger and discussing the problem. With time, the outbursts lessened in frequency and intensity and now (4 years later) she is no longer on any meds for anxiety and expresses anger in appropirate ways. I was terrified for her when all of this was affecting her so badly, but am please to see her maturing so nicely.

JenE
09-06-09, 12:56 AM
Thanks for all the replies! I not necesarilly concerned that he said he hated his sister. I realize he was mad and not able to express his feelings well. But he just seemed so irrational and that was a new thing. We started having issues near the end of the school year last year. He had gotten sick (reflux) right when he got on the bus for aftercare and freaked out. He still won't ride a bus. That lead to school avoidance and horrible meltdowns when we tried to drop him off. We somehow worked through that probably only because we were so close to the end of the year but he probably missed two weeks of school because of it. We tried Tenex but it zoned him out so badly that we switched to Lexapro. I think what concerns me most is that the meltdowns had improved but seem to be worse since increasing the lexapro dose. He's just not in as good a mood, more irritable, whiney and volatile. The lexapro dose is the only thing that has changed outside of school starting. And it could be school too. But he'd had such a great week at school that this outburst on Friday was so unexpected. He still has a lot of anxiety. We had two meltdowns the first week of school--one he was sent home for and the other, I told the school he had to stay. He has social anxiety and walking into a class full of kids overwhelms him. The second week, i started walking him to class just before the bell so he is the first one there and he did great all week.

Again, I seem to be rambling, sorry. Just so much on my mind. We're really new at this and grasping for anything to help our son.

Thanks again for listening!

MGDAD
09-08-09, 03:49 PM
Those rages are probably a sign of something else. How about other issues with your son. Sleep problems? Food issues? Is he skinny or overweight?

My daughter has similar rages like your son. She is just so easily overwhelmed by her emotions, she just explodes. It can be over nothing, but I can also forsee certain situations that make it happen more often. While it is normal for a child to be upset over loosing a race the level of rage your son showed is not normal. My daughter does that all the time.

While the lexipro helps with anxiety it also can allow thes problem behaviors to come out more, because he is less anxious. Although people argue about what is worse, anxiety or the behaviors.

Abilify and Respirdal can help lessen the rages. Vyvase can make the rages worse. For my daughter, no amount of calming helps her calm down. It is simply time. It takes about 20-30mins for her to calm down once she has become enraged.

Good luck and talk to your doctor.

JenE
09-11-09, 12:58 PM
Thanks for the reply. As for other issues, his sleep is fine. He goes to sleep easy but IS hard to wake up in the mornings. He is more tired on the medications, for sure. He doesn't eat that well but he never has so that is not that new. He is about 60% on weight and 75% on height. He has a lot of anxiety--crowded rooms, buses, new places/people. He used to play hockey and loved it but halfway through the season last year, he refused to play anymore. I think it may have been moving him to the next level. It was the first time he had to pay attention to positions and such and they had him in a position he didn't want to play. He wasn't medicated at that time and we wonder if it was too much for his brain to process.

The rages could well be due to something else. He's always had them but when he was younger, we chalked it up to just extreme tantrums. He is like your daughter, once he gets going, he pretty much has to rage it out and then he's exhausted. But he does have some knowledge of what he is doing but I'm not sure he can always make the "right choice". I agree, the improvement in anxiety may allow him to act out more.

I don't know. we did drop his lexapro back to 10mgs and he seems to be doing better. I did it on my on that same day and the dr confirmed it on Tuesday. We are going to go on like this until our next appt on 9/21 and then discuss any needed changes. it is really frustrating trying to find the right combos!!

MGDAD
09-11-09, 04:26 PM
One thing about the lexipro, dont just stop it cold turkey. There are side affects if you do that. You need to taper it off. Talk to your doctor if you decide to quit the Lexipro.

Good luck with everything.

JenE
09-11-09, 10:54 PM
Yes, thanks MGDAD. I don't want to drop the lexapro because he has major anxiety that the lexapro has helped but not erradicated. We had raised the dose to 15 to see if we could knock some more of the anxiety down but it didn't seem to help and may have made some things worse. So we fell back to the 10mg dose which he seemed to tolerate better.

I have more info on his "rages". The big one from last week happened at afterschool care when his sister won a relay race and he lost. When I picked him up today, they said he did fine and had a good afternoon but when I asked him about his day....... he had lost a "challenge" which would be like a race. This wasn't against his sister but another child. He said he got a little upset and when he went to get his shoes, the counselor put him in timeout. Now, i really don't know what really happened without talking to the counselor. My son said he got upset and cried about going to timeout because the counselor didn't understand. He was getting upset and crying while telling me about it. I told him I was proud that he kept his control and didn't meltdown.

Now this is what concerns me. He said he would have melted down if he hadn't been able to think. He said his "brain was turned on" and he was able to think today but it was hard. He also said they were competing for tickets which he didn't care about but if it had been for candy he would have gotten upset like before because that was more important to him. I tried to talk to him about the meltdowns been unacceptable but he was shutting down on me.

I'm really concerned about these behaviours. We have seen them at home over not getting what he wanted but never outside of the home except for the meltdowns over separation at school. We thought the school issues were related to anxiety and since we've been dropping him off early so no one else in the classroom, he's not have any problems going to school. But I worry every day that he'll lose it at afterschool for some reason or another. I quizzed my daughter and she said there were no issues all week until today--same thing last week. On Friday, they don't have homework to do so they do more games and that seems to be a problem. He also apparently kicked her and told her he hated her this afternoon.

I know this is long but I'm just so concerned. My friend's son takes abilify to help tame these aggressive impulses. Another's daughter takes risperdal. Is that something we should consider with the doctor? I will be talking with them on Monday b/c I am really concerned.

MGDAD
09-12-09, 10:59 AM
Of course talk to his doctor. I dont know if I would add a strong medication like Abilify or Respirdal for something like that. Those are really serious meds. For my child I decided to do it because in her rages she would talk about suicide. If we were near a busy street she would threaten to jump in front of a car. Thus it was really a safety thing for me. Those meds are not even approved for kids. Although I think Abilify is approved for certain autism symptoms in kids.

JenE
09-12-09, 05:26 PM
Thanks for the input! I understand what you are saying about the meds. I do have a friend who's 9yo is on abilify. will definitely be talking to his doctor. I don't want to sound like I just want to keep giving him meds because I'd prefer he not take anything but I understand that may not be possible. I'm just grasping at straws trying to get my little guy back.