Friday, May 29, 2015

Medications for Anxiety, Depression, and OCD in Children and Teens.

     Many of our patients suffer from issues with anxiety, depression, and obsessive-compulsive disorder. These conditions may respond to time and counseling, but if the symptoms are routinely interfering with everyday life, we will often discuss further treatment with medications. The medications used are the same medications that are used with adults, the dose is just adjusted. Despite these all being different conditions and diagnoses, the medications used are the same. These medications work on the neurotransmitters (brain chemicals) to help balance how they affect our emotions.


Types of and Commonly Used Medications:

Name                                 Usual Dose           Dosing Forms                Usually Given   
SSRIs or selective serotonin reuptake inhibitors

Prozac® (fluoxetine)       10-40mg               Capsule, tablet, liquid    In morning        
Side effects: Brief nausea when starting.

Zoloft® (sertraline)          25-100mg            Tablet, liquid                   In morning       
Side effects: Brief nausea when starting.

Celexa® (citalopram)      10-40mg              Tablet, liquid                   In morning      
Side effects: Brief nausea when starting.

Dopamine-Reuptake Blockers
Wellbutrin (bupropion)   150-450mg          Tablet                             In morning        
Side effects: Not likely to cause stomach upset or weight gain. 


Serotonin/Norepinephrine Reuptake Inhibitors
Effexor® (venlafaxine)  37.5-150mg         Tablet                                In morning       
Side effects: Brief nausea when starting. If causing drowsiness, take in the evening. 

Tricyclic Antidepressants
Elavil® (amitriptyline)     25-100mg            Tablet                             At bedtime       
Side effects: Likely to cause side effects -- weight gain, constipation, dry mouth, urinary
retention, blurry vision, drowsiness, and dizziness.

      For those medications that can cause some nausea and stomach upset once the medication is started, these symptoms usually improve significantly over the next 2-4 weeks. Making sure the medication is taken with food helps. As with any of the above medications, if your child is taking the medication each morning and is drowsy during the day, switch to taking the medication in the evening. In fact, for those children who are anxious or depressed who struggle with falling asleep, taking the medication in the evening may very well help with falling asleep.

     Just as with other medications, it is often hard to tell what the right medication is for any individual. If someone in the family has taken one of these and had a good or bad experience with it, that can be helpful. We often start with one of the SSRIs then try something else if that medication is not helping. There are children and teens who will benefit from seeing a psychiatrist to manage and prescribe their medication. This is especially true if we are unsure of the diagnosis, if there may be another diagnosis (such as bipolar disorder), we are having issues finding the right medication for that person, or the symptoms are more severe. We have a list on our website at

     Symptoms of anxiety or OCD tend to respond to the medication within just a week or two. Depression symptoms often take longer to respond, often 3-6 weeks. If we change doses, it may take less time to notice a difference. If we change medications, it will likely take this long to notice a difference.

     None of the above medications require any type of monitoring lab work. Although there are anti-depressants that require blood work to be checked, these above medications do not. Many children and adults take one of these medications for years. We have every reason to believe this is safe.

     If a medication is stopped, we recommend weaning off the medicine instead of stopping it suddenly. Stopping it without weaning can cause a very rocky emotional stretch and we want to avoid this from happening. Many times, we will have someone take half of their normal dose once daily for a week than half of their normal dose every other day for the following week before stopping. We will discuss with you if you will need to wean off a medication. This is most important when going from one group of medications to another (such as SSRI to dopamine-reuptake blocker).

     For children with depression, it is important to talk about suicide risk. Over the last 20 years, there has been much discussion of this issue. Children and adults with depression are certainly and sadly at risk for suicidal thoughts, suicidal attempts, and suicide. Some very depressed persons are so down and sad that they are not taking care of daily living activities – sleeping, eating, showering and hygiene, etc. When they start an anti-depressant, they often will have “activation” or more energy and desire to take care of these issues. This often happens more quickly than the help from the medication with the sadness and depression. If someone has been thinking of suicide and has been so down without the help of the medication that they have not acted on it, sometimes that “activation” of their “get up and go” to do something happens before they feel better. That would mean they may attempt or commit suicide. So the medicine did not cause the suicide or suicide attempt, but it had not helped yet with how sad and desperate they feel. This all emphasizes that it is important to ask the tough questions: Are you thinking of hurting yourself? If so, do you have a plan to do it? Someone with a specific plan to hurt themselves or others needs more evaluation and often hospitalization for further help. Note: it has not been shown to increase suicide risk by asking someone about it.

     A “no one’s favorite topic” is the SSRIs and sexual side effects. It is unfair for teenagers to not hear about the potential side effects, as almost half of the people taking SSRIs experience these side effects. Because these things are difficult to discuss with the doctor, many patients will simply stop taking the medication to avoid these side effects. These side effects can be discussed in the office. If they do occur and are bothersome, discussing a change in medication is appropriate.











Tuesday, May 5, 2015

Listeria, ice cream, and your health.

          Listeria is a bacteria that can enter our system through contaminated food. There are about 1600 cases per year of illness from Listeria each year in the US. Nine out of 10 people who become ill with the bacteria will be pregnant women, their newborns, persons older than 65 years of age, or adults with weakened immune systems. Most infected people will require in-hospital care and about 1 in 5 persons with the illness will die due to Listeria infection.
     For adults with a Listeria infection, the symptoms often are fever, muscle aches, and diarrhea. Sepsis (a life-threatening whole-body inflammation due to an infection with fever and lethargy) and meningitis (infection of the lining over the brain and spinal cord with a fever, miserable headache, stiff neck, and lethargy) are how older adults, adults with a weakened immune system, and newborns present with Listeria infection.
     Listeria has been in the Central Ohio news recently due to the issues Jeni's Ice Cream, where the company found that the Dark Chocolate ice cream was contaminated with Listeria. Here is Jeni's Ice Cream recall statement. I applaud Jeni's for being so responsible about this issue! I like them even more now.
     So the chances of any of our patients becoming ill with Listeria is quite low. And if you presented to the emergency department with fever, stiff neck, and lethargy, the doctors would find the Listeria while testing for other bacteria also. As a matter of fact, those symptoms would likely be caused by some other bacteria.