Anxiety: adjusting medication, expectations, and providing support

Parent Cafe
1

Sorry this is long. I’ve mentioned our struggles with anxiety, but hadn’t gone into any detail before.

We are trying to help my D. This is very hard. We’re all feeling fragile. I guess I’d like some moral support, as well as input on how to deal with everything. Please don’t tell me to take her off the medicine. That was a very difficult decision, and I very much hope that she can stop taking them at some point…

My D has been struggling with anxiety for a while now. It hit crisis mode in the middle of her sophomore yr of HS, She is a senior in HS now…the home stretch. In retrospect I can see signs that anxiety has been an issue further back than that.

Sophomore year she had what we assume was a panic attack, and began having a lot of physical symptoms related to the anxiety. We did quite a bit of medical testing, counseling, more exercise, diet…, but after months (about a year) she decided she wanted to try medication and we finally agreed.

She started on a low dose of Sertraline (Zoloft) during her junior year, and though the dose was low, it made such a difference! She stopped missing school, and was able to fully participate again. (All along, we worked with teachers, and she was able to maintain her grades and stay caught up, and made some changes to her classes.) At one point things got a little rough again, and the medicine was bumped up slightly, still a very low dose, and things improved again, and had been much better for several months.

Along the way she has continued counseling (once a month…trying to increase that) and has very much dialed back her perfectionist tendencies, and has been learning more about when to push herself and when to give herself a break. But that can be trial and error. Around Christmastime this past year (a few weeks ago), she had an event she knew was going to be challenging to get through…sort of a perfect storm of things to deal with, but she really wanted to try, and she ended up having a bad panic attack.

This affected her more than she wanted to admit. The panic attack made her realize that this could still happen, that she wasn’t ‘over it’…though she already knew that, this made it hit home…and comes at a time when college applications and acceptances are a big focus. She’s gotten an acceptance and positive feedback from a couple dream schools, but this is tempering her excitement with worry about not being able to go, adding to the anxiety.

Now she has been missing school again, and feels awful when she is confronted with the prospect of sitting through her classes.(There are other things that bother her…anytime she feels ‘trapped’ in a situation, but the commitment / constant responsibility to school seems to be the big thing) She has been so strong and brave through this, and she is so excited about college, etc It is so hard to see this holding her back. =((

Now her medicine has been bumped up again, but so far has not made the difference we’d hoped for. We kept expecting the meds to kick in like they did before, so I didn’t worry too much about missing a couple days, but a couple became a few., became too many…I am going to contact her school tomorrow to see what options we may have.

(We are told the dose of Sertraline is usually 50-200 mg. She started on 50, then up to 60 a while ago. Since the recent panic attack, it was briefly up to 70, now up to 80 for the past week or so…using liquid… so easily adjusted)

The Dr had told us that the idea was to do the meds for about a year or so, to give her time to “reset” then ease her off. But we also know that many people stay on the medication for years. Of course we hope that won’t be the case, but that is one reason we hesitate to just bump the medicine up more. If she does that each time she struggles again, what happens if she reaches the upper dosages and cannot take more? How do we know when she should increase it and not wait and try to work through a set back? We see how these set backs can spiral, but also wonder if she needs to find ways to work though them…before increasing the meds.

We have learned that when the medicine was working, and she was feeling so much better, she wasn’t quite as ‘fine’ as we thought…She was markedly improved, but says there was still anxiety she dealt with. She just didn’t consider it a problem. I am realizing now that we didn’t take advantage of the time when she was feeling better to get more things in place, routine exercise (but getting a reluctant teen to exercise,…well…that’s another challenge!)

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Will send you a PM. Hang in there.

3

More regular counseling (is it evidence-based counseling like CBT?) is probably a good idea if possible. I find it tough to believe that a lot of progress can happen from once a month visits. CBT really focuses on developing skills to manage anxiety/mood/etc which can be really helpful in the long run.

I do think that if her pdoc thinks that increasing the dosage is a good idea, then do it. The idea of having her work through things is not bad in theory, but if her anxiety is so bad that she can’t get to school, then she probably just doesn’t have the mental energy or reserves to face the issues head on. Ideally, she should be working on building skills in counseling while her medication is working, so that she has built up and practiced those skills by the next time things get rough.

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Perhaps there’s another medication that can be added to what she is taking already. Talk to the doc.

And there is absolutely, positively nothing wrong with continuing to take meds for a long time-- even for a lifetime.

Best of luck to your daughter.

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Some of these meds lose their effectiveness after a period using them. Ask about switching.

6

OP - it is really hard to see your sweet D struggle. Hugs to you. You sound like a loving parent doing the best you can for her. Be sure to take care of yourself as well. Best to you all.

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Is your daughter seeing a psychiatrist? A primary care doc may not have the skill to adjust her meds optimally. There are other anti anxiety agents that may work better for her.
You are displaying an ambivalence about her medication that is common, but hard to understand. If she had a heart condition impairing her functioning, would you hesitate to have her cardiologist maintain/adjust her heart medicine? She has a biochemical neurotransmitter imbalance that is causing her illness and pain, and needs treatment.
Lastly, I second the Cognitive behavioral therapy recommendation due to its proven effectiveness with this type of symptomatology.
Wishing you and your daughter the best.

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Hang in there! I do think more counseling (with someone your D can relate to) would be helpful. She’d hopefully learn to manage her symptoms. Lots of people do. The regular exercise, good diet are extremely helpful in a condition such as your D’s. I hope she gives it a try. The patient really has to take an active role in their wellness. You can’t “make” her exercise–she needs to learn for herself to take control.

The meds can work really well but as you’re discovering the effect they have can level out at some point. She hasn’t reached really high levels of meds yet–it’s good you have a more cautious physician. Talk with him about adding an anti-anxiety agent to the protocol to be used in high stress situations. I don’t know if that would work for your D but ask him. Another problem is if at higher doses your D experiences side effects but your not there yet.
If at some point your D doesn’t want to take the meds they must be titrated back down–don’t ever just stop taking them cold turkey.
Taking meds for years does not mean she will be taking them forever–it is quite common for people to get off them as they learn other coping strategies.

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“Lastly, I second the Cognitive behavioral therapy recommendation due to its proven effectiveness with this type of symptomatology.”

I third this. Find a good psychologist, preferably experienced working with teens and young adults.

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Hugs to you. My dd had a similar path, and a medication change made a world of difference. She is thriving in college, and has found her niche, and is doing better than we could have dreamed of. There is no shame in staying on medication - our brains get used to one set of chemicals over a long period, and there isn’t a magic fix, or a universal one. A support group for your daughter might help her feel less alone. There are many online resources, which are free and non-threatening. This is a tough time, and it feels awful to watch your child suffer, but you will get through this and be stronger for it.

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Thank you all for your input. I had hesitated to put this out there too much, but felt I needed to reach out for support. Thank you.

She does have a psychiatrist (pediatric specialist) that is handling the medication, and the psychologist she sees has assured me that it is CBT that she works with and is experienced with, with teens…both work out of the same well-regarded practice. I talked to the office today and they said if she doesn’t feel some improvement in the next week or so, so come in to talk about the meds. (that will be when she is at this latest dosage for nearly 3 weeks).

I have also put in a request that the psychologist see her more often, but it is really a matter of getting appts. I think we will be able to work out every 2 weeks, but I have requested aiming for weekly. She did try a couple other psychologists/counselors before, but seems to be most comfortable with this one.

Another issue is that she is aging out of the practice (pediatrics and teens), so by the end of the summer (coinciding with the start of college) she’ll need to find new dr’s…but a step at a time right now.

I talked with admin at the school. They are trying to be flexible and work with her as much as they can, but are somewhat limited (no homebound option…) because of the program she is in. We are going to try to have a meeting with all the teachers to be sure we are on the same page, and see what is possible.

When she isn’t feeling well…I just want her better NOW. Talking it out a bit and hearing other stories does seem to help me step back and gain some perspective. It is appreciated.

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@Sakacar3, Thank you so much for sharing that hopeful story. Sometimes I just need that…and to be able to share those with my D.
Can you tell me any more about the online resources you mentioned? I checked into the NAMI website and discussion groups, but there were only a couple posts in the anxiety section, so apparently it isn’t very active.
If you have any input or advice on what to look at when choosing a college, or how to approach them…anything along those lines, I would welcome it.

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My younger than your daughter also has anxiety and perfectionist tendencies and we are relatively new to the process. The therapist told us that often much higher doses of zoloft are better for perfectionism and the lower doses for depression. Her take (I don’t know if this is common knowledge or not) is that the perfectionism type where the student has to do things to their OWN standards (“until it feels right”) is in the OCD spectrum.

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In my experience, there’s a limit to what psych meds can do and it varies a lot on the person and the med. One SSRI might work great for one person, while another does nothing, while another has horrible side effects and you can only tell which is which by trial and error. As someone who has dealt with anxiety, I’ve never found a med that could just make me feel better. For me, CBT worked much better (and monthly would not have been often enough). Even Benzos - I think I still have half of an old prescription left of Ativan because all it does for me is make me sleepy. I’m not saying that medication is a bad idea, but I think you need to approach it knowing that you’re taking a bit of a chance on whether or not it will be effective, and if it’s not, it’s worth trying others that seem similar. For some people even generic vs brand name makes a difference. And if she has meds that work, I’m seconding the point that there is nothing wrong with being on them for the rest of her life if that’s what it takes.

Is her counselor available for emergency appointments? Most therapists will take a phone call and maybe schedule something if there’s an emergency, and in a case like this, I think that could be helpful in terms of setting small goals, figuring out what it would take to get into school, etc - so you don’t have her seeing the therapist after she’s missed three weeks of school.

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Helpguide dot org has some great articles on panic attacks which may be useful to you.
Since one of things that helps many people is learning to control their breathing, yoga may be a great help to her.
But really look into the congnitive behavior therapy on a more frequent basis.

I totally understand you wanting her to be better NOW! But look forward to the future, You admit with that wonderfully in focus 20-20 hindsight that it’s been developing for longer than you knew. And it will probably take time to get it controlled. But that does NOT mean that your D sits in a box and waits for it all to resolve! Life keeps moving.
Keep looking towards college, find a doctor close to where she wants to go, and develop a “plan B”. If she isn’t able to go to college as planned and you have to punt for a period of time then punt. It’s a blip in life not a bail-out. Take a longer view.

You (and your D) are not alone–just go look at the number of threads on CC alone. Anxiety, depression hit a lot of teens especially. You’ve got lots of support!

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Ideas? How to keep healing and stay productive?

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I had a good talk with a friend yesterday whose D has similar issues. She brought up a great point that may apply to your D. Her D definitely has perfectionist tendencies too and is in general a great kid. She is the kind of kid who everybody thinks is amazing and puts on a pedestal. It can really be a burden to a teen to have to live up to those expectations. She thinks once she leaves our school community and reboots at college it may be much easier because she won’t be the Golden Child anymore and won’t have that burden. She can start over where no one knows her and no one expects her to be the best at everything. Of course, there are still her own expectations to wrestle with but I think it will be a bit easier.

Continued good thoughts to your D.

18

Thank you all for your input and support. Several people have also PM’d me and that support is also very, very much appreciated. This is such a difficult process, and I have to try to remember that it is a process. It’s a roller coaster ride, one day thinking things are looking up, the next…well, not. Sometimes thinking you are doing the right thing, the next, not so sure. =((