Anxiety and getting sick?

Parents Forum
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My youngest is finishing up his junior year of high school. For the past 2 years, he is nauseous almost all the time. He has a GI doctor who did an endoscopy and colonoscopy and an MRI as well as blood work and can’t find anything physically wrong with him. He prescibed him an anti-nausea medication at bedtime but he seems to throw up every morning after taking it so he stopped.

He’s had a neuropsych and was confirmed to have ADHD and some general anxiety. He takes Ritalin twice a day on school days or to do his homework or work on weekends and he feels it really helps him focus. He also takes an anti-anxiety med at bedtime (forget the name). He sees a psychiatrist for meds twice a month. He is a super quiet kid and not at all hyper. Plays a couple sports but other than that is not really a joiner.

My concern is that he has stomach issues nearly every morning, esp when he gets up for school. He throws up most mornings and also has issues the other way. This often makes him late for school. He just got a job to be a camp counselor and was excited for it but now says he doesn’t think he can do it as he thinks his anxiety will be bad in the mornings and he’ll end up being sick and then late.

I’m just not sure where to go from here. I feel like the GI doctor points to the psychiatrist and vice versa and I have no idea how to help him. And obviously worried about how this will go for college.

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I’m sorry, this is so tough. This problem can be crippling. He might need to change anti-anxiety meds, and I’m wondering if a second opinion from a different psychiatrist might be a good idea?

I can’t give you advice about the job, of course, but maybe consider the possibility that now that school is out of the equation for the summer, the anxiety might be a little less crippling, and the camp counselor job might be more manageable?

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Are you near Boston? My D20 did her BSW field placement here, and said the vast majority of patients they treat are dealing with a glitch in the “mind/gut” connection. Perhaps this would be a place to look?

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Is he doing CBT regularly with the psych? If not, perhaps that could be worth a try…either with the psychiatrist or another mental health provider.

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Does he have a pediatrician or internist coordinating his care and reading test results, tracking his meds, etc. to make sure nothing is falling through the cracks?

My primary care physician is a DO (not an MD) and is quick to tell me 'this isn’t my area of expertise, you need to see XYZ specialist" but he is PHENOMENAL at coordinating, thoughtfully looking at an ultrasound even after the radiologist has weighed in, carefully tracks all meds and tests.

Does your son have that and if not- can you go back to the original prescribing doc for a review of his tests?

Agree that summer time may be less anxiety provoking for him, but there are techniques to deal with his stressors in addition to the meds. And if he hasn’t been evaluated by a nutritionist— just to make sure that with all the upchucking he isn’t experiencing some dietary deficiency???

Hugs. This is scary.

I have one tip for you though-- STOP thinking about college! It will be there when he’s healthy! Don’t add a ticking clock and calendar to his worries. The world isn’t running out of macroeconomics or psych 1 or differential equations or Spanish literature or whatever else he’s interested in studying. It will be there in due time.

Another hug.

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So sorry to hear that you are going through this. We have had similar issues with D22 and D29, both developing right around ages 11-12. With D22 (our oldest), we first tried every possible GI-related test and procedure that might explain her endless nausea and other GI problems, only to have multiple GI docs tell us that she was normal. It was eventually her pediatrician that gently suggested anxiety/depression treatment, which in our inexperience never occurred to us. After just a few weeks of antidepressants, she showed significant improvement. Over the years since, the meds have been adjusted several times, and she has recently begun working with a nutritionist to further assist with ongoing GI issues. Overall, she’s probably doing as well now as she ever has, but it seems like it will be a matter of lifelong management.

When D29 started complaining of similar symptoms, we knew to start looking into antidepressant/anti-anxiety meds right away. Her GI symptoms weren’t quite as severe as D22, and the psychoactive meds have largely cleared up those symptoms.

I don’t have any real advice - you are already doing the right things. Just letting you know that we have walked (and are still walking) that path and can empathize.

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Sorry this is happening. If things improve over the summer that will be a notable data point.

If it is any consolation, it sounds like you are taking the appropriate steps to figure things out.

Honestly the best advice I can offer is to be sure to see top specialists (preferably in a large city near you).

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I caution about using Boston Children’s or, for that matter, a “top specialist.” The most likely recommendation from these sources is psychiatry (they are very busy with more easily diagnosed serious issues). The tendency is to dismiss symptoms as psychological and I would not accept that without more investigations. For starters I would consult a functional medicine or integrative medicine doctor.

Has anyone tested for food allergies or celiac? Even without the testing, he could try an elimination diet with a nutritionist via functional medicine, or even just try giving up gluten and dairy. To state the obvious: all of this testing does not mean there is no physical issue. (I assume Crohn’s and ulcerative colitis were ruled out.)

Since he takes meds at night (what meds? this is important info!) I wonder about the morning after effects. For instance, trazadone causes nausea for a lot of people. (It is also not approved for under 18, leading me to wonder what drug is being used.) Also Ritalin can cause nausea. There are other options for ADHD. Is he seeing a specialist for that? (Just google his meds and nausea…)

Maybe consult with a psychiatrist to do a “med wash” (stop all meds, gradually and safely) to see if the nausea improves.

Some SSRI’s cause nausea too.

I have two kids who had/have this kind of issue. One was referred to psychiatry but ended up having celiac and had colitis at the time we were seeking help. One is on Lithium and despite am nausea, has to stay on it. They tried zofran (anti nausea med) for awhile but it is intended only for short term use.

I completely understand the barriers to work and school. Your son should have accommodations at school via a 504 plan, accommodations for SAT and ACT, and accommodations at college. This will require a diagnosis (including psychiatric if that ends up being the answer, but I doubt it) and documentation from a professional. Online non-synchronous classes in both high school and college can be helpful too. Our high school accepted them and they gave flexibility for health issues. vhslearning.org

One of my kids teaches/advises at a college and deals with morning nausea with one student. The student only takes classes that start later and was exempted from a required 9am class, doing independent study as an alternative.

Many kids with anxiety at this age, improve over time, and there are supports available to help him function at his best.

ps McLean Hospital, top in the country for psychiatry, does not prescribe sleep meds for adolescents, in our experience- even for kids who are hospitalized. Your son could get off the sleep med safely and try CBD gummies and melatonin, which McLean’s uses first. His brain is developing and I would ask doctors (including psychiatrist) or research the effects of sleep meds used so frequently, on the adolescent brain. I have no idea, but just a thought based on what McLean’s suggested to us.

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I have no suggestions beyond what has already been offered, but just wanted to say that I very much empathize and am sending hugs. Your son is fortunate to have a family that is so supportive and proactive about seeking help and solutions.

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Just a warning that cannabinoids can cause cyclic vomiting for some people, so be mindful of that.

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We had nothing but good things to say about Boston Children’s (just to give you a counterpoint). We were referred to a specialist there when we were living in the midwest-- actually got on a plane with a toddler to see this person and it was well worth it. We had gotten conflicting advice from the pediatricians in our small city “back home” and then one of them suggested breaking the logjam with the vote of an “expert”. Worth the hassle.

And the next time wasn’t such an ordeal (living in the Northeast by then although not near Boston) and managed to snag an appointment with someone who books month ahead of time. Took less than five minutes to hear “this is the answer, here’s the treatment protocol, your pediatrician can manage this, tell them to call me if they have questions”.

Most of the families I know who have gone there have equally positive things to say. Their docs WILL look aggressively for something organic/infectious if that’s the cause; their default is NOT “get psych involved” unless there are clear indicators that this is the issue at least in my experience. The team there likely sees hundreds of cases like yours, vs. your own docs who may see a dozen.

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I second this. Our daughter had both problems - first, anxiety causing nausea and then meds causing nausea. I suggest you check the side effects associated with the drugs your son has been prescribed and see if that might be the problem. Even if not, maybe a different medication might work better - they are not all alike. I also agree with the suggestion that you try CBT (cognitive behavioral therapy) - this will probably require including a psychotherapist in your treatment team, but a good therapist can add a lot. Only psychiatrists can prescribe medication, but they are not always the best resources for counseling-type therapy.

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Our family has also received amazing care from doctors at top children’s hospitals (though we have no experience with Boston). In particular, their team approaches can bring a lot of insights for addressing complicated and/or rare conditions.

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Thanks for all the reponses. Just to answer some questions and topics that were brought up.

He has been tested for celiac, crohn’s, etc. Also been tested for food allergies and have tried eliminating foods. He’s super picky and literally eats about 10 foods so that was pretty easy to do. He also sees a dietician. Had a feeding tube when he was 1.5-4 as he just refused solid foods and had a failure to thrive diagnosis but they never found any medical condition after about a milion tests. He had feeding therapy for years and I think added 2 foods to his repertoire. His GI Dr doesn’t think his current issues are related to his previous issues as he had about 10 year in between where he was okay.

We do live outisde Boston and he sees a great GI Dr at Mass General, which is where he was also treated when he was younger. My other son used to be treated at Childrens for a different issue and I’ve always personally prefered the care we’ve received at MGH. (obviously not to say Children’s is not a great hospital).

I don’t remember all of the names of his meds off the top of my head as I have 3 kids with mental health issues and they’ve been on various meds throughout the years. He is 18. The GI Dr prescribed him Cyphroheptadine to take at night and in the AM but that seems to make his vomiting worse so he’s not taking it. He takes mirtzapine at night to help him sleep and for anxiety. He takes a slow release clonidine in the mornings to help with anxiety. The vomiting happens when he first wakes up, before he takes any meds so I don’t think the ADHD med (Ritalin) is causing it. He does not typically vomit on weekends when he can sleep in. He als has Xanax on hand for those days when his anxiety is super high. (has only taken a couple times for job interviews & SAT’s and says it does help).

He is on an IEP and is able to come into school late without any consequences if he’s sick in the morning. He also got accomodations for the SAT & ACT. He’s socially super shy but has no problem doing things like ordering food or going to the doctor by himself.

I just ordered him a pulsating band that’s supposed to help with nausea as well as a homeopathic medicine that’s called “Calm” to see if either of those help.

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Does he take omeprazole or another proton pump inhibitor? I only ask because of his history of GI issues and because it gave me pretty bad morning nausea when I took it. It was particularly bad before I ate something each morning.

Do tums help at all?

Does he sleep later on the weekends? Wondering if it’s a time of day thing or a no school thing.

Wonder if his blood pressure and/or blood sugar is getting too low in the morning. He could try Gatorade or juice and crackers on the nightstand to have first thing before even getting up. I get weirdly nauseated when my blood sugar gets too low, and low blood pressure can make you feel crappy.

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He took Omeprazole twice a day for 2 months on the advice of his GI doctor but it sisn’t help. Hes been off it for several months. He occasionally takes Tums but they don’t really help. Low blood sugar/pressure might be a good thought, I’ll give the Gatorade/juice a try.

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I’m sorry you - and your S - are going through this. One of my kids and I have both dealt with anxiety throughout the years and it feels debilitating when you’re in the thick of it. The main things that have helped us:

  • Finding a good therapist who can help teach coping strategies. Having a few techniques or tools to use can help break up or prevent the anxiety from taking over. My S also liked having this person to talk to each week that wasn’t mom or dad who could help him work through his thoughts and feelings.

  • Meds. This took a little trial and error and a few different psychiatrists, but we were able to find a therapeutic dose of one med where S felt like himself again enough to practice the grounding and mindset techniques he learned in therapy.

  • Seeing a functional medicine doctor. This was recommended by his therapist actually and was incredibly helpful. He did some testing and made some recommendations that helped the psychiatrist finally find the right med. He also recommended some supplements that helped balance some other levels that were throwing things off and contributing to his anxiety.

In regards to the morning nausea, for me that had to do with increased cortisol and adrenaline in the morning. It would hit me like a wave before I was even fully awake and felt awful. What helped in the moment was breathing exercises (look up box breathing for example) and getting up and moving. Usually within 20-30 minutes most of the adrenaline had burned off and it was more manageable.

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If he is “picky” and only eats a limited, and very specific diet, another possibility is eosinophilic esophagitis, which can cause nausea. It is diagnosed via biopsy.

I googled mirtazapine and immediately came up with that med causing nausea but then here it is a suggested treatment: Newest Drugs for Chronic Unexplained Nausea and Vomiting - PMC

Clonidine lowers blood pressure (or maybe raises then lowers) but nausea isn’t a listed side effect and it seems he takes it later than the vomiting period in the am.

Have beta blockers been suggested vs Xanax for interviews and testing or is that contraindicated with the clonidine due to effect on bp?

My first kid vomited in the am due to ketotic hypoglycemia, which my third kid has without vomiting, Low blood sugar and high ketones. But that usually resolves by age 6. (Second kid has type 1 diabetes. Who knows what is going on with our pancreases!)

I’ll stop throwing spaghetti on the wall here. @MAmom111 you seem to have things well in hand and are doing an impressive job. These medical mysteries sometimes resolve but in the meantime you and your son are being commended in the way you are dealing with a no doubt complex situation (and you have other kids with issues too!). So yeah, hugs.

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Morning (and sometimes all day) nausea has plagued me for years with anxious mornings being much worse. Omeprazole and an elevated head of bed helped. And limiting full or heavy meals late.

I also have zofran at my bedside. If I wake feeling crummy, those help quickly.

Feeling nauseated makes me anxious. Which makes me more nauseated.

I also find waking hours before I need to leave for work helps. I cannot pop up and be ready quickly. It’s basically like life long morning sickness.

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