<p>I’m a psychotherapist and usually about half of the people my practice are on SSRI medication, so I get a lot of feedback about it. Some people have worse side effects than others – the sexual side effects can be distressing. Some people experience vertigo and vivid dreams going off of Zoloft. Some people will report feeling a bit flattened in their affect – the depression and/or anxiety lessens but there is also can be a feeling that other emotions are not experienced as fully as they used to be. Some people feel fine and don’t seem to have any trouble with the medication. For many, SSRIs are an absolute godsend and they find themselves freed from very debilitating depression or anxiety. </p>
<p>I think the decision to go on any serious drug for any condition should be made after a thoughtful risk analysis. Is the benefit of the drug worth the potential side effects? What about the risk of not taking the drug? In the case of SSRIs, sometimes it seems like a no-brainer. When someone is so severely depressed that they are suicidal or has a crippling anxiety disorder, the benefits usually outweigh the risks. As with any medication, it becomes a harder decision when the symptoms are milder. </p>
<p>I’m not sure what you mean by him being okay to go to school on Monday. Do you mean leaving home for college or starting classes? I don’t see why he would not be okay to go to school. I’ve never seen anyone take off work or miss school because they started an SSRI. I would check in closely if it was my kid starting an SSRI. He probably won’t feel the effect for a few weeks so you aren’t going to notice much unless he had some kind of unusual reaction in the first days. But I’d leave that to Shrinkrap to comment on.</p>
<p>I only meant off to regular old high school on Monday. I’m not usually much of a mother hen but have read about possible tummy aches/headaches/. . . And I suppose now that I think about it, this is partly my wanting it to work. I’d like him to have an easy entree. (I’d like him to be a happy kid.)</p>
<p>If he starts the Zoloft, he’ll go back to see the pediatrician in three weeks, and currently has weekly appointments with his therapist. And there has been a lot of thought about this. DH is not fond of putting a pill in anyone’s mouth, particularly not someone who’s not fully grown. The therapist said he’d try therapy alone for a month or so, but reports that DS can still only address very surface issues at their sessions. Complete meltdown when he veers the conversation to anything more substantial. He said therapy could continue on a support basis, but real treatment for this kid really needs a push from an anti-depressant.</p>
<p>I would suggest you talk with a child psychiatrist about meds. They are more informed than a pediatrician about appropriate med and side effects.</p>
<p>I attend pschopharm dinner meetings about 3x/month, and couldn’t agree more with Shrinkrap about the Black Box. Other than that you, the OP, have had a good experience with Zoloft, I find it a strange choice.</p>
<p>My adolescent and young people have had wonderful success with meds. After 6 months, one of the young men cut back to very low dosage, because of the sexual side effects. It was terrific that he was then dating and doing better in every aspect of life.</p>
<p>Side effects can vary with each individual- some take in the morning because it keeps them awake, others at night due to drowsinesss. Also, the seratonin effects can mean GI effects for some if not taken with food first… Unfortunately “trial and error” is the only way to customize usage, it literally takes weeks to ramp up to the proper dose and effect, and also to discontinue, be back to a drug free body. Pharmacology is fascinating for some of us physicians… I also would favor the least expensive drug that does the job with acceptable side effects and trust a psychiatrist more than a pediatrician to know which drugs to try.</p>
<p>Black Box refers to the suicide warning, which scares some people away from trying med.s If a few adolescents commit suicide while on SSRIs, then this warning goes out to all. There is no mention of all the suicides that occur with teens who are not in treatment.</p>
<p>Statistically, we know that 11% of X drug may feel nausea in first 10 days, 9% have headaches initially, etc. No one I know tries a medication in less there is a good reason. In general, therapy alone can improve the problem 60% of time, medication alone 60%, but far more improvement when both used. </p>
<p>Celexa is generic, so less costly than Lexapro. These drugs are chemically similar, but supposedly Lexapro has less initial side effects. Depending on insurance, cost differential can be neglible. In my office, we have bags of Lexapro that can be given as samples, but no samples of generic med.s, so our patients given sample kits of Lexapro. A good psychiatrist will monitor closely. For example, if a starting dose of Lexapro is 10 mg, but the pt complains of side effects, the MD might suggest going slower, with 5 mg. Alternately, MD may suggest taking 5 mg in AM, and 5 mg 1 PM. My point is that the MD will be available for quick phone calls and visits, with the goal of helping the pt acclimate to the med and begin to feel better.</p>