Lexapro, Celexa or Zoloft

[hayden]

My 12 year old son (almost 13) has been on Celexa for approximately 3 1/2 years for OCD which has worked well (his symptoms are more doubt related and some repetitive actions e.g. stepping over things, turning a light switch off a particular way). He was on 40 mg for at least one year but over the summer, he was bumped to 60 mg because his symptoms were starting to worsen.  Between switching him from 40 mg to 60 mg, I had switched therapits.  His psychiatrist was so...busy and about 45 minutes to 1 hour away and at times we would have to wait 1 to 1 1/2 hours to get in to see him after appointment time.  Since it was more medication management, I decided to find a reputable person in my area; however, she is not a psychiatrist but a nurse practioner/nurse clinician with behavioral medication management as her expertise. Once she switched him to 60 mg, it did not seem to help so she decided to wean him off of celexa and put him on Lexapro since he had success with Celexa and it would be an easier transition.  She started with 20 mg for two weeks, then 25 mg for two weeks and then 30 mg. Currently he has been on the 30 mg for 8 days.  I spoke to his therpist a couple of days ago and asked her if I should be seeing some improvement since switching to Lexapro.  She felt that I should see at least some improvement since 30 mg is equivalent to 60 mg of Celexa; however, she wanted him to stay on 30 mg for at least two weeks before making any additional adjustments. She mentioned switching him to Zoloft; however, I don't know whether it's better to switch him again or try going even higher on the Lexapro.  Right now, he already seems figidity on the 30 mg of Lexapro so I worry about going any higher.  But, then again, maybe he is figidity because of his OCD and anxiety associated with it. I'm always looking for alternatives to medication and am trying to have him work with a counselor for CBT but don't believe he has true CBT training.  I'm also not sure that my son is ready for the CBT commitment at this age.  I worry that I made a mistake of taking him off of Celexa and putting him on Lexapro.  I understand that they are mirror images of one another but that Lexapro is cleaner and maybe since Celexa was not working as well recently, I shouldn't have assumed that Lexapro would be better.  But, I also worry about switching him to another medication -- especially Zoloft, which I understand takes longer to work.  He is in 7th grade, is very social and I don't want any medication changes to cause him stress in school or with his friends but he wants to feel better. For the last couple of days I've had him tell me a number between 0 and 10 (0 being the best, 10 the worst) for how he feels that day. The first day was a 5 and the second day was a 7/8.  I need a crystal ball but since I don't have that I need an outside opinion. I hate having my child on meds but if he has to have them, I want the best one for him.  Please help!!!

[Kevin Kennedy, Ph.D.]

OCD is one of the biologically-determined emotional disorders, so having your son on medicaton is absolutely sensible. He is also at an age when CBT might be useful, but he is certainly at the lower end of the range at which that would be true. If you decide to switch medication, a worthwhile alternative to consider is Luvox. It tends to be quite effective in the treatment of OCD, though it does have to be taken at the higher doses in order to achieve maximum effectiveness. It sounds like you are in good hands with the nurse prescriber - be patient, since she is trying to be prudent in her prescribing practices.

[OCD]

My son has been on Lexapro for a year. He was diagnosed with OCD about a year ago but has had signs of it his whole life. He is turning 14 in December. The doctor about 2 weeks ago decided to start weaning him off. The first week we went from 10 mg to 5 mg for a week and he was ok but the second week we went to 5mg every other day and he is starting to show signs of severe anxiety, crying over everything, sullen, angry - really back to the way he was before the medication. DOes that mean he needs to stay on and will always need the medication? He was so confident on the medication and was always with alot of friends. Being off these few days he seems so different. I hate the fact that he has to be on medication . I know it helps him but in the long run I feel I may be hurting him more than helping him. Are there any natural alternatives? I did read that vitamin B in powder form for kids helps to raise seratonin. Does anyone know anything about that? Thanks for any help you can give me. Debbie