Question diagnosis of Conversion reaction/disorder

[HW]

My 16 year old son was treated for depression in mid august with Welbutrin and reached a dose of 300 mg. by mid september with little benefit. He also was in weekly psychotherapy since August..  He then was switched to Lexapro, 10 mg with welbutrin 150 mg. and quickly developed constant shaking, for four days. The psychiatrist said to discontinue the lexaparo, but my son then began showing a seizure-like presentation, with grimacing, teeth clenching and fist tightening, head jerking, eyes rolling back and when brought to the emergency room, his b/p was 150/90. He was given IV Benedryl and Ativan and he calmed down and went to sleep. These episodes have not stopped since then. We took him of Welbutrin and he was med free for 8 days. His seizure-like episodes continued and were prompted by any negative thought or stressor. He then began Zoloft therapy, with slow titration until reaching 175mg. Along with this, he was given Buspar, clonopin, and cogentin to help him with these supposed panic attacks that the dr. was treating. We found no improvement with these meds. Two weeks ago he obtained 36 hr. continuous eeg. monitoring and video taping in an epilepsy unit in a hospital. The neurologist found no EEg abnormalities, and a psychiatrist who works with epileptic patients evaluated my son as well. Both doctors concurred that my son has pseudosiezures and a conversion reaction. They felt that once my son was made aware of no physical cause for his siezures, he would improve with psychotherapy. Two weeks have passed. He takes only Zoloft, 150 mg. daily now. Symptoms have not subsided and we are now going to see a doctor who specializes in hypnosis and conversion disorders. We wonder if any other tests should be performed to rule out any organic problems. He  has had a cat scan of the brain-no significant findings. We wonder if an MRI would be more conlusive. No doctor is recommending this. We also wonder about the adrenal gland-tumor? or any endocrinological imbalances-He took a 24 hrs urine VMA  test and found elevated catacolymine and VMA levels but dr. felt this was of no concern based on volume of urine collected.
Do you feel psych testing could confirm this diagnosis?. How could psych testing be helpful? We don't want to miss a medical condtion that may be causing these spasms. What other tests should he take? Could a sensitivity to SSRI medications cause an extra sensitivity in a person to stressful stimuli. These symptoms all occured after his dystonic or extreme shaking for 4 days from Lexapro. We wonder whether we should stop all SSRI medication(Zoloft) and see if these spasms stop. It was recommended that we first pursue treatment for conversion reaction before taking him off Zoloft since he has experienced positive mood elevation from it. He has missed 2 months of school. Has just begun home tutoring in limited subjects-he has spasms during instructions but can regroup after an attack and resume instruction.Please advise us.Thanks

[Marie R]

please these are "CHILDREN" there fragile little minds do not need to be disturbed by chemical malaise...I was diagnoised with clinical depression and took every concoction they could come up with by the first year I was a mental case...I was unsure of my every thought....One day I said that's the end of this mental torture...  I began to read herbal and homeopathic remedies I recommend you buy the book "the natural physicians healing therapies and start your child on 100 mg of 5-htp which is a brains own chemical (5-hydroxy L-tryptophan) buy it on EBAY colorado nutrtion is a great brand...find the child a good therapist learn how to listen and pray to the good lord for help and guidence...and leave the pharmacuticals alone!!!!I understand as a parent you are trying to help your child but you do not have any idea what effect these drugs have on your childs mind ...I do I have taken them prozac..zoloft my goodness there are so many the one that really gets me is nurontin spell check ...this is being taken off the market because it makes you suicidal...HELLO...these drug companies are here to make money and the doctors who prescribe them you are the guinnea pig maybe you will feel better if not let me know we have many more to try!!!!get a clue depression in a child is caused by 2 things ones self and ones family bring them together and work on these problems with gods help you will work as a unit and recovery from whatever your childs problems are.....god bless

[Kevin Kennedy, Ph.D.]

The sudden onset of your son's symptoms does lend support to the possibility of biological process vs psychological process. Whenever conversion reaction is diagnosed, it is crucial to rule out medical conditions, for obvious reasons. It would be a mistake to treat something as psychogenic in origin when it is really a biological phenomenon. The idea of a MRI certainly makes sense, particularly because of the presumed diagnosis of conversion reaction. While you son is gaining some benefit from his SSRI, under the circumstances it is sensible to try him off the medication. The association between onset of symptoms and start of SSRI is important (though by no means is it indicative of causation). Actually, I would be suspicious of the role of Wellbutrin in the onset of your son's seizures. As you may know, at the dose he was taking, approximately 4 in 1,000 patients might display seizures as a side effect of the medicine. I assume your providers have addressed this possibility.