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Re: Daughter labeled severe/drugs deemed experimental

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>Hi ,

I would try a new therapist first. Do you have an anxiety center (at a

university) in your area? Contact them and ask their advice. Your daughters

rituals are making her OCD worse. If she can eliminate or at least reduce these,

you'll start to see improvement.

Good luck. My thoughts are with you and your family. I've been there.

Terry

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone). My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

> Thank you and I will pray for your families.

>

>

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My dd took Risperdal when she was 12. It was a good drug for her for the most

part. It did cause her to start lactating and that was more than my dd would put

up with, so we switched her to a different med. Is your dd doing ERP and CBT?

Good luck, Stormy

________________________________

To:

Sent: Wednesday, September 2, 2009 8:37:10 AM

Subject: Daughter labeled severe/drugs deemed " experimental "

 

Dear Community,

I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone) . My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

Thank you and I will pray for your families.

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I can tell you that my nephew was on risperdal at age 6 -- and he was on the max

dose and he experienced no side effects.  Most children are on a very low dose

of it and respond very well.  The one side effect you may want to talk to the dr

about is increased salivation.  My nephew did have that and had to take another

drug to counter that effect.  In your daughter's case, that may be a problem.

Wishing you the best.

in WA

Subject: Re: Daughter labeled severe/drugs deemed

" experimental "

To:

Date: Wednesday, September 2, 2009, 10:06 AM

 

>Hi ,

I would try a new therapist first. Do you have an anxiety center (at a

university) in your area? Contact them and ask their advice. Your daughters

rituals are making her OCD worse. If she can eliminate or at least reduce these,

you'll start to see improvement.

Good luck. My thoughts are with you and your family. I've been there.

Terry

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone) . My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

> Thank you and I will pray for your families.

>

>

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my daughter was on this at 6! it was a miracle drug for her.  I hope it works

for you daughter.

jennie

[ ] Daughter labeled severe/drugs deemed " experimental "

 

Dear Community,

I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal ( Risperidone ) . My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

Thank you and I will pray for your families.

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Your Doc maybe hasn't given it so young--but others have-it is even

available in liquid form. We have a number of kids on it in our

program that are young. My son went on it at about 11-12. Helped him

alot, but the eating side-effect was hard. He gained 16 pounds in the

first 3 weeks. Went from extra slim to husky. We eventually changed

to Abilify ( Similar) - Joy

Joy Liebeskind,Coordinator

Ct Lifespan Respite Coalition

Medical Home Initiative

2138 Silas Deane Highway

Rocky Hill, Ct 06067

fax cell

CTRESPITE@... CTRESPITE.org

Family To Family Health Information Network

2138 Silas Deane Highway

Rocky Hill, Ct 06067

ext 108

fax cell

Ct Parent Resource Library

CTPARENTRESOURCELIBRARY.org

> My dd took Risperdal when she was 12. It was a good drug for her for

> the most part. It did cause her to start lactating and that was more

> than my dd would put up with, so we switched her to a different med.

> Is your dd doing ERP and CBT? Good luck, Stormy

>

>

>

>

> ________________________________

>

> To:

> Sent: Wednesday, September 2, 2009 8:37:10 AM

> Subject: Daughter labeled severe/drugs deemed

> " experimental "

>

>

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed

> with OCD and possible PDD last December. I wrote in once about her

> holding spit in her mouth. Since then, though she is in counseling

> and on Sertraline (Zoloft) since April, she has barely improved. She

> literally cannot walk, talk or even get to the bathroom

> spontaneously because of rituals. Her rituals are mainly mental

> which make them very difficult to treat. The counselor and the

> psychiatrist are recommending an atypical antipsychotic called

> Risperdal (Risperidone) . My husband and I are just heartsick about

> the possible side effects of this drug. Yet we know of no other

> options. The psychiatrist said that she has never given this drug to

> a child so young! My daughter is an experiment of sorts! Do any of

> you have any experience with this? Can you refer me to any

> resources? Do you have any alternatives?

> Thank you and I will pray for your families.

>

>

>

>

>

>

>

>

>

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Risperdal is used widely in the Autism population. If you look

at the National Institute of Health clinical trials this

medication has been used widely with young children in this

population usually for outbursts, self injurious behaviors.

My question is does the MD suspect she needs a mood stabilzer?

Risperdal is sometimes used with Bipolar population too.

Our friends daughter was depressed and zoloft did not help

enough. Then they used Abilify (similar class as rispedal) and then it was clear

she needed a mood stabiler.

But your child sounds so clearly OCD. maybe there are other

issues with sleep disturbances or mood issues?

Many times if one medication alone does not work the psychiatric community adds

a second medication.

For OCD if one SSRI (zoloft) doesn't work the protocal is to try another SSRI

like prozac. If that doesn't work then some MD's go to Anafranil an older

medication that requires more checking for adverse reactions but has been used

in the pediatric population for years.

Our daughter's pychiatrist doesn't use anafranil but is considering adding

klonopin to her zoloft (for her panic). My husband too has xanax added to his

zoloft as zoloft seems to not touch his panic at all.

I have a friend who's son has Bipolar and the daughter had OCD

she was only put on Anafranil since the SSRIs were so activiating for the son.

So I know some people are prescribed Anafranil still.

Medication management is so complex, I would seek out a pyschiatrist

that specializes in children.

Also make sure you start out with very low doses of medication.

The MD will know this. But I am very careful about this.You can

see small improvements and increase the dose. You want to avoid

a big adverse reaction. I am never in a hurry about increasing

dosing. Some People/kids are very sensitive to medications and need

to just go slow.

Good luck,

Pam

-- In , " jemarcellino2000 "

wrote:

>

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone). My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

> Thank you and I will pray for your families.

>

>

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Share on other sites

Just a quick comment. Sometimes a 2nd medication is added to the SSRI med

(e.g., Risperdal) and it " boosts " the effect of the SSRI, sort of kicks it into

gear, helps it work better. This may be why he is adding it? Here's an excerpt

from an article on meds/OCD:

" Medications used to enhance the efficacy of SSRIs or Anafranil in reducing OCD

symptoms (often referred to as " augmentation " ) include: BuSpar (buspirone),

Remeron (mirtazapine), Klonopin (clonazepam), Risperdal (risperidone), Zyprexa

(olanzapine), Seroquel (quetiapine), Geodon (ziprasidone), Abilify

(aripiprazole), Depakote (divalproex), Neurontin (gabapentin), Lamictal

(lamotrigine), Topamax (topiramate), Gabatril (topiramate), and Lithium

Carbonate. In addition, Inositol, a B-vitamin available without prescription

from most health-food stores and many pharmacies, has shown effectiveness in

reducing OCD symptoms when taken with SSRIs, and, in some cases, even when taken

alone (although dosages had to be pushed to fairly high levels). "

http://westsuffolkpsych.homestead.com/OCDmeds.html

>

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone).

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I think the doses used for these meds to boost the effects of SSRI's are much

lower than is used for mood stabilization like my dd takes for her bipolar.

Stormy

________________________________

To:

Sent: Wednesday, September 2, 2009 11:52:38 AM

Subject: Re: Daughter labeled severe/drugs deemed

" experimental "

 

Just a quick comment. Sometimes a 2nd medication is added to the SSRI med (e.g.,

Risperdal) and it " boosts " the effect of the SSRI, sort of kicks it into gear,

helps it work better. This may be why he is adding it? Here's an excerpt from an

article on meds/OCD:

" Medications used to enhance the efficacy of SSRIs or Anafranil in reducing OCD

symptoms (often referred to as " augmentation " ) include: BuSpar (buspirone),

Remeron (mirtazapine) , Klonopin (clonazepam) , Risperdal (risperidone) ,

Zyprexa (olanzapine) , Seroquel (quetiapine) , Geodon (ziprasidone) , Abilify

(aripiprazole) , Depakote (divalproex) , Neurontin (gabapentin) , Lamictal

(lamotrigine) , Topamax (topiramate) , Gabatril (topiramate) , and Lithium

Carbonate. In addition, Inositol, a B-vitamin available without prescription

from most health-food stores and many pharmacies, has shown effectiveness in

reducing OCD symptoms when taken with SSRIs, and, in some cases, even when taken

alone (although dosages had to be pushed to fairly high levels). "

http://westsuffolkp sych.homestead. com/OCDmeds. html

>

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone) .

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,

I am so sorry for what you and your daughter are going through. What sort of

counseling is she in? If it is not exposure and response prevention, it is not

likely to help although if her anxiety is too high, she may not be able to

participate that well in therapy. What dosage of Zoloft is she on? My 9 yr old

daughter was on a low dose for quite a while and fairly stable, but got much

worse in June. We have been increasing her dosage since May or June. She is

now at 150 mg/day of Zoloft and doing much better although she still has work to

do. Have you tried any medications other than Zoloft? Try posting a question

on this list with the specific heading " Ask Dr. Geller " . You could also contact

the OC Foundation and e-mail Dr. Jenike, who has a great deal of experience with

severe cases of OCD. He may be able to advise you on where to seek treatment.

Also, if you tell us where you are located, perhaps someone on this list will

have suggestions for you on treatment providers.

You definitely want to research medications before giving them, but do remember

that the side effects of not giving medications if your child cannot function

and is not improving are definitely not good. I think risperdal may also be

used in ADHD (someone please correct me if I am wrong), so you might want to

look at information for those families and see what you find.

Thinking of you both,

>

> Subject: Daughter labeled severe/drugs deemed " experimental "

> To:

> Date: Wednesday, September 2, 2009, 9:37 AM

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was

> diagnosed with OCD and possible PDD last December. I wrote

> in once about her holding spit in her mouth. Since then,

> though she is in counseling and on Sertraline (Zoloft) since

> April, she has barely improved. She literally cannot walk,

> talk or even get to the bathroom spontaneously because of

> rituals. Her rituals are mainly mental which make them very

> difficult to treat. The counselor and the psychiatrist are

> recommending an atypical antipsychotic called Risperdal

> (Risperidone). My husband and I are just heartsick about the

> possible side effects of this drug. Yet we know of no other

> options. The psychiatrist said that she has never given this

> drug to a child so young! My daughter is an experiment of

> sorts! Do any of you have any experience with this? Can you

> refer me to any resources? Do you have any alternatives?

> Thank you and I will pray for your families.

>

>

>

>

> ------------------------------------

>

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> Our list advisors are Gail B. , Ed.D.(http://www.ocdawareness.com ),

Tamar Chansky, Ph.D.( http://www.worrywisekids.org ), and Dan Geller, M.D.

> (http://www2.massgeneral.org/pediatricpsych/staff/geller.html

> ). You may ask a question of any of these mental health

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-

Have you ruled out PANDAS? Has your daughter ever had strep? Has she ever been

on an antibiotic for anything and you saw any improvement? I am sorry for what

you are going through. A red flag always goes off in my head when a child with

OCD does not improve on psychiatric meds OR worsens, b/c this is common in

children with PANDAS.

Colleen

>

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone). My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

> Thank you and I will pray for your families.

>

>

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Hi, .

I've read the same as it's boosts the effectiveness of the SSRI. My

brother in law was recently given lithium for the same reason (to boost his

antidepressant).

I agree, the mental rituals are hard to treat. Is the Zoloft the only SSRI

tried? Sometimes a change to a different antidepressant can help, since they

can affect people differently. Just wondering if that had been considered.

Also, has her counselor been using CBT/ERP (cognitive behavioral

therapy/exposure and response prevention) therapy with her?

I will say a prayer for you and your family. It's so hard to watch our kids

suffer and not know what the right thing is that will get them well. Been

there. <sigh> Unfortunately, it can be trial and error for some.

Hugs,

BJ

>

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone). My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

> Thank you and I will pray for your families.

>

>

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My daughter has been on Zyprexa (similar med.) 3 different times for a

short period (1-2 mos.) starting at age 8. She is now 14 and hasn't

taken it for 4 years. Our pdoc used it as an augmentation to her Prozac

to boost it's efficacy. It worked wonders and elimated ALL the bad

thoughts going on in her head. Unfortunately it had bad side effects.

She gained 20 lbs. in a month. But, we were able to wean her off and

she stayed stable for a period of time. If she needed a med. like that

again, I would try Abilify because it isn't known as such a big weight

gainer. She did try Risperdal for a week before the Zyprexa, but she

became even more agitated. So, they aren't all the same, but worth a

try if one doesn't work.

Even though it was horrible to have to give her a med. like that, it

truly saved her life. (She wasn't eating and had to be hospitalized.)

Dina

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Hi ,

Another thought. The ctsa at Penn where my daughter was treated has a pediatric

specialist now on staff. I don't know if Phila. is a possibility for you, but I

thought I'd pass it on. The center is excellent. They also have free treatment

for research programs if you meet the requirements.

Terry

>

> Dear Community,

> I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone). My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

> Thank you and I will pray for your families.

>

>

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We just had the same experience. My 14 yr old stopped functioning in the 8th

grade. Last Nov. they wanted to put her on Abilify. We were not open to it at

all for months, until our whole family was truly suffering. In the begining of

Aug. We tried 2mg ,typical staring dose is 5mg. I saw inprovement right away,

after the first week she started to " come back " . She just started 9th grade

today and we were not sure she would be able to go to school. I was at the very

last edge of my wits end before we chose to try. I am hopeful for her. I knock

on wood every time I think, OK she is good now. But, I stay with; " we had a

good day today " . She has had a string of good days in the last weeks. It is a

brutal choice to make to try these strong drugs on children. my advise is follow

your gut and do lots of research. (Expect on the internet) So far we are having

a good experience with it.

I would like to hear more about the spitting or holding spit. My daughter spits

and the can't say if it is the OCD or maybe TS. She also has ADHD. If you want

to contact me directly my e mail is @.... I would like to discuss

more if you want.

Abilify is the newer version of Risperdal. They wanted us to do an SSRI, Abilify

and blood pressure meds, to control tics. We had a tough time with the SSRI's

they make her manic and the blood presure meds may still happen....

Good luck in your research,

>

> Hi ,

> Another thought. The ctsa at Penn where my daughter was treated has a

pediatric specialist now on staff. I don't know if Phila. is a possibility for

you, but I thought I'd pass it on. The center is excellent. They also have free

treatment for research programs if you meet the requirements.

> Terry

>

> >

> > Dear Community,

> > I am desperate for some advice. My 9 year old daughter was diagnosed with

OCD and possible PDD last December. I wrote in once about her holding spit in

her mouth. Since then, though she is in counseling and on Sertraline (Zoloft)

since April, she has barely improved. She literally cannot walk, talk or even

get to the bathroom spontaneously because of rituals. Her rituals are mainly

mental which make them very difficult to treat. The counselor and the

psychiatrist are recommending an atypical antipsychotic called Risperdal

(Risperidone). My husband and I are just heartsick about the possible side

effects of this drug. Yet we know of no other options. The psychiatrist said

that she has never given this drug to a child so young! My daughter is an

experiment of sorts! Do any of you have any experience with this? Can you refer

me to any resources? Do you have any alternatives?

> > Thank you and I will pray for your families.

> >

> >

>

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,

So sorry your daughter and you are struggling so much. I, and others, certainly

understand.

I got desperate in May of this year and stumbled into a good therapist who

specializes in childhood anxiety disorders and does ERP. I also stumbled upon a

psychiatrist who happens to also be a pediatrician and has Ph.D in molecular

chemistry. Maybe I'm putting too much faith into these people but I really

think that, as a team, we can help my 11 year old daughter.

The psychiatrist recommended she be put on a very low dose of an atypical

anti-psychotic, Abilify. I couldn't believe the difference it made. The side

effects were minimal in comparison to the outcome which was a much more relaxed

child and one who was willing to boss back OCD.

After a month, we doubled the dose from 1.25 mg. to 2.5 mg. and she developed a

facial tic. Without consulting with the dr., I pulled back to 1.25. Her OCD

has now plateaued and she doesn't seem to be working at all on her assignments.

On the other hand, she is quietly making progress in other areas and she is

making friends and has become more social.

Just to clarify, I am still frustrated with her OCD. She is incontinent because

of her fear of germs in the bathroom. I am frustrated with her smelling bad and

cleaning out her underwear. On the other hand, she is in a much, much better

place than she was three months ago. I credit the Abilify for giving her the

nudge she needed.

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,

My daughter was on risperdal and trileptal at age 8. I too was

horrified after reading the side effects but it only took 6 weeks of

her symptoms (rages) getting worse before I tried it. It really

stabilized her for 4 years until she reached puberty. Things spiraled

out of control but I don't think it was due to risperdal. When we

called in another psychiatrist who is top in the state of IL.

(specializes in bipolar) she said risperdal was the drug of choice.

Still, we switched to abilify.

My point is if your daughter can' function, these drugs can

really help them reach a point where they can benefit from therapy.

No one wants a child on antipsychotic drugs but I'm thankful they are

available. No one wants to see their child loose the ability to

function.

Dorelle

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:

My daughter (9) was put on 25 mg of Risperdal and 25 of Sertraline and then they

increased the Risperdal to 50 mg. She got a breast lump and I took her off. She

is now on 50 mg of Sertraline  and is doing better- although far from cured. She

also does ERP. You may want to see about increasing the dose or moving another

SSRI. What does is your daughter on? You  may also want to try regular Zoloft

and not the generic to see if it makes any difference.

Kerry   

Subject: Daughter labeled severe/drugs deemed " experimental "

To:

Date: Wednesday, September 2, 2009, 1:37 PM

 

Dear Community,

I am desperate for some advice. My 9 year old daughter was diagnosed with OCD

and possible PDD last December. I wrote in once about her holding spit in her

mouth. Since then, though she is in counseling and on Sertraline (Zoloft) since

April, she has barely improved. She literally cannot walk, talk or even get to

the bathroom spontaneously because of rituals. Her rituals are mainly mental

which make them very difficult to treat. The counselor and the psychiatrist are

recommending an atypical antipsychotic called Risperdal (Risperidone) . My

husband and I are just heartsick about the possible side effects of this drug.

Yet we know of no other options. The psychiatrist said that she has never given

this drug to a child so young! My daughter is an experiment of sorts! Do any of

you have any experience with this? Can you refer me to any resources? Do you

have any alternatives?

Thank you and I will pray for your families.

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