A Panicked Child, a Worried Parent, a Controversial Pill - fluoxetine, the generic version of Prozac

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A Panicked Child, a Worried Parent, a Controversial Pill

By HARRIET BROWN

http://www.nytimes.com/2004/11/16/health/16case.html

We were at the county fair the night I realized my 8-year-old was having

panic attacks.

She and her 13-year-old sister had gone on a ride, the kind where a

round room spins, the floor drops away and centrifugal force holds the

riders to the walls. I stood outside and watched the ride start to spin

and then, puzzlingly, slow down.

The door opened and my 8-year-old stumbled out, in the midst of what I

thought was yet another temper tantrum.

She had been having them since the previous winter, when she'd been

hospitalized for several days and then convalescent for months with a

rare and potentially lethal disease. Thankfully, she had recovered. But

she'd been, well, cranky ever since, subject to unpredictable bouts of

rage far worse than any she'd had as a 2-year-old.

That night at the fair, something clicked as I watched her body stiffen

and her brows sweep together. " Are you scared? " I asked.

" No! " she said through gritted teeth. " I feel like I'm going to throw up

or pass out! "

I got her to breathe deeply, and the tantrum eased. At home that night,

I thought back over the last eight months. There had been more and more

of these tantrums, and they had affected her life, I now saw, on just

about every level.

Her friendships were suffering, and so was her schoolwork. Always a

picky eater, she was now eating only three or four acceptable foods.

Born with an anxious temperament, she'd developed so many fears that

we'd begun taking her to see a psychotherapist. A homebody by nature,

she now never wanted to go out. Her world, I realized, was shrinking,

just when it should have been exploding with new experiences, feelings,

friendships and ideas.

Our daughter's therapist asked if we had considered antidepressants.

" There's only so much I can do with a child this age, " she said candidly.

My husband and I made an appointment with our pediatrician, Dr. C., who

had been caring for our daughters for the last dozen years. We talked

for more than an hour.

" Hard science doesn't really back up the idea that helping a kid in the

short term will change her life in the long term, " he told us, " though

anecdotal evidence suggests that, of course, if you make things better,

it will help. "

He described the immature brain, how fragile and vulnerable it could be.

And he confirmed what I'd learned on the Internet: some children not

only get worse on antidepressants, they become suicidal.

" But Prozac, the only one that's been studied for kids, is remarkably

well tolerated, " he added, " and the potential for really bad side

effects is pretty much nonexistent. "

" Really bad side effects? " I asked.

" Like death, " he said.

" Oh. "

At the end of our conversation, Dr. C. pulled out a pad and wrote a

prescription for fluoxetine, the generic version of Prozac.

" We see the best outcomes with a combination of medication and talk

therapy, " he said.

" What would you do? " asked my husband.

" If she were my kid, I'd treat her, " Dr. C. said without hesitation.

It took us a week to fill the prescription, a week of angst and what-ifs

and soul-searching.

One morning I told the 8-year-old that this medicine might help with the

panic attacks. She put the tiny pill on her tongue and gulped it down

with a glass of water, and I saw how trusting she was. What if the

medicine made things worse? What if we were wrong?

Dr. C. had said it could take weeks to see results. By the end of Day 3,

our daughter's mood had lifted. She bounced around the house and through

the neighborhood. At bedtime, she still recited a long list of worries

and fears, but seemed more easily reassured.

The only side effect was that her ears popped half a dozen times a day.

By the end of the first week, neighbors were commenting on the change.

Our daughter's dance teacher called us to say, " She seems like her old

self again. "

I realized that my daughter hadn't been herself since she'd been sick.

The change had been invidious, and we hadn't really taken it in.

School started, always a difficult transition for our daughter. She made

a new friend and said she looked forward to going every day. She

regained her goofily amusing charm. The clincher came one afternoon when

she was walking home from school and a thunderstorm - one of her biggest

panic triggers - broke. A month earlier, she would have run home in a

blind panic, screaming.

" This time, " she told me afterward, " I just sang loudly to myself and

kept walking. "

It's been three months now. We watch her closely, knowing she could

backslide, that it's hard to spot the moment a child (or an adult, for

that matter) begins to lose her way. We are alert for any hint that her

brain is being harmed by our efforts to heal it. So far, so good.

*

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