meds question

[Guest guest]

Amy,

When my son started on Paxil, he was started at 10mg then

titrated up to 20 and then 30. We didn't see alot of improvement in

his OCD and were advised that this lower dose was therapeudic for

depression, but 60mg would be therapeudic for OCD. Unfortunately,

even 20mg was too sedating for him, so we took him off and he since

has refused other options. (He really hated being so sleepy, and

doesn't trust other meds now)

Hope this helps.

Melinda S.

Dallas

> what is the best medicine for ocd at this time for children? i've

not researched it at all. my daughter, jordan is on 20mg of paxil and

has gotten about 20-30% better. i'm wondering if she should be

switched to a different medicine, or have her paxil dosage upped to

30mg. she has been on 20mg for about 4 weeks now, and 10mg for

another 4. i hope someone can answer my question. thank you, amy

[Guest guest]

Amy:

Unfortunately, there is no one size fits all med for anyone, kids or

adults. It's a matter of trial and error, and the process can take

months or longer due to the long half-life of most of the SSRIs. You

have to titrate up to therapeutic level slowly, put up with BSEs, and

even then you may find that what works beautifully for my child is a

disaster for yours. I think if we polled all the parents on the list,

there would be few who are on the same cocktail. And, sad to say,

what has been working well may turn out to not work so well down the

road.

For example, my son did not do well at all on Luvox, the first med

that was tried. He did really well on Prozac for 2 years, after which

it seemed to quit working almost overnight. In the meantime, we added

Risperdal. When the Prozac pooped out, we switched him to Celexa,

ended up adding Wellbutrin, and keeping him on Risperdal. He now is

doing well on Celexa alone, with a very small dose of Risperdal at

night to help him sleep.

Other kids have done well on Luvox, Zoloft or other SSRIs. Guess

that's a long answer to your question. Bottom line is, hang in there

and see how much more improvement you get as you continue to taper up

the dose. It's a good sign that you're seeing improvement already.

Jule in Cleveland

[Guest guest]

Todd,

I have to agree, every child is different and you will have to really

decide on your own what is best for your daughter. My daughter is 7yr

old and has been on paxil as the first med 8 months ago. we started on

10mgs and just moved up to 20mgs. I have had very little *I'm tired*

from the meds. Just more in the beginning from the increase. But big

improvements on paxils from before when we were on nothing. So in my

case, paxil has been great. I do worry hearing all the *med* changes

that you can go through, and am not looking forward to that if we get

there. But I take one day at a time. And with a good Dr, I feel we

will manage with any med change.

STeffie (GA)

> todd mowry wrote:

>

> what is the best medicine for ocd at this time for children? i've not

> researched it at all. my daughter, jordan is on 20mg of paxil and has

> gotten about 20-30% better. i'm wondering if she should be switched to

> a different medicine, or have her paxil dosage upped to 30mg. she has

> been on 20mg for about 4 weeks now, and 10mg for another 4. i hope

> someone can answer my question. thank you, amy

>

> You may subscribe to the OCD-L by emailing listserv@... .

> In the body of your message write: subscribe OCD-L your name. You

> may subscribe to the Parents of Adults with OCD List at

> parentsofadultswithOCD-subscribe . You may subscribe

> to the OCD and Homeschooling List at

> ocdandhomeschooling-subscribe . You may change your

> subscription format or access the files, bookmarks, and archives for

> our list at . Our list

> advisors are Tamar Chansky, Ph.D., Aureen Pinto Wagner, Ph.D., and Dan

> Geller, M.D. Our list moderators are Birkhan, Kathy Hammes,

> Jule Monnens, Gail Pesses, Kathy , and Jackie Stout.

> Subscription issues or suggestions may be addressed to Louis Harkins,

> list owner, at lharkins@... .

>

>

[Guest guest]

Amy,

I have two suggestions for you....

This is the link to the FILES. There are several

excellent articles which might be of interest to you...

/files/

This is the direct link to the article on the ocfoundation webpage

that discusses medication for children with ocd.

http://ocfoundation.org/ocf1060a.htm

take care, wendy, in canada

==============================================

--- todd mowry <mowry@...> wrote:

> what is the best medicine for ocd at this time for children? i've

> not researched it at all. my daughter, jordan is on 20mg of paxil

> and has gotten about 20-30% better. i'm wondering if she should be

> switched to a different medicine, or have her paxil dosage upped to

> 30mg. she has been on 20mg for about 4 weeks now, and 10mg for

> another 4. i hope someone can answer my question. thank you, amy

_______________________________________________________

[Guest guest]

Hi Amy, SSRIs as a class are the drugs of choice for OCD. Zoloft and Prozac have been approved for use in children (I think I'm right about this), but all the SSRIs are thought to have an equal chance of being effective in any particular child. Sometimes if a sib or parent has had a good response to a certain SSRI, that's a good place to start for the child. Some SSRIs are *generally* more activating (Prozac), some *usually* more sedating (Paxil?) but paradoxical and unique side effects are common especially in children. So there is no one best SSRI for OCD in children and unfortunately, it is usually trial and error to find the right med at the right dose for a particular child. This process can be excruciating when we are watching our children suffer day by day, but there is no way to get around it with SSRI therapy. Many "start low and go slow" when increasing SSRI dosage in a child, to minimize side effects.

Paxil is usually dosed at 10mg to 40mg/daily, the upper range is for OCD, according to "Straight Talk about Psychiatric Medications for Kids" by E. Wilens, MD. SSRI dosage is not weight or age related. At 20mg/day, Jordan is taking a lowish dose for OCD. A 20-30% reduction of symptoms at this dose is pretty good and encouraging. I'm just a mom and not a doctor, but if Jordan were mine I would probably wait a few more weeks, or try another Paxil dose increase at some point in hopes of further symptom reduction.

Don't forget that ERP is at least as effective as any SSRI in reducing and eliminating OCD symptoms. The two together are what let my daughter get her life back from OCD, and she is now taking only a very low dose of Zoloft.

Hope this helps,

Kathy R. in Indiana

----- Original Message -----

From: todd mowry

what is the best medicine for ocd at this time for children? i've not researched it at all. my daughter, jordan is on 20mg of paxil and has gotten about 20-30% better. i'm wondering if she should be switched to a different medicine, or have her paxil dosage upped to 30mg. she has been on 20mg for about 4 weeks now, and 10mg for another 4. i hope someone can answer my question. thank you, amy

[Guest guest]

jordan is also in therapy and the therapist said yesterday that she thinks jordan is ready to be seen every other week. i feel that shes not even 50% better. i don't get it. in fact i feel that jordans meds should be upped too, but didn't discuss this with the therapist. how could i if she thinks jordans doing so well? amy

Re: meds question

Hi Amy, SSRIs as a class are the drugs of choice for OCD. Zoloft and Prozac have been approved for use in children (I think I'm right about this), but all the SSRIs are thought to have an equal chance of being effective in any particular child. Sometimes if a sib or parent has had a good response to a certain SSRI, that's a good place to start for the child. Some SSRIs are *generally* more activating (Prozac), some *usually* more sedating (Paxil?) but paradoxical and unique side effects are common especially in children. So there is no one best SSRI for OCD in children and unfortunately, it is usually trial and error to find the right med at the right dose for a particular child. This process can be excruciating when we are watching our children suffer day by day, but there is no way to get around it with SSRI therapy. Many "start low and go slow" when increasing SSRI dosage in a child, to minimize side effects.

Paxil is usually dosed at 10mg to 40mg/daily, the upper range is for OCD, according to "Straight Talk about Psychiatric Medications for Kids" by E. Wilens, MD. SSRI dosage is not weight or age related. At 20mg/day, Jordan is taking a lowish dose for OCD. A 20-30% reduction of symptoms at this dose is pretty good and encouraging. I'm just a mom and not a doctor, but if Jordan were mine I would probably wait a few more weeks, or try another Paxil dose increase at some point in hopes of further symptom reduction.

Don't forget that ERP is at least as effective as any SSRI in reducing and eliminating OCD symptoms. The two together are what let my daughter get her life back from OCD, and she is now taking only a very low dose of Zoloft.

Hope this helps,

Kathy R. in Indiana

----- Original Message -----

From: todd mowry

what is the best medicine for ocd at this time for children? i've not researched it at all. my daughter, jordan is on 20mg of paxil and has gotten about 20-30% better. i'm wondering if she should be switched to a different medicine, or have her paxil dosage upped to 30mg. she has been on 20mg for about 4 weeks now, and 10mg for another 4. i hope someone can answer my question. thank you, amyYou may subscribe to the OCD-L by emailing listserv@... . In the body of your message write: subscribe OCD-L your name. You may subscribe to the Parents of Adults with OCD List at parentsofadultswithOCD-subscribe . You may subscribe to the OCD and Homeschooling List at ocdandhomeschooling-subscribe . You may change your subscription format or access the files, bookmarks, and archives for our list at . Our list advisors are Tamar Chansky, Ph.D., Aureen Pinto Wagner, Ph.D., and Dan Geller, M.D. Our list moderators are Birkhan, Kathy Hammes, Jule Monnens, Gail Pesses, Kathy , and Jackie Stout. Subscription issues or suggestions may be addressed to Louis Harkins, list owner, at lharkins@... .

[Guest guest]

HI Amy:

It is very encouraging when m.h. professionals tell us our kids are doing

better and need less of their help. Nevertheless I commend you for paying

attention to your own intuition that more improvement is needed.

I met a number of families in Denver who had also been told this and later

they realized that their kids needed more than the typical 16-session CBT

intervention. Some kids do very well and manage to do self-ERP after 16

sessions but others need much longer interventions. Steve needed three

tries of E & RP over a period of about 2.5 - 3 years to really be able to

boss back OCD on his own. Sometimes he was getting three CBT sessions of

about 2 hours each weekly, and when things improved it was reduced to every

couple of weeks with some supportive therapy included. We found he needed

some supportive therapy about non-OCD issues after spending so long dealing

with OCD.

I hope you can discuss your concerns about Jordan with her therapist soon.

GOod luck, take care, aloha, Kathy (h)

kathyh@...

At 09:00 AM 07/13/2001 -0700, you wrote:

> jordan is also in therapy and the therapist said yesterday that she

>thinks jordan is ready to be seen every other week. i feel that shes not

>even 50% better. i don't get it. in fact i feel that jordans meds should be

> upped too, but didn't discuss this with the therapist. how could i if she

>thinks jordans doing so well? amy

[Guest guest]

-Donna...

Im glad you can avoid surgery, at least for the time being. I was so

suprised you are not on any DMARDS or even biologics. That blew me

away when I read that. I hope you find a new doctor that can help

you out and i hope with the addition of something stronger you can

get some relief and put off that sugery for a " good long time!! "

hugs Helen and (7,systemic)

-- In , ajaoky@a... wrote:

> here is the latest..I went to a new orthopedic today regarding my

knees and

> he says they are bad but not horrible. He believes surgery can be

held off as

> there is still spacing and wants to try a few new things including

glucosamine.

> Anyone seen a difference when trying this? He did say dont expect

the

> cartilage to grow back, that don't happen. He did say it could

slow down the

> deterioration. He also recommended more exercises and the ol heat

routine as I have

> some hamstring problems. His main question to me was (remember

this was my first

> visit with him) why am I not on any DMARDS? My response was, I

dont know.

> Sounds silly I suppose but I dont know. I have not been for 14

plus years. So now

> he recommends I get a new rheumy (which I am working on anyway)

and try

> changing meds and he recommended lodine over celebrex. Anyone with

lodine

> information????

> Thanks gang!

> Confused more than ever!

> Donna

[Guest guest]

britral,

You wrote:

> ...Today when I went to pick up prescriptions

> my pharmacy informed me that insurance doesn't cover levo and will

> only cover synthroid So of course I paid $25 for a months supply of

> levo Is it just my provider (First Health) or does everyone else

> have this problem?

Normally, it is the other way around. Levothyroxine is the generic for

Synthroid. It is cheaper. Most insurance companies will insist on the

generic unless the doctor specifically prescribes the brand name. This

may be what happened. Your doctor may have written the prescription

specifically for Synthroid, in which case the pharmacy does not have a

choice.

For most people, there should be no difference, unless you go to an

alternative brand name. If you are one that reacts differently to

Synthroid than to its generic, then get your doctor to write the

prescription for your needs. However, most of the " adverse " reactions

reported to one or the other tend to be symptoms of an incorrect dosage,

rather than a reaction to other ingredients. This gives you the option

of changing the dosage as well as changing brands to fix the problem.

Chuck

[Guest guest]

Do people take Synthroid or the generic Synthroid for T4 replacement only.

Does that mean their Free T4 is not in the upper 1/3 range while their TSH is

elevated? Does everyone with elevated TSH and normal FreeT4/T3 first start with

Armour than move onto T4 and T3 replacements if Armour alone isn't effective?

Armour is a prescription correct?..as is Synthoroid and the generics?

sorry to post so much.

---------------------------------

Relax. virus scanning helps detect nasty viruses!

[Guest guest]

Jack ,

You wrote:

> Do people take Synthroid or the generic Synthroid for T4 replacement

> only. ...

The vast majority of hypoT patients take a synthetic T4 only. I'm one of

them.

> ... Does that mean their Free T4 is not in the upper 1/3 range while

> their TSH is elevated? ...

Most get the prescription due to an elevated TSH test, nothing more.

Most doctors will not even consider measuring T4 or T3 unless there is a

problem with the T4-only prescription. Most will still not check for

antibodies, either, although that is catching on. Again, from the few

doctors I have talked to about this, they tend to only look at the other

tests, when the original prescription fails to work properly.

> ... Does everyone with elevated TSH and normal

> FreeT4/T3 first start with Armour than move onto T4 and T3 replacements

> if Armour alone isn't effective? Armour is a prescription correct?..as

> is Synthoroid and the generics?

My impression is that it usually progresses the other way around. If T4

replacement alone does not work well, some doctors will consider adding

T3 or Armour, which is a T4/T3 combination. Armour is still prescribed

much less often, in spite of recent research that shows that the

addition of T3 helps many people.

Chuck

[Guest guest]

Hi Chuck

you wrote:

>Most get the prescription due to an elevated TSH test, nothing more.

Most doctors will not even consider measuring T4 or T3 unless there is a

problem with the T4-only prescription. Most will still not check for

antibodies, either, although that is catching on. Again, from the few

doctors I have talked to about this, they tend to only look at the other

>tests, when the original prescription fails to work properly.

don't Drs check for FreeT4 before prescribing T4 replacement. mine checked

for both at the same time. my TSH is 2.9 while my FreeT4 is 1.5 (range .8 to

1.8). should I still be pursueing T4 replacement as it looks like im in the

higher range though i've seen ranges go to 2.8. my question is should I start

with T4 first? not sure if T4 is right seeing my levels aren't low for the range

given. if TSH is elevated though T4 is in the range than is it pointless to

treat the TSH? im gonna get my freeT3 checked this wed though it'll be another

week for results and then week after that to follow up with the Dr. i'd like to

get a prescription this visit...not sure to push for T4 replacement or for

Armour.

---------------------------------

Relax. virus scanning helps detect nasty viruses!

[Guest guest]

Jack,

You wrote:

>

> don't Drs check for FreeT4 before prescribing T4 replacement. ...

No, most don't. Mine never did.

> ... my TSH is 2.9 while my FreeT4 is 1.5

> (range .8 to 1.8). should I still be pursueing T4 replacement as it

> looks like im in the higher range though i've seen ranges go to 2.8. ...

That depends. Do you have symptoms?

It is the Free T3 that really counts, but that is more difficult to

measure reliably. Free T4 can be used as an indicator of Free T3, if you

once measure the ratios. By itself, it is only slightly more revealing

than TSH. Both are less reliable if you have active antibodies.

> should I start with T4 first? not sure if T4 is right seeing

> my levels aren't low for the range given. if TSH is elevated though T4

> is in the range than is it pointless to treat the TSH? im gonna get my

> freeT3 checked this wed though it'll be another week for results and

> then week after that to follow up with the Dr. i'd like to get a

> prescription this visit...not sure to push for T4 replacement or for

> Armour.

I would say the best medication depends on whether you have a conversion

problem. That is what the FT3 should tell you. Some on this list will

say Armour is better either way.

Your TSH is not really elevated, unless you are already on Armour or

have antibodies. For an initial screening, it is seems to just be in the

high normal range. What is the published lab range for your test? What

symptoms do you have?

Chuck

[Guest guest]

Hi Chuck:

you wrote:

>Your TSH is not really elevated, unless you are already on Armour or

have antibodies. For an initial screening, it is seems to just be in the

high normal range. What is the published lab range for your test? What

symptoms do you have?

im not on Armour. my symptoms are all that fall under they hyptoT

bucket...nothing less nothing more...well other than fatigue as i don't know how

to define that...though im always tired and blah feeling. also my whole family

pretty much has it. the range given is .3 to 5.5. i measured 2.9. last march

i measured 1.95...didn't have my FreeT4/T3 checked. thanks for ur post. i

think i will ask for Armour as it has everything...no sense in taking multiple

pills when its combined in one right?

[Guest guest]

Jack,

You wrote:

>

> im not on Armour. my symptoms are all that fall under they hyptoT

> bucket...nothing less nothing more...well other than fatigue as i don't

> know how to define that...though im always tired and blah feeling. ...

Could you please give us some specific indications? Tired and blah

feeling is characteristic of thousands of diseases and disorders. What

makes you think it is hypoT, other than the familial pattern?

> ... the range given is .3 to 5.5. i

> measured 2.9. last march i measured 1.95...didn't have my FreeT4/T3

> checked. ...

Even under the revised range suggested by the Endo Society, 2.9 is

normal. How are you hypoT?

Chuck

[Guest guest]

Chuck

you wrote:

>Could you please give us some specific indications?

well my libido has taken a dive over the last year. its been very difficult to

lose weight though i run/work out daily...and the weight that i have put on

doesn't bode with the rest of my body tone. feel bloated and irratable

constantly (my estrogen levels checked normal). hair has been dry/thin/brittle

over last few years but more so this year. also dry skin. face is seems to

retain water over night and goes down once i splash come cold water over my

face. heavy constipation (will not go into details:). intolerance to cold (grew

up in Michigan just fine..now get cold easily). once very keen with memory..now

very forgetful and find it hard to remember simple converstations. this all at

the age of 30. while my TSH is under the normal range, i'm still feeling the

symptoms of Hypo T with exception of brittle fingernails...and while my eyebrows

aren't falling out...i do find strands in my fingers after scratching them.

though TSH is within range i've read several sites that say anything over 2

should be investigated. i don't want to wait anthother year to see if my TSH

goes over the 3 mark.

your thoughts?

---------------------------------

- Helps protect you from nasty viruses.

[Guest guest]

Jack,

Estrogen? Am I perhaps talking to Jack's wife?

You wrote:

>

> ... while my TSH is under the normal range, i'm still

> feeling the symptoms of Hypo T with exception of brittle

> fingernails...and while my eyebrows aren't falling out...i do find

> strands in my fingers after scratching them. ...

Your symptoms do fit the list. However, there are other things besides

failure of the thyroid gland that can cause this constellation. The big

one you are already testing for, the antibodies. Adrenal failure is

another. Several people on this list can tell you about that.

> ... though TSH is within range i've read several sites that say anything

> over 2 should be investigated. ...

Perhaps, but not necessarily treated with replacement hormones. It

depends on the circumstances. I'm over 2.5 right now without symptoms.

Do you eat any soy? Fluoride? Tea? Goitrogenic vegetables?

Chuck

[Guest guest]

Chuck

you asked:

>Estrogen? Am I perhaps talking to Jack's wife?

No this Jack. I mentioned my Estrogen (Estradiol) is in check. I used to take

Propecia up until last year for thinning hair and the concern was my

Testosterone was converting into Estrogen rather than DHT (which is what

propecia prevents it from doing). If that was the case the excess Estrogen can

cause the symptoms of bloating/weight gain/libido/etc.

What/how do u test for Adrenal failure? As for tests and ranges, I gather

several ppl on this board will suggest being symptomatic and having TSH over 2

would call for treatment. I've had the symptoms for close to a year now. I've

had my Testosterone levels checked 4x over the last year with nothing indicating

a pituatory disease or testicular failure...though the symptoms never went away

even after quitting the propecia (which i took for 5 years with no issues)

Having my TSH over 2 and all the symptoms assoc with HypoT along with so many

ppl from my mom's side (including men) having HypoT and getting treated for it

leads me down this path.

>Do you eat any soy? Fluoride? Tea? Goitrogenic vegetables?

don't eat anything out of the ordinary...though i do eat tofu when i order

Thai food which isn't more than 2 or 3x a month and not much of it. don't drink

Tea. not sure what Goitrogenic veggies are.

---------------------------------

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[Guest guest]

What/how do u test for Adrenal failure?

1.Serum Cortisol (Morning and evening)

2.Free Cortisol,24 hr Urine

3.ACTH stimulation

4.ACTH Plasma

5.Saliva Test

Salive test is consisdered most reliable,although testing for adrenals is not

100%.

As for tests and ranges, I gather several ppl on this board will suggest

being symptomatic and having TSH over 2 would call for treatment.

I dont agrete on this.If your Free T3 and Free t4 levels are normal and you

dont have anti-thyroid anti-bodies(TPO,Tg),how taking thyroxine supplements can

be justified is beyond me.

I've had the symptoms for close to a year now. I've had my Testosterone

levels checked 4x over the last year with nothing indicating a pituatory

disease or testicular failure...though the symptoms never went away even after

quitting the propecia (which i took for 5 years with no issues) Having my TSH

over 2 and all the symptoms assoc with HypoT along with so many ppl from my

mom's side (including men) having HypoT and getting treated for it leads me

down this path.

Get tested for Free T3,Free T4 levels and anti-thyroid anti-bodies(TPO,Tg)

---------------------------------

Relax. virus scanning helps detect nasty viruses!

[Guest guest]

Jack,

You wrote:

>... I gather several ppl on this board will suggest being symptomatic and

> having TSH over 2 would call for treatment.

Again, I would check for other things first.

> ... not sure what Goitrogenic veggies are.

Cruciferous, brassica, such as broccoli, cabbage, brussel sprouts, and

cauliflower, especially eaten raw. These attack both the thyroid gland

and inhibit conversion. Soy is even worse, and you need to watch for it

as a hidden ingredient in many " health " foods, not just in tofu.

http://www.ithyroid.com/goitrogens.htm

Chuck

[Guest guest]

hi puneet

you wrote:

>I dont agrete on this.If your Free T3 and Free t4 levels are normal and you

dont have anti-thyroid anti-bodies(TPO,Tg),how taking thyroxine supplements can

be justified is beyond me.

As the website states..slightly elevated TSH with normal FT4 still should

consider treatment if the patient is symptomatic. As for Antibodies...didn't

get them tested. Will have TPO and TG tested six weeks from now. After

discussion with Endo he prescribed 25mg of Synthroid. Has flat out said he

rejects many requests for treatment. He goes by 3 or 4 things..labs, family

history, physical exam (checking for swelling of thyroid gland)and i think heavy

signs (skin, goiters, etc). After I cited some stuff from the website 'Up To

Date' he gave me some 'points' and decided to write the prescription.

---------------------------------

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[Guest guest]

Jeanne,

the psychiatrist at my son's treatment center said that if my son's behavior was

inconsistent during the day, we could cut his pill in half and dose him twice a

day, so he'd get the same daily dose, only split in two. I guess that means

you'd give your child 1/4 pill?

---------------------------------

oneSearch: Finally, mobile search that gives answers, not web links.

---------------------------------

Moody friends. Drama queens. Your life? Nope! - their life, your story.

Play Sims Stories at Games.

[Guest guest]

Hi i been off LDN for 4 days .Will taken a percocet for pain do me harm?