Prozac for anxious out of control 6yo. Help! Advice needed.

[mindinggaps]

Hello, all my 6 year old daughter was recently diagnosed with severe anxiety and prescribed 5mg of Prozac. We feel completely lost right now and are looking for any support, advice or guidance from those who have children on Prozac or any other similar medication. Was medicating the right choice? How did your child respond? Anything you wish you knew in advance?

Background

Our daughter started showing troubling behavior as a toddler and as she grew, the issues escalated. From a young age she has been terrified of everything, afraid to try new activities, scared to interact with new people and generally petrified to participate in developmentally normal things. As a result, she has struggled to integrate with her peers. Perhaps most concerning, unlike most children who adjust as they grow, each year her meltdowns got worse. Lately, she throws tantrums nearly daily that can turn violent to the point where she was a threat to herself or others. She performs very well academically in school but getting her there and through the day is a near impossibility at this point.

We've been trying to get her help for a couple of years. She's been doing "play" therapy for a while but to be honest we have seen little to positive impact from this. Her pediatrician referred us to a child psychiatrist who monitored her for a couple of months and got to know the situation carefully. They did extensive testing and ruled out ASD or any other sensory processing issue. The child psychiatrist diagnosed her with severe GAD and said medication was the way to, starting with Prozac since, according to her, it is safe and effective for young kids.

We hesitated for a few weeks - I am concerned about giving her this medication. However, we're also at our breaking point. Are we doing the right thing?

What happens if you don't pressure her to do anything? So if she expresses fear or worry acknowledge it and reassure her she doesn't have to do anything she doesn't want to? Even if you feel her world is quite small can you build her confidence at home.

Yes, we've tried the gentle approach but she's too afraid to go to school. If we acknowledge her fear and worry about everything and place no external pressure she is unable to leave the house or do anything at all. We are working to build her confidence through therapy and other techniques. Just not sure where to go at this point.

Ahh ok yes I see, if she even wont go to school I can imagine it could end up with her being at home and the situation getting worse.

Oh OP I really feel for you. My daughter is like this, although not as severe, and it is incredibly hard and distressing.

I don’t have any experience of it being prescribed for children but what I will say is that I have been on Prozac for GAD for five years now and it has been transformative. Over the years I’ve tried lots of antidepressants and found them all to be awful. But Prozac changed me from an anxious wreck who obsessed and panicked and worried to the point where I was essentially non-functioning and attempted suicide to a strong, confident, contented woman who can deal with life’s challenges and find joy in the small things. I wish I’d been on it from childhood, I really do. I look back at the way I used to live and I’m so sad for myself. Such a waste.

If the psychologist recommends it, I would go for it.

@peachgreen Thanks for sharing this. In her current state she is exactly as you once felt - obsessed, panicked and worried to the point where she cannot function. It's encouraging to hear how much it has helped you. I do have a lot of concerns about giving it to her so young, but we are at a loss. According to the psychiatrist it is very safe and well studied, but the thought of medicating her without her being fully aware is concerning to me. However, as you said, if you wished you had it as a child maybe this is the right choice.

I don’t want to read and run. This must be so hard. I am sorry you and your child are going through this. I am not an expert in this issue.

Have you tried researching the issue yourself? The below link is helpful re antidepressant and children. You can then ask your doctor questions (eg why not sertraline as it has been fda approved for 6 yrs old).

www.mayoclinic.org/diseases-conditions/teen-depression/in-depth/antidepressants/art-20047502

I know it is frightening to think of medication for such a young child! But you have to reason about whether the status quo (rampant anxiety etc) is more dangerous than any side effects. I don’t know the answer. And I can completely understand how tough this must be.

I would be shocked if a 6 year old required Prozac for GAD. Which country are you in?

Is the Psychiatrist experienced in assessing girls for autism? Many psychiatrists won't be. I would try to find somebody experienced in assessing girls, who can present very subtly.

I would hold off the medicine and seek a second opinion.

@hopelesslydevotedtoGu We are in the US. We have had extensive evaluations for autism twice - once at age 4 and later at age 6. Both negative. She's seen a couple of psychiatrists who confirm this. I'd definitely like to get a second opinion if possible, but confident it is not ASD.

@BeardyButton Thanks, we've done a lot of research. The psych says it is safe and the they regularly treat people this young, but who knows....they are more worried about her in her current state than they are about side effects.

If you are in the US can you ask for an appointment with psychiatrist to talk it through again - without your daughter there.
Is she also seeing a psychologist? In theory medication should be combined with therapy.
Have all blood tests been done to rule out physical reasons for the anxiety eg anemia

@Flowersinmai We will speak further with the psychiatrist for sure. For your other questions, yes she is seeing a therapist and has been for a while. Her pediatrician did blood testing and ruled out physical causes before referral to psych.

As a mum with a DD who was the same age when her anxiety started to cause suicidal ideation I wish we could have started Prozac at that age. Here the NHS sent us through so many loops before finally medicating at 15 for MAD (mixed anxiety) by which time she had developed ptsd as well

Prozac along with ADHD medication completely changed her life but she lost a decade of her childhood because they delayed treatment and has cost a fortune in private therapy to deal with the consequences of the delay

Try the drugs and allow her to enjoy being a child

Do you have any pets? Would that help

Prozac at 6 years old? Knew you had to be in the USA. I'm another one that's wondering about ASD, as the overwhelming majority of children with significant anxiety at that age are on the spectrum.

Even if she is autistic though it doesn’t change the fact of the anxiety. I have an autistic DD similar age and have discussed possible medication for anxiety with her GP. The anxiety is one of the most disabling parts of her daily experience. I would certainly try it if I were you!

@Tomnooktoldmeto Thanks for sharing. I appreciate this feedback. We're definitely worried about not trying the medication as the risks of continuing on the current path seem pretty high. How long as DD been on Prozac? Have there been any side effects?

@nocoolnamesleft Feel free to judge the US for its numerous issues but please at least read the original post before making assumptions. She's been tested for ASD multiple time by expert physicians and I mentioned this in the original post. Assumption is GAD or maybe OCD. Wonder all you want, but we've seen top doctors in the US who surely know more than an armchair expert.

Thanks for sharing. Yes for her the anxiety is pretty debilitating. Given that we've tried everything and it is the recommendation from the psychiatrist, we're thinking of starting the Prozac. However, still a bit apprehensive about side effects, longer term issues, how long will she need to be on it, etc.

@mindinggaps DD has now been on Prozac for 5 years, her younger brother started Sertraline 8 months ago also for GAD and my DH is also treated

All 3 have a mix of ASD/adhd and anxiety which runs through my husband’s family and are only ever settled in life when on medication

Life without the medication has caused untold damage for DH and DD, they may be autistic but the anxiety conditions have led to suicidal ideation and I’ve had to disrupt 2 attempts by DH

Medication has turned the lives around for all 3 and has allowed DD to finally live her life and attend University along with DS where she is finally thriving

@Tomnooktoldmeto Thanks so much for sharing - it is reassuring to hear a positive success story. We're certainly hesitant to medicate so young, but I think a lot of people who haven't lived through the struggle don't understand how hard it can be. It's true that medications may be more common in the US, but I think the concept here is that early intervention prevents longer term problems. There's risks, but the risks of doing nothing are not good.

@mindinggaps i totally agree that it’s hard for people to understand when it’s starts so young but I think you’re actually very lucky to have access to medication so young

Im actually a nurse, now retired but spent 12 years working in paediatrics and so was quite able to understand what was happening with DD however accessing the right care here is very difficult, there are so many ‘gatekeepers’ that send you down pathways to talking therapy etc it’s almost impossible to see a medical practitioner who can actually prescribe medication without going private.

And a lot of the therapy was counterproductive in our case and caused further issues to the point we have spent 4 years with a private therapist to finally unpack all the damage when I believe meds at 7 could have helped her enormously

We were less naive when DS started to display symptoms and paid to see a private psychiatrist, even though we have private health care as it rarely covers mental health in the UK

I wish you good luck, ignore the doom sayers, you know your child. Meds can make a huge difference but don’t be surprised if when she settles and starts to unfold you find other conditions are finally visible. It’s like unpicking a great big knot, eventually you’ll be sat there one day and something quite innocent and age appropriate will happen and you’ll realise you’ve got her back to just being a kid again just like any other girl her age

your DD will have you to thank for being a great mom and caring enough to push the boundaries and get her the care she needs

@mindinggaps I was mis-diagnosed with GAD and pumped full of Prozac. It did absolutely nothing for me as I’m actually autistic and have ADHD. ADHD meds have transformed my life.

I had to battle for the right diagnosis as the psychiatrists I saw on the NHS were adamant I wasn’t neurodivergent.

Has your daughter seem a specialist in neurodiversity and girls?

If your dd had a physical issue you would medicate straight away. GAD is a debilitating illness that does sometimes need medicating to treat.

this is causing your DD to have a low quality of life giving it to her may well allow her to flourish.

I won't express an opinion on prozac. But prescriptions of SSRIs for this age group effectively don't happen in the UK.

The US has a really high rate of prescribing.

I'm a psychologist. I think meds are important as part of a treatment plan. But only ever as part of a plan. I work exclusively with young adults 16-25. Many but not all are on meds. One of our goals is always to ensure they are on minimal meds with other treatment and management strategies in place when we discharge them. Meds are not a long term solution for what, in young people, will often be a soft term problem. And meds are by nature long term.

At 6 I would want to know have you had family therapy and explored together how you respond when your daughter is anxious? Working with her can you come up with a shared consistent strategy to identify one source of her anxiety and work in it with her - she may well find it hard to name which is where play therapy can help. Once you know one area to work on as a team can you identify triggers, strategies to de-escalate anxiety and things that make her feel safe.

It may be school itself is the trigger in which case short term withdrawal with a view to slow reintroduction once her overall anxiety is lower may help.

Meds may be part of that package - but remember they don't cure anxiety. They may reduce her threshold for getting distressed. But ultimately she still needs to learn to feel safe.

She is very young and this is very treatable. Outcomes are very positive in this age group.

The other thing I would be concerned about in a very distressed 6 yr old with ASD ruled out is trauma - has she witnessed anything distressing she has not told you about? Again this is why it is really important to focus on addressing the cause and not treating the symptoms. GAD in that age group is not strongly genetic. In the absence of developmental factors to explain it there are likely to be environmental ones.

@OllytheCollie Following-up on this from a while go, thanks for this thoughtful post - I appreciate the insight rather than direct criticism of medication. We have held off meds for a bit, but now have confirmation that it is in fact OCD. This explains a lot - we started ERP and play therapy and are working through exercises to help us figure out how to manage. We'll see how it goes..

@Tomnooktoldmeto Again, thanks. She's been confirmed to have OCD. Frankly, don't know how much longer we can hold off the meds. Life is not good for her right now.

@mindinggaps so sorry to hear this, you are playing out much like our DD who collected multiple diagnosis’s

If I can give you any comfort and hope DD is now 20 and after having to move to online education for 8 years due to the complexity of her conditions she is now at University albeit living at home for support

DD is thriving, on Saturday a piece of her writing was performed live ( the 2nd in 2 weeks) in a travelling show after it was chosen from hundreds of submissions

Her experience has given her voice wings and she is finally coming to life and it’s beautiful to see

I truly believe that without meditation she wouldn’t be here and I worked in healthcare and spent time in acute psychiatry working with young adults

right now I think you need to listen to her doctor and if they suggest meds give them a try and see

@Tomnooktoldmeto Thank you so much. This is such an ecouraging and inspiring story and I appreciate your time. Do you mind if I shoot you a PM?

I know there is an anti medication bias in the UK, but in the US, there is serious concern that doing nothing can be worse - not acting may have more significant impacts on her development than the risks of side effects.