14yo with multiple issues, ADs not working

[TragicMuse]

As the title says...

My 14yo is currently dealing with
Depression
Anxiety
An eating disorder
Suicidal thoughts
Self harming
Chronic insomnia
Gender dysphoria
A sexual assault (only recently disclosed)
Developmental trauma

The psych prescribed sertraline months ago and it's just not making a difference.

They take it in the morning but the insomnia is worse than ever. They've now been up for over 48 hours, are exhausted and still can't sleep.

Our local Camhs has been woeful. They've got us on the waiting list, it's 8 months. My child said 'I'll probably be dead by then'.

We need a medication review, but what should I be asking for? Fluoxetine, Escitalopram? I don't know. They are reluctant to offer anything for the insomnia beyond melatonin or anti-histamine, neither of which have worked. At all. We're up to 50mg of anti-histamine and still nothing.

I don't know what to do to get them to hear us and act...

Anti d's often have unpredictable effects on under 18s.
But they tend to work differently from person to person rather than being the same for everyone so it's hard to recommend one.

Has your child tried to access support from the local rape crisis after the sexual assault? Some can also support family members.

And could your child be neurodivergent? If so, luke beardon's books on anxiety might be good.

Camhs are often woeful. If there are any charities offering support it might be quicker and better.

Sorry to hear this. I can't offer advice on NHS help as my DD was diagnosed overseas. Escitalopram has been perfect for her, after a few trials with other meds.
CBT and simply being heard was also key to her stability. Can you afford private therapy? It's worth it.

I was also thinking neurodivergent and could be worth exploring.

Anyway, sleep. This is going to be the first hill to tackle today, I think. I hate to suggest this, but you, and your DC sound desperate, but Night Nurse tablets? I don't know what's in them but I took them for the first time last week and slept like a baby for a change.

Anti-histamines (what did you try? Piriton?) often have the completely opposite affect than expected, making some people almost 'speedy'.

Circadin, which is just a form of Melatonin is often prescribed for under 18s to help with sleep. CAHMS regularly prescribe this, maybe ask your GP for this, they often won’t until CAHMS have seen your child but worth a try.

Fluoxetine can work well but be aware you have to start on a low dose that isn’t an antidepressant before moving up to a dose that is. It’s side effects can be suicidal tendencies so please be aware if your child is prescribed this.

I wish you well, it sounds like you are having a really hard time.

Is your child a boy or a girl? Asking because there are quite different presentations of eating disorders and gender dysphoria.

I would do everything you possibly can to get a private psychiatry appointment ASAP. There's no justice in it, but CAMHS are in shambles - not their fault, but when it comes to any individual making decisions for their own child, the best thing you can do is go round them and put things in place for yourself.

Why do you think the melatonin didn't work? Was the DC using screens at night?

Thanks all.

I meant to add that we have adoption in the mix too which complicates things. But we do get access to support from children's social services at least. And they are helping, we get some therapies from the ASF. But they aren't clinical practitioners and they can't prescribe, of course.

SuperLoud - we are just about to get some support for the SA from a local support charity. I don't know what but it's in a couple of weeks.

I don't know if they're ND as such. It's never been picked up, though I know it's less often identified in one sex than the other. They are female-sexed but NB and edging into trans (which is a whole other post!) My gut feeling is that it's more the childhood trauma rather than ND, I have a number of ND female friends and my child doesn't really seem to align much or at all with the criteria.

The anti-histamine is promethazine (old fashioned Phenergan). We've tried Circadin too, that did not a thing.
Our GP won't even look at changing the prescription because they weren't involved in the original prescribing, that was from a Camhs psychiatrist but not one they did therapy of any kind. And who also wrote the entire opposite of what our child said in the discharge letter. So we are on the loop back to Camhs for the medications but it's so slow.

They don't use screens at night. I have a sleep disorder so I am VERY well versed on good sleep hygiene. We've got weighted blankets, dark curtains, no caffeine, curfewed devices...

They just don't go to sleep. Their head is full of noise. We've tried sounds and music, they didn't work either.

I feel like we lurch from one day to the next. I have all sharp things and all meds locked away but I wake up every morning thinking that this might be the day. My cortisol is a mess.

We've tried CBT and a local eating disorder organisation.

CBT was not a success. The ED charity were TERRIBLE. Just entirely unhelpful and unsupportive in all ways.

It's so defeating.

Okay, thanks. Yes, it sounds like it's probably all or mostly coming from trauma. (I'm an adult with PTSD and now-stable-ish anorexia, have done 15 years of therapy privately which has helped immensely.)

Definitely suggest you go on the 'Around the dinner table' forum. It sounds like the ED is at a level where they're not currently looking at admission for your DC, in which case you will be primary meal support.

Thanks Innocenta, I'll look at that forum.

@TragicMuse

We've tried CBT and a local eating disorder organisation.

CBT was not a success. The ED charity were TERRIBLE. Just entirely unhelpful and unsupportive in all ways.

It's so defeating.

I think investigating the trauma with a good psychotherapist (not CBT, not person centred) would be a good move

CBT doesn’t touch the sides with trauma

My DC sounds similar to yours.

The worst thing for us has been the sleep and the lack of it then makes the other issues so much worse.

We had Circadin prescribed and it wasn't anywhere near as effective as melatonin in liquid form.

I believe Circadin is widely used for children with autism and that it is a slow release to keep them asleep rather than continually waking. That wasn't our issue which might be why the melatonin liquid has been more successful.

We ordered it from America but I think there are uk options on the internet.