Would you start a 16 yr old on Citalopram weeks before exams?

[Katisha]

DS has anxiety and occasional panic attacks but otherwise seems his usual self - does his revision, his weekend job, all the usual things he'd be doing.
He says it feels like a feeling in his chest, fight or flight.
He was prescribed beta blockers couple of weeks ago but says they are not having any effect
Dr today says to go on to Citalopram but I am concerned about doing this weeks before GCSEs start as I've read of the tiredness and nausea at first.
Any advice? My instinct would be to try upping the dose of the beta blockers in case the Citalopram knocks him off course in these crucial weeks, but I'm no expert.

Does he want to try the pills or does he think stuff like mindfulness or exercise could see him through?
Have you spoken to the school? Can they help at all?

Absolutely not
Start after exams yes but not before. They take weeks to take effect and make you feel worse to begin with, and not everyone gets on with the drug or dose given. No definitely not in a million years before an important event

I'm not sure upping beta blockers good idea as can reduce alertness etc so need to test run it first but better idea than starting ADs now.
I would say make sure getting enough sleep, encourage daily exercise outside, eat well, plan something nice for after the exams, then start ADs afterwards

Yes been been though it all with school and counseller from local youth centre and he's received some counselling but we won't have access to anything else any time soon.
He wants to try the pills for a couple of days to see if he gets bad side effects and stop if he does. Is this an option?

I really think that's a terrible idea. These are SSRIs which can make you feel worse to begin with and wont show benefit as quickly as exams. I think the risks far outweigh the benefits. It's not a fast cure in 2 weeks. He needs to slowly titrate the dose up to an appropriate level and leave it there for some time to see benefit. Stopping suddenly can be dangerous, too.

Is the counselling ongoing? Breathing exercises and some psychoeducation around feelings of panic can be incredibly helpful with the symptoms you describe.

Are his school aware of the issues? What arrangements have they put in place to support him? Have you considered applying for special consideration for him?

The doctor cannot psychically know exactly how your ds will respond to citalopram - everyone is different. Citalopram for anxiety does tend to be prescribed at a lower dose than for depression though.

It is possible that citalopram may impact on your ds' exam performance. But this must be balanced against the likelihood that his anxiety will impact on his exams as well, and possibly more so. My feeling is that the doctor was right to leave this decision to your ds - only he knows exactly how he really feels.

Finally, it should be remembered that there are many things more important than exams, and that even if he failed them all - and failed all the resits - the sky will not fall in.

I started on a 10mg dose a month ago and I felt better within days.
No real side effects apart from a dry mouth and some strange dreams.

And yes, if he tries the pills and they make him feel worse he can stop taking them.

What strength has he been prescribed? I’ve been on up to 40mg a day and apart from the first 24 hours feeling strange, they have definitely been helpful. They won’t necessarily make motivation go down - I have studies for exams whilst on citalopram and done very well. It obviously differs between individuals though. How does he feel about it?

How many weeks does he have until his exams?

When I first started citalopram I had side affects. I was nauseous, and I had excessive yawning, I was dizzy and had fatigue . Supposedly it was affecting my Vasovagal. I still have excessive yawning but the nausea is gone. I've been on it a year and a half and it's helped my anxiety. If I forget to take it I get dizzy and tired.

Just wanted to share my experience. I had rare side affects.

I think that your questions are very good ones and need to be discussed with a professional. Could you write a list of any questions you or your son have and give the GP a call to go through them. Stopping and starting meds can cause all sorts of problems, so I really wouldn't recommend doing it two weeks before exams without discussing with a pro. It is also important that you both have a full picture of potential sideeffecfs before he starts taking them.

He's been prescribed 10mg a day. Exams start mid May

One of the big problems with mental health meds is that gps often don't know enough about them, and yet it's nigh on impossible to see a psychiatrist to discuss them. As is clear in all the responses, people's bodies can react so differently to them, it's v v hard to generalise. I've seen lives changed hugely for the better from taking meds, and also know people who are trapped on them because the physical effects of coming off them are absolutely unbearable. It's an absolute minefield.

That's why I think education about mental health is so vital, and why understanding why our bodies respond the way they do to feelings of fear and threat.

No. It fucked me for weeks I was totally spaced and anxious before it got better.

Last year we saw our super fit, super calm and confident (competes at national level in his sport) 16yr old totally floored by anxiety a few weeks before his GCSE's.

GP prescribed Propranolol (BetaBlocker) it didn't have any effect, DS was physically being sick every morning and panicing so badly that he couldn't catch the bus to school and walked the 3 miles every day. He also couldn't eat.

Took him back to GP, they doubled the dosage of Propranolol and the change was miraculous. He got through the exams, and is now settled into his A levels with no more panic attacks or feelings of anxiety. He came off the Beta blockers the moment the exams finished (they aren't allowed in his sport!).

In your situation I would go back to the GP and explain your fears.

I hate what the state education system does to kids. School made him sit 13GCSEs, his brother is sitting the same number this year. Friends DC at private school do no more than 9 to allow them to focus on them properly.

Good luck to you both

Is it your GP that wants to prescribe citalopram? I am quite surprised because guidance is that these type of meds should only be initiated by a specialist ie adolescent psychiatrist for young people under the age of 18. For good reason. Has your GP also explained that Citalopram is actually not licensed for use in young people under 18, and so he would be prescribing it off licence? Also have you had a thorough discussion around ALL the possible side effects? And what are your GP's plans for monitoring for side effects?
I don't want to frighten you but have a look here for more info on the use of citalopram in young people:
www.headmeds.org.uk/medications/10-citalopram/warning_and_side_effects
It is a good medication, and CAN be really helpful for anxiety in adults. It is more complicated in young people/adolescents under 18, though is still used with good effect occasionally.
Generally for anxiety disorders though all the evidence base suggests that targeted psychological interventions (eg cbt by a qualified therapist) is the best option.
With regard to side effects there is a chance that your ds may experience an initial INCREASE in anxiety - which may be unhelpful right before exams. All side effect will be worse in the first 1- 2 weeks and the positive effects will not be apparent fully for around 2-4 weeks. Trying the medication for a couple of days is a bad idea as it will ONLY produce side effects and will not give his body chance to adjust to the medication and for any positive effects to take hole. I suggest you go and speak to your gp in more detail, ask about proper psychological interventions and maybe a referral to CAMHS.
Good luck to you and your ds.

I'm on them and had no reaction at all to them. I know everyone is different but you have enough time to give them a go for a month before exams.
Good luck to your DS x

I was prescribed it a few years ago and had bad side effects so stopped taking it. I was exhausted. Slept for hours on the sofa during the day. And my heart felt like it would beat right out of my chest.

I had those panicky feelings and found Bach Rescue Remedy helped. To my surprise as I was sceptical. Had a bit of a panic attack at the hairdressers one day and she gave me some to try and I was amazed that it helped.

Also acupuncture can help with stress.

I would research upping the beta blockers before trying citalopram. DS was on Propanolol last year for migraines and it didn’t help but we discussed later with a paediatric neurologist and he said DS wasn’t on them long enough or at the right dose.

Also forgot to mention. Your son won’t feel any effect from the tablets for at least 2 weeks (although he will experience any possible side effects straight away) and it takes roughly up to 6 weeks before they work to their full effect. Just something to keep in mind!

DS aged 18 started 20mg citalopram 3 months ago. He's always been prone to anxiety and low mood and got by just with counselling a couple of years ago.
He's now living away from home and on the outside, functioning perfectly normally in a more than full-time job, but recognised that he was literally 'dying inside ' and didn't know how to cope.
He's started talking therapy in conjunction with the citalopram but is only now finding the citalopram is settling him down rather than making him feel much worse - extreme fatigue but unable to sleep, nauseous, generally unsettled.
As others have said, everyone reacts differently but this close to GCSE's, other strategies might be safer for your DS. Good luck to you both.

I'd wait until after exams. I started on ssris about 7 months ago and was much worse for the first few weeks, but fine now! I would definitely do it after though. I've had depression and anxiety since 15 and was fobbed off for years until I finally suffered a huge nervous breakdown aged 28 and pregnant. I can't help but feel anger that nobody helped me sooner. Do this for your son and hopefully you can avoid the absolute waste of early adulthood that I experienced! Good luck to you both!

I'm amazed your GP has prescribed antidepressants to your DS due to his age, as I've just taken my DS just about to undertake his GCSES to the GP and even though he is showing symptoms of depression;(triggered from a bereavement) anxiety, not sleeping, not enjoying life anymore, withdrawing from his friends, I've been told that the policy is that GPs are unable to prescribe antidepressants to under 18 year olds.

I've been told to go down the herbal/natural route (kalms, St John's Wort) and school counselling,at least until his exams are over. If symptoms are not subsiding in a couple of weeks, I have to go back to the GP and they will refer him to a specialist team.

I wouldn't risk it, the side effects are horrendous. I felt like a zombie and as if I was in thick fog for weeks. Not the best time to to be starting antidepressants.

As has been mentioned, everybody responds differently especially as regards to side-effects.

But for me one of the scariest side effects for Citalopram was memory loss, my memory was not great anyway but it was destroyed during that time. I was completely non-functional at work, and the six weeks I was on it, I can barely remember anything about that time either. I felt a lot more content whilst my reality got much worse.

Given how important memory is for exams, I'd be very careful just in case he reacts like I do. That said, there's still time to try them, and come off if he does react badly.

Somebody mentioned CBD oil - it has more of an immediate effect (or so it seems to me, anyway) so it might be worth looking into until post exam. For me at least, it does reduce anxiety without affecting me cognitively.

@Shattered04

What's CDB oil?

It's cannabis oil, without the THC (high) part of it so it can be legally bought and used in the UK. Even Holland and Barrett do it, although in our local branch it was behind the counter, probably because it's quite pricey. It's cheaper and better quality from various specialist online retailers. It's usually sprayed under the tongue a few times a day.

As always, it's a case of do your own research, although unlike many supplements, there does seem to be genuine published medical evidence backing up a lot of the claims, which aren't restricted to mental health. It doesn't always work on anxiety etc for everyone though.