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18yr dd struggling so badly

26 replies

springbringshope · 01/04/2025 18:22

My dd has been struggling with really bad anxiety for the past 3-4 years. She was an extremely easy and fun young child but as life has become more intense, her MH has taken a nose dive. She was diagnosed with adhd a year and a half ago and I have no doubts that her neuro diversity with regards to school work has been a big part of the issue.
she is very bright and academically able but exams have always been a bit up and down. But she has done ok. Just not to her full potential but good enough that there is nothing holding her back.
but her anxiety built and built until she was having terrible exam panic attacks. And panic attacks in the days and nights leading up to the exams.

she was on sertraline for about 7 months but after being up on 150mg and still having terrible panics the psychiatrist decided (with our agreement) to try citalopram.
She’s been on citalopram now for 4 weeks doing up from 20 to 30 to 40. So really fast. She’s been on 40 2 weeks.

She’s just not happy. She said her emotions are blunt. She feels no joy. She has had panic attacks most days but she thinks they are due to the side effects of starting the new medication and titrating up fast. She’s on 40mg and just feels so sick of it all. She’s says she’s sick of feeling blunt. Sick of the side effect headaches. Sick of still having panic attacks.

im hoping this is still the settling in period but I am so stressed she’s going to stop taking them or that they aren’t the right ones. Or that’s she’s just going to go further and further down a spiral.

I don’t even know what I’m asking for here. Advice? Experience?

OP posts:
AnyUmbrellasToFixToday · 01/04/2025 20:50

That's a very rapid increase in the meds over a month and my reflex would be that she's overmedicated, so a lower dose would make more sense.

I'm curious about the psychiatrist and presume that a bunch of prescriptions over a short time, or at the least phone consultations to monitor the dose changes, means they're a private doctor?

springbringshope · 01/04/2025 22:17

Psychiatrist is an NHS and private consultant and yes we see him privately at a leading hospital. The titration is rapid but guidelines state you can titrate with as little as a week between doses and as the anxiety was extreme the view was taken to get her up to a higher dose quickly. Consultations can be in person or zoom. We have done both.

OP posts:
AnyUmbrellasToFixToday · 01/04/2025 22:52

Settling in period is usually around five to six weeks for SSRI, but that will reset with each titration.

I am reading between the lines (but that is my job) but wondering whether you had considered her experience might be (rightly or wrongly) that parental pressure to perform, and to grow up successfully and be the kind of person who gets private medical treatment for their children, "at a leading hospital," might be part of the cause of her panic? I wonder why medication and not a proper psychotherapy to explore causes and work it through? Does she feel like a problem you want fixed?

Maitri108 · 01/04/2025 22:54

I would suggest working on emotional regulation and perhaps DBT.

Does she exercise, have a good diet, get lots of fresh air? What about beta blockers for the panic attacks?

JazzyBBBG · 01/04/2025 22:57

Sorry to hijack but may I ask what symptoms of ADHD are apparent as I am wondering about this with my own DD and some things sound similar here but it is hard when they are classed as "academic."
I hope she will be ok.

Middleagedstriker · 01/04/2025 22:57

What does she do apart from medication. I had terrible mental health as a teen had to do lots to work through it. Diet, exercise and having a job helped.

Midnightlove · 01/04/2025 23:06

I agree it does sound like she's gone up to the maximum dose of citalopram so quickly. No wonder her her anxiety is sky high if she is getting such a high dose settling into her system. Has she been offered beta blockers? I take 40mg propanalol 3x a day for panic attacks which have been bad since having to change my meds, they really do help

springbringshope · 02/04/2025 16:39

AnyUmbrellasToFixToday · 01/04/2025 22:52

Settling in period is usually around five to six weeks for SSRI, but that will reset with each titration.

I am reading between the lines (but that is my job) but wondering whether you had considered her experience might be (rightly or wrongly) that parental pressure to perform, and to grow up successfully and be the kind of person who gets private medical treatment for their children, "at a leading hospital," might be part of the cause of her panic? I wonder why medication and not a proper psychotherapy to explore causes and work it through? Does she feel like a problem you want fixed?

I may be sensitive but you do sound like you have jumped in with a narrative you carry regarding middle class people.
firstly she is our youngest so we have learned an awful lot about parental pressure with our eldest dcs and seeing the devastating outcomes with some of their friends (suicide). We have always maintained healthy communication with our dd. She is remarkably good at advocating for herself and incredibly self aware.
secondly, she sees a psychologist weekly or fortnightly for talking therapies CBT and EMDR. We are not pill shovelling parents. She is not some pampered princess with attention seeking issues or rebelling against her helicopter parents. She is a strong, independent young woman from a family genetically predisposed to mental health issues. She is completely fed up of feeling the way she is feeling and we are simply approaching her very very severe anxiety and panic disorder from every angle we can.

OP posts:
springbringshope · 02/04/2025 16:45

Maitri108 · 01/04/2025 22:54

I would suggest working on emotional regulation and perhaps DBT.

Does she exercise, have a good diet, get lots of fresh air? What about beta blockers for the panic attacks?

Do you mean CBT? I don’t know DBT. she has CBT. Until very recently she exercised a lot. She has in the past 4 weeks with the side effects of new medication been much less active but previous and for years rode her horse 5x a week and trained at the gym 5-6x a week. Very strong, very active. We are hoping as the side effects wear off and with the sunny weather she will rediscover her love of action and activity. It’s hard to know when to cajole and when to just back the heck off. Because she’s never needed much pushing to get out and do things, we’ve been much more waiting for her to make the moves. With just gentle reminders eg: ‘lovely day, I’m driving into xxxxx. Would you want a lift to the stables today’
beta blockers were a disaster. Turns out she has POTs and they just keep your heart rate down so she was fainting on them.

OP posts:
springbringshope · 02/04/2025 16:55

JazzyBBBG · 01/04/2025 22:57

Sorry to hijack but may I ask what symptoms of ADHD are apparent as I am wondering about this with my own DD and some things sound similar here but it is hard when they are classed as "academic."
I hope she will be ok.

My dd is also considered academic. It really was only around the end of year 11 start of 6th form that the anxiety spiralled. Prior to this we were not aware beyond knowing she was ‘a little anxious’ around exams. But as it seemed within the realms of normal anxiety we didn’t know how deep it ran.
How does it show up? Actually quite standard for a bright female. Lots of stuff online regarding women with adhd.
adhdchatter is quite good on Instagram for posts on women with ADHD.

lots of zoning out. Looked like daydreaming. Got super into whatever she was doing which I realise now was actually hyper focussing. Her tests and exams were always fine but never quite up to what teachers thought she would achieve. So underperforming in tests relative to her understanding and class work. Used to have a spotless room. Now looks like a bomb site. I don’t mean messy. I mean complete chaos 😂 starts cleaning but ends up designing a bed structure for the dogs and then realising 4 hours later that she has made the room messier than ever.
Seperatelybut often present in people with ADHD , she’s a skin picker. Will lose hours picking and plucking.
super fast to pick things up. Super quick brain. Very able to see social dynamics and read who is trustworthy and who is best avoided.
Signs and symptoms are often very late to become apparent with some women because girls often are naturally able to multitask and are good at masking impulsive behaviours better than boys. They are often better at appearing to have patience and wait their turn etc than boys if a similar age with adhd. Often they will be bored but rather than act out or speak out of turn they will zone out instead.

OP posts:
springbringshope · 02/04/2025 16:58

Midnightlove · 01/04/2025 23:06

I agree it does sound like she's gone up to the maximum dose of citalopram so quickly. No wonder her her anxiety is sky high if she is getting such a high dose settling into her system. Has she been offered beta blockers? I take 40mg propanalol 3x a day for panic attacks which have been bad since having to change my meds, they really do help

Edited

Yes tried BB. Not good for her. Just made her light headed and sick unfortunately
She was titrated up fast due to the severity of her anxiety and panic. She was very very severe. Not severe enough to be hospitalised and given intravenously but bad enough to warrant a speedy titration

OP posts:
Maitri108 · 02/04/2025 16:59

DBT is specifically for people who have difficulty regulating their emotions.

There's some information here on panic attacks.

Fresh air, exercise, good diet, yoga, social engagement, keeping busy will all benefit her.

Young Minds has a good helpline and other resources for both of you.

springbringshope · 02/04/2025 17:01

Middleagedstriker · 01/04/2025 22:57

What does she do apart from medication. I had terrible mental health as a teen had to do lots to work through it. Diet, exercise and having a job helped.

Used to exercise a lot. The past 3-4 weeks not so due to the side effects of introducing citalopram making her sleepy and anxious. Hoping she will rediscover her love for action and activity as the side effects calm down. I just pray this is the right medication and I don’t want her to have to keep going through this process of finding the ‘right’ medication
had a part time job for a few years but it closed down a year or so ago and she hasn’t worked since then. But she was very active riding 4-5x a week and gym 5-6x a week

OP posts:
springbringshope · 02/04/2025 17:05

Maitri108 · 02/04/2025 16:59

DBT is specifically for people who have difficulty regulating their emotions.

There's some information here on panic attacks.

Fresh air, exercise, good diet, yoga, social engagement, keeping busy will all benefit her.

Young Minds has a good helpline and other resources for both of you.

Edited

Oh that’s interesting. I read DBT has evolved out of CBT and is good for depression and anxiety.
She does have CBT and also EMDR which is specifically supposed to be good for panic attacks.
I will speak with her psychologist about DBT. I wonder if it will be any better than CBT + EMDR but everything is worth considering 🙏

OP posts:
springbringshope · 02/04/2025 17:05

Midnightlove · 01/04/2025 23:06

I agree it does sound like she's gone up to the maximum dose of citalopram so quickly. No wonder her her anxiety is sky high if she is getting such a high dose settling into her system. Has she been offered beta blockers? I take 40mg propanalol 3x a day for panic attacks which have been bad since having to change my meds, they really do help

Edited

What meds did you change from and to? Have you been in the new med long and has it started to help you in any way yet?

OP posts:
springbringshope · 02/04/2025 17:06

Middleagedstriker · 01/04/2025 22:57

What does she do apart from medication. I had terrible mental health as a teen had to do lots to work through it. Diet, exercise and having a job helped.

do you mind sharing what you did when you say you had to do a lot of work to get through it as a teen?

OP posts:
springbringshope · 02/04/2025 17:09

AnyUmbrellasToFixToday · 01/04/2025 22:52

Settling in period is usually around five to six weeks for SSRI, but that will reset with each titration.

I am reading between the lines (but that is my job) but wondering whether you had considered her experience might be (rightly or wrongly) that parental pressure to perform, and to grow up successfully and be the kind of person who gets private medical treatment for their children, "at a leading hospital," might be part of the cause of her panic? I wonder why medication and not a proper psychotherapy to explore causes and work it through? Does she feel like a problem you want fixed?

My using ‘at a leading hospital’ wasn’t to brag. It was just to put your mind at rest that the psychiatrist isn’t some random poorly qualified money grabbing quack. I know there are a lot of clinics opening up with slightly dubious motivations. He really is lovely and works in the nhs as well as in his private practice.

OP posts:
Midnightlove · 02/04/2025 17:25

springbringshope · 02/04/2025 17:05

What meds did you change from and to? Have you been in the new med long and has it started to help you in any way yet?

I was on citalopram for 15 years, it worked great for me. Unfortunately I'd have to increase my dose every few years as my body got used to it, and I had no further I could increase it too.
I'm now on fluoxetine. 4 weeks at 20mg and 3 weeks at 40mg, I'm only just feeling them starting to work this last week to be honest. It's been really rough with the increased anxiety!

springbringshope · 02/04/2025 17:58

Midnightlove · 02/04/2025 17:25

I was on citalopram for 15 years, it worked great for me. Unfortunately I'd have to increase my dose every few years as my body got used to it, and I had no further I could increase it too.
I'm now on fluoxetine. 4 weeks at 20mg and 3 weeks at 40mg, I'm only just feeling them starting to work this last week to be honest. It's been really rough with the increased anxiety!

Well you give me hope then. If it’s been this long and you are now starting to feel something good but that during the introduction and titration period you felt increased anxiety then maybe my dd will also feel benefits soon. It’s so hard waiting wondering if the awful
bit now is in the lead up to success or a conclusion that it’s not the right medication.

OP posts:
AnyUmbrellasToFixToday · 02/04/2025 18:49

@springbringshope
I may be sensitive but you do sound like you have jumped in with a narrative you carry regarding middle class people.
You might say sensitive, but one could also wonder if you're being defensive. Any assumptions I have made were because of the absence of contrary information. The whimsical narrative I provided was because your original post was missing a lot of information. My professional experience of this is predominantly as I described.

firstly she is our youngest so we have learned an awful lot about parental pressure with our eldest dcs and seeing the devastating outcomes with some of their friends (suicide). We have always maintained healthy communication with our dd. She is remarkably good at advocating for herself and incredibly self aware.
I hear this a lot and one thing I have shared with parents, health visitors and school nurses is to avoid any ideas that you can learn about one child by parenting another; children tend to figure out their own unique niches in the family, often avoiding as much overlap in the Venn diagram of parental attention. I am sorry to hear that your other children have had those experiences, but equally children, especially teenagers and young adults, are very good at keeping secrets and not raising suspicion. You very rarely hear about normal children who struggle killing themselves, it is either those who have been 'let down by the system' or 'nobody would have known'.

[S]econdly, she sees a psychologist weekly or fortnightly for talking therapies CBT and EMDR. We are not pill shovelling parents.
This is important context that was missing from your OP. My narrative was based on the fact that this was missing. Your priority, reading this OP was about her exams and academic capacities, it reads like they are your concerns.
Secondly, talking therapies and CBT are (almost) the same thing, and EMDR is a trauma therapy, so here is something else missing from the OP.
Edit: I acknowledge your later post saying that this is for the panic, but the evidence for EMDR in panic disorders is only that it is, "better than sitting on a waiting list."

She is not some pampered princess with attention seeking issues or rebelling against her helicopter parents.
I have never in my whole professional life worked with an attention-seeking pampered princess. The closest would be attention-needing, emotionally neglected princesses, whose parents might ask me, "I bought her a yacht for her birthday, I don't know what she has to be depressed about." My post placed no judgement or blame on DD.

She is completely fed up of feeling the way she is feeling and we are simply approaching her very very severe anxiety and panic disorder from every angle we can.
Except you're not... this was my point... not one of judgement about your profound wealth, but your lack of curiosity about her.
You have decided she is genetically predisposed.
You have decided that all of her difficulties are because she is a girl with ADHD
You have taken her to the best private psychiatrist you can, who will reinforce the biological model, even though the medication isn't working.
You've probably gotten her a really expensive psychologist who can do all of the therapies that she needs... and she is getting worse.
Why is her mental health worse now than before, but there's no mention of a review and change of tack. As another poster mentioned, DBT or EmReg might be helpful for her, but if the problems aren't purely genetic or ADHD-related, then psychoanalysis would likely help (and you'll love it, it's super expensive; very NW8! [also available in the NHS in some places])

I might be completely wrong, I occasionally am, and I don't know you from Adam, and this is just a short Mumnet post, but my point was that all you mentioned at the beginning was your anxiety about her exam results, the private psychiatrist and the medication, and your desperation. The only part that seemed to belong to her was the description of feeling blunted (which is usually a sign of being overmedicated)

JazzyBBBG · 02/04/2025 19:05

Thanks for replying.

springbringshope · 02/04/2025 19:24

AnyUmbrellasToFixToday · 02/04/2025 18:49

@springbringshope
I may be sensitive but you do sound like you have jumped in with a narrative you carry regarding middle class people.
You might say sensitive, but one could also wonder if you're being defensive. Any assumptions I have made were because of the absence of contrary information. The whimsical narrative I provided was because your original post was missing a lot of information. My professional experience of this is predominantly as I described.

firstly she is our youngest so we have learned an awful lot about parental pressure with our eldest dcs and seeing the devastating outcomes with some of their friends (suicide). We have always maintained healthy communication with our dd. She is remarkably good at advocating for herself and incredibly self aware.
I hear this a lot and one thing I have shared with parents, health visitors and school nurses is to avoid any ideas that you can learn about one child by parenting another; children tend to figure out their own unique niches in the family, often avoiding as much overlap in the Venn diagram of parental attention. I am sorry to hear that your other children have had those experiences, but equally children, especially teenagers and young adults, are very good at keeping secrets and not raising suspicion. You very rarely hear about normal children who struggle killing themselves, it is either those who have been 'let down by the system' or 'nobody would have known'.

[S]econdly, she sees a psychologist weekly or fortnightly for talking therapies CBT and EMDR. We are not pill shovelling parents.
This is important context that was missing from your OP. My narrative was based on the fact that this was missing. Your priority, reading this OP was about her exams and academic capacities, it reads like they are your concerns.
Secondly, talking therapies and CBT are (almost) the same thing, and EMDR is a trauma therapy, so here is something else missing from the OP.
Edit: I acknowledge your later post saying that this is for the panic, but the evidence for EMDR in panic disorders is only that it is, "better than sitting on a waiting list."

She is not some pampered princess with attention seeking issues or rebelling against her helicopter parents.
I have never in my whole professional life worked with an attention-seeking pampered princess. The closest would be attention-needing, emotionally neglected princesses, whose parents might ask me, "I bought her a yacht for her birthday, I don't know what she has to be depressed about." My post placed no judgement or blame on DD.

She is completely fed up of feeling the way she is feeling and we are simply approaching her very very severe anxiety and panic disorder from every angle we can.
Except you're not... this was my point... not one of judgement about your profound wealth, but your lack of curiosity about her.
You have decided she is genetically predisposed.
You have decided that all of her difficulties are because she is a girl with ADHD
You have taken her to the best private psychiatrist you can, who will reinforce the biological model, even though the medication isn't working.
You've probably gotten her a really expensive psychologist who can do all of the therapies that she needs... and she is getting worse.
Why is her mental health worse now than before, but there's no mention of a review and change of tack. As another poster mentioned, DBT or EmReg might be helpful for her, but if the problems aren't purely genetic or ADHD-related, then psychoanalysis would likely help (and you'll love it, it's super expensive; very NW8! [also available in the NHS in some places])

I might be completely wrong, I occasionally am, and I don't know you from Adam, and this is just a short Mumnet post, but my point was that all you mentioned at the beginning was your anxiety about her exam results, the private psychiatrist and the medication, and your desperation. The only part that seemed to belong to her was the description of feeling blunted (which is usually a sign of being overmedicated)

Edited

Look I’m sure you mean well most people who work in the area of mental health do. But saying this in the calmest and most tactful way I can but as a professional you of all people should know that trying to assess and diagnose people via a forum is inappropriate and not just a little unethical.
I am not sure what your actual profession is but your manner of communication is hostile and accusatory. It is also very much tainted with an awful lot of ‘gotchas’. None of these is what I would expect to see in a mental health professional even one at the lowest level of qualification or position.
We are all very happy with the highly trained, experienced and qualified psychologist and psychiatrist we have on board. Most importantly our dd is very happy with them.
Please refrain from commenting further as you seem to be demonstrating some need to contradict, diagnose and come up with conclusions based on a handful of posts on MN. You are also attempting to over-ride the decisions and treatments suggested by these qualified specialists who have actually met with us and our dd. This is a very questionable action on your part.
Im not sure where you got the idea that EMDR is better than waiting on a wait list only. It is considered a useful and valuable tool in resolving triggers for panic disorders. Your lack of knowledge in this area dues make me question what professional position you hold.

No one demonstrating this lack of professionalism or ethics is someone I would ever listen to. So any future posts by you will be disregarded.
Please consider your position as your approach is frankly concerning and as I have repeated several times, lacking professional ethics.

OP posts:
Notgoodatpoetrybutgreatatlit · 02/04/2025 19:40

@AnyUmbrellasToFixToday
Well I'm sold. I've not thought of psychoanalysis, I'm going to look into it now. I love the idea that it's for self indulgent rich people, that sounds like me!
But I'm a South London Nationalist so I'm not going into those ends. I hope I can find one in Central London.
Seriously OP, it's the Internet people post all manner of stuff. But I hope your daughter feels better. My poor brother had bipolar and he hated that feeling of not feeling.

Midnightlove · 02/04/2025 20:09

springbringshope · 02/04/2025 17:58

Well you give me hope then. If it’s been this long and you are now starting to feel something good but that during the introduction and titration period you felt increased anxiety then maybe my dd will also feel benefits soon. It’s so hard waiting wondering if the awful
bit now is in the lead up to success or a conclusion that it’s not the right medication.

I felt AWFUL! Which is something I didn't experience when starting citalopram so came as a shock, but is apparently common. I was about to give up with it just a week ago because I felt they weren't working. I'm guessing it's the increase to 40mg that's helped. Fingers crossed for her

springbringshope · 02/04/2025 20:51

Notgoodatpoetrybutgreatatlit · 02/04/2025 19:40

@AnyUmbrellasToFixToday
Well I'm sold. I've not thought of psychoanalysis, I'm going to look into it now. I love the idea that it's for self indulgent rich people, that sounds like me!
But I'm a South London Nationalist so I'm not going into those ends. I hope I can find one in Central London.
Seriously OP, it's the Internet people post all manner of stuff. But I hope your daughter feels better. My poor brother had bipolar and he hated that feeling of not feeling.

I hope your brother has found a protocol that works for him. I know a couple of people with Bipolar and from what I see it can be very difficult to stabilise.

As I have grown older I have realised how very many people struggle with one thing or another or have a family member/partner/friend who does.

all of society benefits when individuals get well

OP posts: