Depression and fluoxetine seems to be making it worse

[KielyKiely]

My DS1 (14) has been diagnosed with depression and started fluoxetine just before Christmas. He is coming up to the end of his sixth week on a very low dose (12mg) and after what appeared to be a short improvement he now seems to be getting worse. He has said he feels "worse every day" and has admitted to thoughts about dying. On Wednesday after a meeting with CAMHs where these thoughts were discussed he cut his arm several times - a first.

Like all mums I have scoured the internet looking for views on how effective fluoxetine is and what the timescale is for it to take effect. It seems to be one of the slower acting SSRIs but with a positive record once it kicks in. Timescales for positive effects seem to vary but 6 - 8 weeks is often quoted.

I have emailed CAMHs and am waiting for his psychiatrist to call back as he has refused to go to school today and I a very worried about him. All views and thoughts welcomed about whether we should preserver with fluoxetine. I have asked the psychiatrist to review it.

You need to speak to the psychiatrist ASAP. Feeling worse can be a side effect and fluoxetine, as I'm sure you know, can make teenagers feel suicidal, though he is on a very low dose so that should minimise the risk of side effects but the notes do clearly say to speak to the psych if you feel things are getting worse. The trouble is getting hold of the psych if my experience of CAMHs is anything to go by. I wouldn't rely on an email, phone CAMHS and ask to speak to the 'clinician of the day' or the 'duty clinician' or whatever they call them in your area. Don't just speak to the receptionist, not because the receptionists aren't any good (sometimes they're the best!) but because the clinician (who will be a mental health nurse or other medical professional) will be able to get advice from a pysch. The problem with email is that if your pysch works part time no one may see the email for several days.

My DD was on fluoxetine for about 9 months. It was a disaster. A few months on it and she started getting very jittery and unpredicatable. Crying uncontrollably, unable to get up, suicidal thoughts and lots of self harming. She would disappear and make very disturbing phone calls to me. She ended up in A&E once.

As I understand it, there is a small percentage (4%?) have a devastating reaction to the medication. CAMHS never acknowledged this but eventually after another crisis they told her to stop. DD is a little better as her illness has lost its darkest edge. Certainly the self-harming is much reduced. I know that DD did not feel 'right' when taking the pills.

I think you are doing the right thing by querying with CAMHS. To my mind, these pills are prescribed a little too freely with not enough monitoring of the patient. Hasn't there been a government report recently that advises on extreme caution when prescribing antidepressants to young people?

Hope things improve for your DS

hi , I am going to be intrested in any answers you get as my dd 14 has just started fluoxetine two weeks ago , due to depression and self harming ,20mg a day . side affects are at the moment a few headaches and feeling abit sick in the mornings . psychiatrist said to work through the sickness and headaches side affects but if her feelings any worse to get in contact with them (camhs) and they would look into changing the tablets to something different if really bad . I would contact camhs to discuss what to do next .
fingers crossed for your ds and my dd that it starts to work and things start to improve .

My dd is on it too, same age.
CAMHS gave it to her without my knowledge though dd told me, she flips if I mention it though.

Thank you all for your responses: Mumsnet truly is such a supportive place.

Our experience of CAMHs has been positive - I know that is not the experience of everyone on Mumsnet who have used them, so I appreciate that we are lucky. The psychiatrist called me at lunch time and we have a twenty minute chat. He said that as DS said he was feeling worse each day that he should come off it and we have a meeting with him on Wednesday morning to review how DS is and whether or not an alternative SSRI might be appropriate. He took the time to listen to me and answered all of my questions and queries.

Florida DS also felt nauseous throughout although it didn't stop him eating (I think that eating helped relieve the nausea).

Claire and Moody, thanks for your thoughts and experiences. I would love to do things via a more holistic approach but before Christmas things got a little desperate and I found myself asking for a low dose of antidepressant for him.

BrilloHair - are they allowed to prescribe for a 14 year old without parental consent?

I will let you know how we get on after Wednesday's appointment. xx

I think all anti-depressants are a question of trial and error. What works fantastically for one person, won't for another.

You definitely need to ring CAMHS back to advise them of the latest developments and to ask for urgent help. If necessary, stay on the line until someone medical talks to you. Don't be afraid of being that parent - I've done it.

Is your DS not being seen weekly by a therapist as well as having the meds? Mine is, and to be honest, I think that is having just as big an impact as the ADs.

In our case, Fluoxetine worked almost immediately (within a week). But the side effects never really went away and so two months after starting, the psych decided to switch to another AD instead.

x-post. Glad you got through to the psychiatrist.

"are they allowed to prescribe for a 14 year old without parental consent?"

My understanding is that if the healthcare professional judges them competent to understand what is proposed, then yes.

I have no experience of fluoxetine, so can't help with that, but I suffer from depression too, to the extent that I sometimes wonder what is the point of my being here. But in my case I know what causes it - it's a side-effect of the hormone treatment I'm on. It lowers testosterone levels and my understanding is that low testosterone can be linked to depression. Is this something worth investigating? It might be nothing to do with it but if the cause is so far undiagnosed...