Experiences of sertraline for anxiety in autistic teenagers with EBSA

[JamNittyGritty]

15yr old dd, autism diagnosis 6 months ago, pattern of EBSA for 2.5 years, currently 5 weeks out of school. Highly anxious, refuses to engage with any support / therapy etc offered. Psychiatrist has prescribed 25mg Sertraline. Dd would like to take them. Looking for anyone who has a teen who is / has been on Sertraline for anxiety, especially if autistic, and what your / their experience has been,

Thank you!

you don’t need to read anything else - below is just more detail if you wanted more!!

My 15 year old dd was diagnosed with autism 6 months ago, there’s been a pattern of school refusal for over 2 years with one long period of 8 weeks at the end of year 9 and we are currently in our 5th week of maybe making it in once or twice for one lesson.

She’s highly anxious, especially socially - has friends but can be very up & down- big emotions which she either struggles to regulate or goes into shutdown.

We’ve struggled to get her to engage with any support at all- refused therapy after 4 sessions, has autism diagnosis but shuts down any discussion that might help her to understand herself better, won’t engage with school pastoral support (there’s lots on offer).

Apart from to see friends she doesn’t want to go out, leave the house, do anything - especially if it involves public transport. No interests left at all :(

Psychiatrist appt yesterday and a prescription for 25mg Sertraline, another appt in 4-6 weeks with the plan for another attempt at therapy (more neuro affirming)

I am pro SSRIs when needed to support in difficult times but can’t pretend like I’m not a little worried about this for dd at this age.

My DD is AuDHD and so I understand the antidepressants can’t be taken with her ADHD medicine, so no personal experience but this looks useful:

pure.johnshopkins.edu/en/publications/sertraline-treatment-of-transition-associated-anxiety-and-agitati-5/

I don’t have any experience of meds and autism but I have some experience of this situation but with a much younger child.

Do you think she is in autistic burn out?

Have you applied for an ECHNA? Do you know about section 19 and alternative provisions?

My 16 year old is awaiting autism diagnosis, anxious and low mood, couldn't engage with therapy as can't talk when feels under pressure/observed/judged.

Started 25mg sertraline 3 weeks ago now on 50mg no huge revelation but he does seem a little lighter and we hope it will be enough that in a month or so he can give therapy another go.

My 15yr old is autistic and has been on sertraline for a couple of years now - she’s up to 125mg. It has really helped her and her psychiatrist has been responsive and proactive to her changing presentation. Her symptoms have decreased (not linear but on the right track) and I anticipate she will begin to lower the dose once other parts of her life continue to stabilise.

she’s got a good group of friends, she will socialise slightly more in person (still prefers online!) and is developing her interests. I’m very proud of her and the progress she’s made, she puts in the work. She needs to take it the same time every day and consistently otherwise she gets horrible side effects like diarrhoea/shaking/headaches and this also happens when her dosage increases. A positive intervention for my daughter I would say.

My 18 year old DS has a similar presentation to your DD and was prescribed 25mg of sertraline by his private psychiatrist . He had an awful time on it culminating in him going missing and then needing to go to A&E due to uncontrollable anxiety and inability to sleep. The NHS psychiatrist said it was not the right option for someone with AuADHD as it can trigger activation syndrome which is what my son experienced. We are now 3 weeks on and he’s still not quite himself. So although his experience was extreme, I wanted to share it as a word of caution.

Thanks you all, for sharing both the good and the bad.

@Sunseansandandautism I am not sure what an ECHNA is - is it like an EHCP? If so, no she doesn’t. The diagnosis is relatively recent and to my shame for a long time, although in the back of our mind she may have some neurodivergent traits, we approached it as a behaviour issue - I am sure this has cost us lots of lost progress and increased anxiety loads. She did go to panel for a 20 week placement in a therapeutic school but steadfastly refused to have anything to do with it. She is terrified of being different and what that would cost her socially :( Yes she is probably in burnout

@tothefareast80 that must have been really scary for you both, and what I am wary of although dd doesn’t appear to have the adhd side so hopefully the risks are a bit lower but will be monitoring very closely.

@Buscake thank you for sharing your experience, I am glad things are progressing for your dd - I suspect mine is looking for a magic wand and both psychiatrist and I have been clear this isn’t that. But progress over time is a big positive.

It was life changing for us. DD missed most of Y9 (Covid), then almost all of Y10 & Y11.

Sertraline could only be prescribed from CAMHS, and we got the meds once we got the ASD / Anxiety diagnosis.

She went from no friends and never leaving her rooms .. to now, lots of friends, a college course, driving etc, and I think the Sertraline has supported this.

She’s 19 now, nearly 20, so the GP can perscribe, which makes it easier

It just takes the edge off the anxiety, and makes thinks more managable. It’s turned her life around

Not to your shame at all. Being diagnosed at 15 is still on the early side for women and 10 years ago there was so much less info. You’ve done well to recognise it and get an assessment.

If she is in burn out then recovery must come first. Read the barriers to education website, Joodie Clark books are good on the subject too. The advice for burn out is very different to depression and feels very counter intutive and it took me a good 6 months to trust this advice and accept it. I could beat myself up over this but I was doing my best. Once I lent into the advice things started to improve.

At the moment she will be feeling exhaustion and shame. I would say to her that you’re not even going to mention school to her at all for the rest of the half term and you can revisit this after May half term. If your best friend was in this state over work you would be saying they need to be signed off sick by the GP and take some time out.

ECHNA is the assessment process for an ECHP. I would get one started and insist that the ed psych needs to assess her in the home.

Yes, my dd was in EBSA for all of year 10 and was diagnosed with ASD during that time. She was started on 25mg sertraline, and gradually increased to 50mg. She was able to go back to school at the start of yr11 and came out with some GCSEs. She also started to see her friends again outside of school. It was a game changer for us.

Sorry to gate crash I can start my own thread if needed.

I have picked some information out of these replies and thread thank-you.

my daughter is currently on EBSA pathway and year 10 as well. How long did it take for ASD diagnosis? School have referred along with her mental health practitioner she is the most wonderful woman and DD is having CBT for anxiety in school once a week

It took 2 years for us to- referred at 15, diagnosed at 17 - she did start meds before her diagnosis, due to her anxiety

I don’t have a teen that takes it but I do work for children’s mental health services & can prescribe this drug. Sertraline is particularly beneficial for anxiety as a primary symptom. It can be life changing. 25mg is not a therapeutic dose & I imagine the plan is to titrate up.

Best thing ever. Dd did a short use when she was 9 to help her engage with therapy. After a traumatic incident at 16 she went back on sertraline. It’s fantastic. I suspect she is on it for life at this point, but so what. It works.

I also have ASD and take sertraline.

freaking miracle drug. When I first started it I was making up showtunes about my little green pill. It doesn’t do anything radical. It just lets me see that my reaction is anxiety and ASD related. It gives me perspective. I’m still the same person. Having that little bit of separation from the emotion lets me process it intellectually instead of letting it consume me.

25g of sertdaline has been a life-saver for my dd, despite our initial scepticism and worry about it. I would go as far to say that it is transformational!

Her only caveat is that now she has improved to the point she wants to come off it, the withdrawal symptoms are very debilitating indeed and it’s taking her eighteen months of tiny reductions.

I was on that as a teen. Made me suicidal. I tried a few they all made me worse. Dr just kept upping dose or swapping meds. I was into my 20s before I felt confident enough o say I don’t want medication. I drastically improved at that point. I was just autistic completely unsupported and didn’t understand myself (undiagnosed at that point) struggling, in this cycle of trying to be neurotypical and then burning out and puberty. I was late 20s when I got my autism diagnosis and what was left of my struggles abated.

the key for me was structuring my life around my needs and sensory struggles. I can work, keep house pay my mortgage etc. but I have control of my life and don’t choose to work in environments like a school where it’s just too much. No meds could have helped me because the problem was my environment not my brain chemistry. I wish my mother has allowed me to home educate instead I was punished for the school refusal.

if your dd is burnt out let her recover. Help her understand herself. If she wants to take the meds then let her but watch her closely and don’t rely on just meds to be the fix.

I know lots of autistic people have positive experiences on anti depressants but there is also lots of evidence for some they make things much worse. You won’t know how your dd reacts until she tries them. If she wants to then let her feel like she has that control over the decision and support her while watching closely.

it’s shit but school and teen years don’t last forever. It probably won’t help to tell her that but I wish I’d understood my brain was still developing until age 25 and that real life is full of possibilities not the sensory and social hell that was school and trying to force myself not to be autistic