Very low dose ssri

[salempeacock]

Hi,
Any of you have tried very low dose of ssri? Found it useful? for which issue? We are thinking about it for my 10 year old grandson. Anybody tried it please write your experience

 

[Outdated]

Some of us, including myself, have very bad experiences with SSRIs. I would suggest a simple test to see if your grandson can take SSRIs. It could save the poor kid a whole world of issues.

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[MNAus]

ASD can have comorbidities, but for the actual disability itself there is no medication, I believe. There is only management of symptoms, which makes sense. If you believe that your grandson is suffering from depression as a result of ASD or perhaps as a comorbidity, it's probably wise to talk to his GP or paediatrician. AFAIK there's not a whole lot of research providing conclusive results on the effectiveness of SSRIs in treating comorbid depression with ASD, but I'm no specialist.

 

[Rodafina]

Hi,
Any of you have tried very low dose of ssri? Found it useful? for which issue? We are thinking about it for my 10 year old grandson. Anybody tried it please write your experience

Hi @salempeacock,

10 years old is certainly young to start a course of SSRI medication.

Could you say more about what symptoms your grandson seems to be struggling with?

Usually SSRIs are used to treat mood disorders and both the symptoms of things like depression and the effect of antidepressant medications will manifest differently in young people.

Number one issue here, as far as I'm concerned, is to be quite sure you are working with a doctor in whom who have great trust and who knows your grandson and his situation very well. As others have said, most people do not take medication for autism symptoms, but for co-occuring disorders and problems that may arise.

In addition to your medication consideration for your grandson, what other things have been tried?

 

[jsilver256]

I know two boys (of the same parents) who went on SSRIs. They became zombies and gained a ton of weight, went from normal weight to obese. But they can now stay still instead of being active and potentially breaking things, so I guess it worked for the parents, their job is a lot easier now.

I am not a doctor, but I really cannot imagine a childhood condition that is genuinely mitigated with SSRIs. It seems if there were truly serious behavioral issues, then stronger drugs are warranted. Past that, "normal child behavior" is a very wide range especially for NDs.

 

[marc_101]

Antidepressants are on average effective, period.

For some, not taking antidepressants can be deadly, including children.

Having said that, nobody without more information can tell you if it will work for your grandson or if it's appropriate. If a doctor wants to try it despite the black box warning for children, there must be a strong reason provided you have a good doctor.

I'm not a physician but I'm a researcher in the health field and have done research on antidepressants. Please talk to other doctors if you need a second opinion. None of us is qualified to suggest treatments for your grandson, including myself.

 

[marc_101]

Some of us, including myself, have very bad experiences with SSRIs. I would suggest a simple test to see if your grandson can take SSRIs. It could save the poor kid a whole world of issues.

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genesight.com

These tests have had little oversight with little research backing them up. For some medications, the evidence is strong. Note how the company hedges on their site: "Gain Insight on How Genetics May Impact Medications."

Also, note that the test is about drug efficacy at a biological level, not whether a drug is properly indicated for a person. In other words, I can take the test today and get information on whether a statin would work for my body, but it doesn't mean that I need to take a statin (I don't).

@Outdated is correct in saying that the test could be about the "can" take the medication, but not the should.

@salempeacock Please talk to doctors who have examined your grandson and have considered the risks and benefits.

More info on the validity of the tests:

Task Force on Gene Testing for Antidepressant Efficacy Concludes Tests Not Yet Ready for Widespread Use

One problem is lack of transparency regarding algorithms used by commercial entities to determine treatment recommendations on the basis of testing of genetic variations.

psychnews.psychiatryonline.org

 

[Neonatal RRT]

If you do a general internet search on the topic of "autism and psilocybin", either looking for scientific journal articles or YouTube video content, you will find several sources from 2021-23. At this point in time, it is at the study phases, proper dosing, etc, but so far, seems to be a promising alternative to SSRIs. Psilocybin is specific to the 5HT-2A serotonin pathway, which may have specific benefits within the context of autism.

At this point, if you are resistant to SSRIs or have "untreatable" depression, and would like to try psilocybin under the care of a licensed clinician, there are universities that are taking patients for study protocols.

 

[jsilver256]

I'm not a physician but I'm a researcher in the health field and have done research on antidepressants. Please talk to other doctors if you need a second opinion. None of us is qualified to suggest treatments for your grandson, including myself.

I don't wish to argue an issue where your credentials are clearly superior, but as a researcher myself, I think it is important to contextualize the source of funding for research grants. There is no magical money - it is either private companies or governments which in turn are lobbied by private companies. There are definitely things I cannot write or need to frame in a certain way to increase the odds of receiving funding. If I wrote certain opinions, I'd be blackballed forever. And my field is not nearly as politically charged or powerful as pharmaceuticals.

Without arguing the specific topic at hand, I think it is fair to question why the US is far and away the most medicalized nation in the world, and why that happens to coincide with the power of the industry, and why we seemingly get such a poor return on these prescriptions at a macro-level when looking at health outcomes.

 

[tjlxlh]

These tests have had little oversight with little research backing them up. For some medications, the evidence is strong. Note how the company hedges on their site: "Gain Insight on How Genetics May Impact Medications."

Also, note that the test is about drug efficacy at a biological level, not whether a drug is properly indicated for a person. In other words, I can take the test today and get information on whether a statin would work for my body, but it doesn't mean that I need to take a statin (I don't).

@Outdated is correct in saying that the test could be about the "can" take the medication, but not the should.

@salempeacock Please talk to doctors who have examined your grandson and have considered the risks and benefits.

More info on the validity of the tests:

Task Force on Gene Testing for Antidepressant Efficacy Concludes Tests Not Yet Ready for Widespread Use

One problem is lack of transparency regarding algorithms used by commercial entities to determine treatment recommendations on the basis of testing of genetic variations.

psychnews.psychiatryonline.org

You are wrong about this. I have my test results. They have validated every medication I was unable to continue taking. It tested wether or not you will have any genetic reactions to the drugs. Mine stated I will have severe reactions to multiple SSRI's. Which I have.

Maybe my test was done by a different more advanced lab than you are used too. But it definitely states I will have severe reactions to SSRI's.

 

[marc_101]

@tjlxlh Don't mean to be confrontational, but you're a sample of 1. And your test does not indicate whether you should take antidepressants. In no way I'm suggesting that your experience is wrong or is not valid.

 

[tjlxlh]

@marc_101
I did not see your reply to Outdated, which is basically what I was trying to say. I'm very wordy. My apologies!
But no it does not say I *should* take anything. Just what I *should not*

 

[marc_101]

@jsilver256 My credentials are not superior. I tried to be careful with my words. I'm arguing about a very narrow point raised by @salempeacock: should the grandson take a low-dose SSRI?

I'd rather stay on that topic. Happy to discuss other topics in another thread, and I value your opinion

 

[marc_101]

@marc_101
I did not see your reply to Outdated, which is basically what I was trying to say. I'm very wordy. My apologies!
But no it does not say I *should* take anything. Just what I *should not*

No worries. I love discussions, but I try to be careful because in writing one can sound too argumentative or as a know-it-all, which I try hard not to be.

I was a pain in the ass before, and I think it was because I was trying to compensate for feeling so weird.

 

[vergil96]

If I were to advise - SSRIs have side effects, significant ones, but those are outweighed by the benefits in treatment of some issues such as major depression or anxiety disorders that interfere with normal functioning. For a child the risks are higher, because of the small weight and their bodies are still developing. However, if the issues he has are way worse than the side effects - medication supervised by an experienced and thoughtful clinician is likely to be beneficial.

 

[Outdated]

Also, note that the test is about drug efficacy at a biological level, not whether a drug is properly indicated for a person. In other words, I can take the test today and get information on whether a statin would work for my body, but it doesn't mean that I need to take a statin (I don't).

I was offered SSRIs quite a few times and eventually decided "Why not? What harm can it do?". One of the worst decisions I ever made in my life. When I complained about the effects they were having (escitalopram) the doctor told me I was wrong and these drugs don't work like that. The doctor is probably correct for the average person but being autistic I'm anything but average.

It destroyed 50 years of regular sleep patterns, which in turn destroyed all my other routines. I still don't have a regular sleep pattern 2 years after I stopped taking them. If a simple cheek swab could have suggested that they might not be a good option for me then I never would have taken them in the first place.

I wrote to the Minister of Autism and Minister of Health in SA to look in to if this sort of testing could be incorporated in to our public health system. There are no definites in these sorts of tests but if they can save some people from going through the dramas that I have then I think they have value.

 

[WhitewaterWoman]

Low dose amitriptyline is used to improve sleep and in some instances can help to control chronic pain. I have been using it for years for that purpose. I have had no adverse side effects.

Low does amitriptyline generally speaking does not have adverse side effects in adults. A low dose would be 5 to 10 mg, given at night because it can make you sleepy.

A quick google search for amitriptyline shows it being used in the UK in children as young as 13 years old.

Note that I am only speaking of LOW DOSE amitriptyline and not the clinical level dose used to treat depression.

From my own personal experience, I can say that there are medications which have greatly helped to relieve my chronic pain. There were other medications that were tried and when found not to be effective or to have bad side effects, they were terminated.

I agree completely with others, above, who have pointed out the risks of taking medication and the need to research something carefully before you agree to any course of treatment.

 

[marc_101]

@Outdated I understand 100%. It's a very difficult clinical decision, and some doctors can be very, very stubborn and narrow minded. People react very differently to medications. I don't react well to SSRIs either.

It's also true that for some people they are life savers, my mother, for example.

 

[salempeacock]

Thank you all for your replies. My grandson has no history of depression and was diagnosed as autistic officially when he was two and a half years old. From then on we did a lot of interventions including diet, ABA, supplements, HBOT, Glenn Doman method (Institute for the achievement of human potential) etc. Dr. Dan Rossignol was our consultant till he was 7. (We stopped because we ran out of all possible interventions and he gained a lot). All interventions helped a lot especially for his sleep, melting down, sensory issues, language, speech, anxiety, panic attack and comprehension.
His core problems still are selective attention, focus, being immersed in his own world and restricted interest which are manageable to a certain extent.
His biggest issue in the past one year is inappropriate social interaction with peers. He is studying in Year 5 in a mainstream school. He is a cheerful and sociable boy with no social anxiety. He wants to mingle and be friendly with his peers but he can't. Because of his restricted interest he expects others to play and interact in what he is interested (such as mine craft and transformers). Some times he is in his own world and other times he wants to mingle with others. He expects others to be on his own terms and because of this his peers exclude him. He lacks social cues and hence doesn't understand whether his peers are serios or sarcastic and this makes him confused, unhappy and angry. So he is mean and bad mouth to others and vice versa and his peers get together and bully him. His peers call him dumb and weird.
He used to share it with his parents earlier but nowadays he doesn't want to. He cries silently at night. He says that it is embarrassing to talk about it. He says that he realizes that he is somewhat different and event though he wants to change his behaviour and be friendly with others he can't. His school is sympathetic and tries to interfere but in vain. We don't want him to get depressed or aggressive and want to intervene.
Currently he takes some supplements such as Magnesium, L-Taurin, folinic and L-carnitine and no medicine. This month we have engaged a psychotherapist to deal with his social skill issues in school.
My grandson lives in UK with his parents and you know in UK there is no medical help for autism. In some parents' forum I have read about very low dose SSRI (around 2mg fluoxetine per day) helps in social intelligence. That's why I want to enquire about low dose SSRI. Previously we had tried Adderall, galantamine and memantine (prescribed by Dr. Rossignol) but not SSRI. Actually we are scared of using any psychiatric drug.
I can find only one study for low dose fluoxetine with 4 ASD kids and only one study for low dose Sertraline with Fragile X children. Both have positive results,
So I would welcome any suggestion that will help his social intelligence. Thank you once again.

 

[Outdated]

What you write reminds me a lot of my own school years, not happy memories. It's quite normal for autistic children to mature intellectually much faster than other children but be much slower with social maturity. Understanding and emotional support at home would be very helpful.