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Dr. Steve
Dr. Steve, Psychologist
Category: Mental Health
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Experience:  19 years conducting therapy; book author; newspaper columnist; former co-host of radio show
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My 7 y.o. son was diagnosed with a mood disorder 5 months ago

Resolved Question:

My 7 y.o. son was diagnosed with a mood disorder 5 months ago and put on 2.5 mg Lexapro. His behavior improved, but after two weeks of being on 5mg his behavior rapidly declined. He was switched back to 2.5mg and .25mg Risperdal was added. We have seen his troubling behavior rapidly increasing over the past week, so the Risperdal dosage was changed to .5mg. I am wondering if he's developed a tolerance to Lexapro and needs to be put on a different antidepressant.
Submitted: 6 years ago.
Category: Mental Health
Expert:  Dr. Steve replied 6 years ago.

Greetings:

 

Excellent question, but I am sorry your kiddo has been struggling through this. It is really difficult to know exactly what is going on over the internet like this (of course), so I urge you to speak to the prescribing physician. But here is the direct answer to your question:

 

SSRIs (the family to which Lexapro belongs) does not typically have much of an impact on depression in younger children. It can work to curb some anxiety-related symptoms, but not usually depression. Too, in that short of a time (5 months), it would be highly unusual for anyone to develop a "tolerance" to the medication, or for it to decline in effectiveness. Furthermore, it takes about two weeks for the medicine to kick in at all anyway, so it is puzzling that you son showed improvement so quickly - I would be more inclined to believe that the initial two weeks saw either (a) both he and you knew that treatment was started, so you changed everyone's behaviors in the short run just because you all felt that it should be better (this is called the placebo effect). or (b) you kiddo leans more bipolar (you did not mention his mood disorder), and the Lexapro began to kick him into manic phases more rapidly. In this case, the Risperdal would curb some of the manic/acting out tendencies, but is fighting against the Lexapro. It may be necessary to wean him off of the Lexapro entirely in order to allow the Risperdal to maintain its effectiveness.

 

Again, his psychiatrist is going to be in the best position to evaluate the most effective course of treatment, but I like that you are being active in your child's treatment. I think that once you work out the medication, and if you have a good child therapist to work in con junction to manage the cognitive and behavioral aspects of the disorder, then he will have a good prognosis. If you are satisfied with the response, please hit "Accept." That is the only way I can receive credit for my answer. Thanks-

Dr. Steve

Expert:  Dr. Steve replied 6 years ago.

Greetings:

 

Excellent question, but I am sorry your kiddo has been struggling through this. It is really difficult to know exactly what is going on over the internet like this (of course), so I urge you to speak to the prescribing physician. But here is the direct answer to your question:

 

SSRIs (the family to which Lexapro belongs) does not typically have much of an impact on depression in younger children. It can work to curb some anxiety-related symptoms, but not usually depression. Too, in that short of a time (5 months), it would be highly unusual for anyone to develop a "tolerance" to the medication, or for it to decline in effectiveness. Furthermore, it takes about two weeks for the medicine to kick in at all anyway, so it is puzzling that you son showed improvement so quickly - I would be more inclined to believe that the initial two weeks saw either (a) both he and you knew that treatment was started, so you changed everyone's behaviors in the short run just because you all felt that it should be better (this is called the placebo effect). or (b) you kiddo leans more bipolar (you did not mention his mood disorder), and the Lexapro began to kick him into manic phases more rapidly. In this case, the Risperdal would curb some of the manic/acting out tendencies, but is fighting against the Lexapro. It may be necessary to wean him off of the Lexapro entirely in order to allow the Risperdal to maintain its effectiveness.

 

Again, his psychiatrist is going to be in the best position to evaluate the most effective course of treatment, but I like that you are being active in your child's treatment. I think that once you work out the medication, and if you have a good child therapist to work in con junction to manage the cognitive and behavioral aspects of the disorder, then he will have a good prognosis. If you are satisfied with the response, please hit "Accept." That is the only way I can receive credit for my answer. Thanks-

Dr. Steve

Customer: replied 6 years ago.

Thank you for your response. He is seeing a child psychologist, while an N. P. manages his meds. He began seeing both in January. While the psychologist sees some evidence of bipolar disorder, the N.P. does not, which leaves a diagnosis of dysthymia (which I myself have), although neither has stated an exact diagnosis other than a "mood disorder."

If he does have bipolar, is Risperdal the only med he should be on, or should he be prescribed an antidepressant (other than Lexapro) as well? The N.P. mentioned Prozac in January, but elected to go with Lexapro. I myself have taken Cymbalta for years, with no problems/side effects, but I understand that it is not approved for use in children.

Expert:  Dr. Steve replied 6 years ago.

Hello again:

 

I would stay away from the SNRIs (Cymbalta belongs to that family) because they will absolutely kick him into mania. Lexapro (an SSRI) is generally the med to use with dysthymia in teenagers, but (and I hate to say this) I can say anecdotally that it does not appear to be as effective to manage depression in really young kids. In fact, there are no good options for anti-depressants in kids who are that young. And to this point, the dosage of Lexapro he was on is extraordinarily low - and I totally get that his body weight is pretty low at this age - but it is also leading me to be skeptical about the medication losing effectiveness (in reference to your initial question).

 

Risperdal is a pretty heavy duty medication, but I understand the thought process of the NP. Another option would be to a medicine like Lamictal (a different classification than Risperdal), which also comes in chewable tabs for younger kiddos, and has been approved for the treatment of pediatric bipolarity - and works especially well with bipolar depression without triggering mania.

 

Again, this is not an exact science, so please be patient with your NP. Give him/her the feedback you have given to me so that they have accurate data to use in making their recommendations. If you are satisfied with the response, please hit "Accept." That is the only way I can receive credit for my answer. Thanks-

Dr. Steve

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