neurologist or psychiatrist?

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    • #63596

      We live in Mexico and are from the US originally. Our son is almost 9 and has been taking Ritalin LA 20 mg since he was diagnosed at age 6. The Ritalin helped him a lot but has not been a cure-all. He was diagnosed by a psychiatrist whom we continue to see every two weeks. I never thought he was great, but he seemed better (smarter, saner) than some of the other people we saw.

      Our son just started third grade and has been having some problems with concentration and focus in Spanish class, which is in the afternoon. Although the Ritalin LA should last 8-10 hours, it seems to run out or at least begin working less well after 6 hours. He has also been having behavior issues at home in the mornings and evenings.

      When consulted about these recent behaviors, the psychiatrist rather abruptly brought up bipolar disorder. He was not saying our son has it; but bringing it up as something to watch out for. He also suggested we give him prozac, which he once suggested before a few years ago. We did not think it appropriate to give our six year old prozac and we still don’t think it appropriate; we don’t like the cavalier way he seemed to regard it (“Don’t worry, it won’t sedate him, it’s not a controlled substance [here], it will ‘sweeten’ his personality.”) Our son is not depressed.

      During the bi-weekly visits, our son usually sees the psychiatrist by himself, and they play various video games, supposedly to test/enhance his tolerance.

      I would really like to find someone that I have more confidence in than this psychiatrist. Someone who could actually help and advise us, but not talk and talk about things we already know about (he spent 20 minutes explaining co-morbidity to us recently, for example).

      To cut a long story to the chase, I’m wondering if people think it would be useful for us to consult a neurologist, or maybe an neurologist that would prescribe but a psychologist or therapist for the family. Or is there any reason to consult a neurologist?

      Thank you for any suggestions you can give.

    • #63610
      Penny Williams

      A neurologist can be great, IF they are well-versed in ADHD and willing to spend the time treating it (in my city in the US, not one neurologist is willing to see patients for ADHD). I think it matters more if a physician has experience with pediatric ADHD and ADHD medications than the particular type of clinician they are.

      I agree that you should be skeptical of talk of bi-polar and starting your child on Prozac. My son’s therapist and doctor suggested bipolar to us at almost every visit for a few years. I knew it didn’t fit. He was a frustrated kid with poor self-regulation skills who was acting out under the pressure of being so misunderstood. I knew bi-polar didn’t fit.

      Now, there are some children who really need Prozac and do very well on it. There are also many children that have significant bad reactions to it. My son tried Prozac for anxiety when he was about 10 or 11. He took half the lowest dose. By week 2 he was a violent raging kid what we became frightened of. I almost had to call the police on two occasions. He also had a meltdown that looked a lot like a seizure. His prescribing doctor, who had 30+ years experience in pediatric mental health, thought it couldn’t possibly be the Prozac. My husband thought our son just suddenly turned aggressive to try to bully us into doing whatever he wanted. I knew different. I knew this wasn’t my kid and I knew the Prozac was the change. The doc asked us to bump up to a full dose at 3 weeks and see if that helped. My son then had such rapid-fire suicidal ideation that I couldn’t take him to school or even in the car. That was the last day he had prozac. It took another 3 weeks after his last dose to start to get back to himself. It was the scariest, most heartbreaking time.

      I’m not sharing this to say that Prozac is bad and no one should take it. I’m sharing because many of our kids have these rare and serious reactions to these medications. Knowing that may help you to choose a “gentler” SSRI or antidepressant before trying prozac.

      Your Expert Overview: Choosing the Right Professional to Treat ADHD

      ADDitude Community Moderator, Author & Mentor on Parenting ADHD, Mom to teen w/ ADHD, LDs, and autism

      • #64011

        My 11yr old grandson had/is going through the same thing with Prozac. We are raising him. He has ADHD, depression & anxiety. He has a mix, I believe, of mental health and behavioral issues. This summer the psychiatrist, through our Childrens hospital, put him on Zoloft. After 4-6 weeks, we saw one good week at the beginning. Next up- Prozac. Never, ever again. For 2 weeks he was phasing out Zoloft and taking a half dose of Prozac. Again- one good week. All downhill after that. ESPECIALLY when them doubled his dose after 2 weeks and then doubled again a few weeks later. I saw our wonderful grandson turn into a scary, aggressive, violent child. I could see a difference for a few hours after I gave him his daily dose. Those few hours after he took- out came a mean, aggressive and sometimes violent child. It’s been about 2 weeks since I physically could not give him one more Prozac. He was changed over to celexa. I haven’t seen any change in him yet and it is only a half dose for 2 weeks, but the aggressive,violent child is still here. Last weekend he was hospitalized for a meltdown, which is now a potential part of our daily life. We never know what each day will bring. He threatens to run away and/or kill himself on a daily basis. We are slowly, through our grandsons school (who are amazing by the way) and support from his counselor, learning how to deal with these meltdowns, and to differentiate between a mental health issue, which requires the hospital, and a behavioral issue, which may require the police. We now know this is on the table and it’s real. This has now taken over our house on a daily basis and for all of our sanity, has to be handled. My husband and I both feel like we both are traumatized after these last few months, but on the rare day when you see what he’s capable of in the future, even if it doesn’t last long, empowers you to keep going, keep looking for answers, keep finding support, which I can’t say enough is HUGE and you will go nowhere fast without. I have cell phone numbers for his teachers and even the bus driver- I communicate all day long. Keep those lines flowing. They all keep telling me it gets worse before it gets better and I pray all of you find the strength to keep going. These kids didn’t ask for this. Good luck to all.

    • #64724

      Thank you for your responses. I’m also not saying no one should be on Prozac, just that my kid shouldn’t. It doesn’t make sense to me as a response to “there is a lot of bad behavior and difficulty with self-regulation during mornings and evenings when he’s not on Ritalin.”

      It is VERY common here to consult neurologists about ADHD, so I guess the neurologists that have been recommended have a lot of experience. But I also guess that there is no way someone who doesn’t live here can really advise me. Unfortunately it seems like there is no way someone who lives here or even is a counselor at my school can advise me either. It seems like most kids with ADHD get medicated from a neurologist and a few also get some kind of half-assed therapy.

      I am kind of very frustrated about this.

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