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I have been away from this forum for a long time, but now need some help. My DS14 was diagnosed with PANS nearly 5 years ago. Since then we have had ups and downs. He has had antibiotics, IVIG, steroids etc. He was a patient of Dr. K and now a patient of Dr. T. I feel like Dr. T and Dr. K have saved his life. Sometimes he has no symptoms at all. Usually he is about 85%. We have declared 85% is "good enough" most of the time. Recently he has been depressed. No significant increase in OCD or other classic PANS symptoms. I don't think there was a specific trigger - but he admitted to picking up a knife with the intent of committing suicide. Dr. T recommended some counseling. The first counselor we saw said he needs a psych eval - and the counselor will not work with him unless he is evaluated by a psychiatrist. He has seen three psychiatrist in the last 5 years - and every time they just want to medicate him, and are not supportive of a non-medicated approach to therapy. I don't want to be a bad mom here - I have nothing against meds per se. I just know that most PANS kids do not do well on many of them. My son does not want to go on meds. I think if we forced them, he would be really mad, and probably even more suicidal. (I have tried to tell him we would go low and slow - but he will not be persuaded. Maybe it is an OCD thing.) My questions: Broadly - what do you think I should do? Are there supportive psychiatrist out there? If so, how can I find one? Are some medications tolerated well by PANS kids? Which ones should be avoided? Background - He has gone through puberty. At first I was optimistic that we were seeing the end of PANS - but obviously things are bad now. He is currently on a full dose antibiotic (Suprax) - initially for a sinus infection. He has been on that for about 70 days now. His blood titers for things like strep and mycoplasma have only improved in the last few months. There is no Lyme (tested many many ways and times). His blood indicates chronic sinusitis - but also appears to be improving. We will probably try one more IVIG this summer - but at his age it may not work. About 6 months ago he developed a facial tic - which was a new symptom for him. We saw a neurologist who prescribed Guafacine. My son did not want to take it - so we did not force it. The tic is hardly noticeable - so we just chose not to fight that battle. Thanks - I appreciate any help you can offer!