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pandakid11

zoloft - good/bad?

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My DS is taking low-dose Zoloft for anxiety/OCD, and we've had good results. He was 12 when we began, and he started with 25 mg. We titered up slowly over about 3 months to where he is now and has held steady for the last couple of years at 75 mg.

 

My advice would be to follow the now-old saw: "low and slow." Start at a very low dose, especially if your child has never before taken any type of SSRI, because you don't know what the right dose is for him. SSRIs are generally not dosed by either age or weight; it's all about the brain chemistry, so it is a bit of a guessing game, even for the most skilled doc. If your prescribing doc is not PANDAS/PANS-savvy, then all the more reason to be very cautious about dose and the rate at which the dose is increased; we know from experience that what a typical doc considers a "very low dose" can, in fact, be too high for our son, and it might be the same for yours.

 

SSRIs can take 4 to 6 weeks to reach full efficacy, so you don't want to increase dosage too fast; many docs will suggest increasing doses after just a week or two, but that's too fast for most of our kids and can lead to missing the "sweet spot" at which the med can help and advancing to that point at which it's too much and the kid gets activated. Best to wait at least 4 weeks at each dose level before increasing it at all.

 

The good news in our case was that, at a dose that was too much and activated DS, we saw the activation (increased agitation, mood swings, "crawling out his skin") within 48 hours of increasing the dose, so we knew what to blame it on and promptly dropped the dose back to where it was before; within another 48 hours, he was back to himself. So the potential bad impacts of too high dosage aren't long-term so long as you're observant and responsive.

 

I know that many families with kids who try an SSRI for the first time will often start Zoloft at half the lowest dose, even: 12.5 mg., by breaking the 25 mg. pill in half. That should be a pretty "safe" place to start, but assuming you have access to a good, PANDAS/PANS-savvy doctor, consulting with them is your best bet!

 

Good luck to you!

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Zoloft was the first psych med we tried. We started Zoloft at 12.5 mg. Increased it to 25 after about 6 weeks. It didn't really work for ds, and may have activated him at 25 mg. he developed tics 1 week after increasing it, which is why we discontinued it cold turkey after a week at 25 mg. the two weeks after discontinuing it were very difficult. At the time he didn't yet have a PANS diagnosis, and it was only in retrospect that we realized he'd been ill 2 weeks before we increased the dose, which may be what caused the tics and ramping up of anxiety/irritability, but at the time we blamed it on the Zoloft.

Edited by DeterminedMomVA

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My son took Prozac for about 2 years. Highest dose 30 mg. Effects seemed to be waning and he was getting "aggressive," in some instances, which was very uncharacteristic for him.I asked Neuro to change SSRI to Zoloft. He is 12 and approaching puberty. Reportedly, Prozac has higher incidence of aggression in adolescents. He has been on Zoloft for about 6 weeks now (50 mg)and so far, so good. He seems happier, less stressed, less anxious, more social.

 

Improved and better reports of behavior from school with medication change. He can go higher- 75 mg. He is considered low dose now but I am just holding steady and watching. Can go up later, if needed.

 

Storch and Murphy from the children's OCD in FL clinic recommend Zoloft as drug of choice for children for OCD/anxiety over the other SSRI's. That's ome endorsement, I suppose. It's worth a trial. As Nancy said, go low and slow.My DS weighs about 130 lbs. Good luck:)

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Pandas hit with strep (but, didn't know anything about PANDAS)....went for 2 horrible weeks not knowing what was going on and then started zoloft at 20mg....it was REALLY bad for 2 weeks after starting it (but, again, didn't know about pandas)....stayed on that dose for 5 months then upped to 30mg...again REALLY bad for 2 weeks after upping the dose. *Both times the dose increase was just too much at once. We started decreasing her dose over several months (1 mg at a time) until we got down to none....after a week of not taking it her anxiety increased again....so this time I went up drop by drop until she seemed to improve....she is is now seriously taking 4 drops...8mg...and that seems to be the amount that is working best so far (not perfect), but better than the higher doses and better than no dose. (note: she takes liquid and it is mixed with sierra mist so she never knew when I was increasing/decreasing or when she was not taking it b/c I still gave her just the sierra mist).

 

Also...just to note...my daughter's anxiety since this started was VERY high daily...all day long...and there is nothing at all stressful in her life other than PANDAS.

My daughter is 9 and 60pounds

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My son, who just turned 16, started back on zoloft a couple of months ago.  We did 12.5mg for four weeks and are finishing up 4 weeks at 25mg.   We have seen some minimal results, but would like to move up again to see if we can get some added relief for the intrusive thoughts.  We especially want to help him be more productive with therapy as we know this will long term be more beneficial than anything.  I am torn whether to step up to 37.5mg or go to 50mg (therapeutic dose) and see how he responds at the therapeutic dose.  I was hoping that the minocycline would help us as there were some promising studies when mino and ssri were used together, but we did not find it greatly beneficial.  However, we just did a 30 day course to see what happened.  I am starting to think that the OCD is residual and that it may be time to go a more naturopathic route and address basics like nutrition gaps, continuing on gut health, and see what the ssri can bring.  Any thoughts on ramping up or using a more (non abx) route?  

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My dd (12) has had PANDAS for 5 years. After MANY (read as: all available) treatments we are left with LD IVIg and psych meds to manage her. She is doing GREAT. She has been on Luvox for 3 years for her OCD. I finally wanted to try something new to see if something else would work better because she seems to be left with baseline/residual OCD's that are minor, but annoying. I just switched her to Luvox last month. She is doing VERY WELL on it. We started at 12.5 mg and within 10 days were up to 100 mg/day. It is working exactly the same level at controlling her OCD, but her mood has improved tremendously. She is a happy camper now all the time. I am raising it to 150/day to see if it does anything more for her OCD. ** In between for those few days before zoloft kicked in she was EXTREMELY depressed. Waves of sadness would overwhelm her and she would suddenly begin sobbing. Gone completely within a few days once we were at 50 mg/day. Unbeknownst to me, PANDAS has left her with a major depressive disorder that the Luvox was covering up. *smh*

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My 2 cents...zoloft if it works, probably just masks what ever is the real problem. And I'll admit that there may be a time and place where that makes total  sense, but I would rather get to the root cause. 

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In the fall of 2016, we started our son on low dose zoloft to try and bring relief to severe scrupulosity OCD and hopefully allow him to more fully participate in therapy.  We started at 6mg and moved up every 4-6 weeks to 25mg.  Since we did not see any real change (although it was not any worse), we decided to wean off.  In hindsight, we probably should have moved up to at least 50mg at that point. After coming off, we realized that possibly it was helping ever so slightly.  In the summer of 2017, we began again and this time worked up to 50mg and stayed there several weeks.  We still did not notice any big change (although again...it was not worse).  We have been weaning again and are finding that since we have been back down at 12.5mg, OCD has flared.  We are seeing PANS doctor tomorrow and will discuss moving back up on the zoloft and going to 75 or 100mg if needed this time OR trying Prozac (or other ssri) since we have done two rounds already.  Any thoughts on trying zoloft again or moving in a different direction?  We have also been on numerous abx throughout the past couple of years and none seem to be helping too much either.  

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We started Zoloft at an extremely low dose (2.5mg, that's right, that's not a typo for 25).  It had to be specially compounded, but we did it because of Dr. Tanya Murphy's paper on activiation for even very low SSRI's.  We had a dramatic and immediate positive benefit from that low dose, and we never went higher than 5mg.

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19 hours ago, mountainmom said:

Bobh, can you share the paper? Do you still have the link or info?  Thank you!

This link gives the full paper, as well as an option to download the .pdf:
https://www.researchgate.net/publication/228785018_Selective_serotonin_reuptake_inhibitor-induced_behavioral_activation_in_the_PANDAS_subtype

Reply if you would like to discuss it.

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