How low is "low dose" of an ssri?

[chubbermommy]

So non PANS psychiatrist recommended 25mg Zoloft for ds' OCD. Currently treating (or trying to treat) Lyme with abx and supps but would be nice to take the edge off the OCD if possible. I realize it may muddy the waters as to what is working but I owe it to ds to let him try. Hopefully won't regret it.

 

So I believe Dr Swedo or Murphy said 1/10th or 1/4 of a regular dose is a good starting point for pandas/pans kids? Can someone verify?

[MomWithOCDSon]

I can't recall precisely a quantitative amount advocated by either Dr. Swedo or Dr. Murphy; I'm not even certain that Murphy's paper on the topic of PANDAS and SSRIs makes a specific, quantitative statement in that regard.

 

And it'll vary from med to med, too, since those dosages in terms of mgs. can vary substantially.

 

What I've seen/heard is many families effectively halving what their doctor's "recommended" dose is for their kid, to start. So if they're recommending 25 mg. of Zoloft, you might want to start with 12.5 mg. and see how your kid responds. Give it 4 weeks, and if you're not seeing anything palpable, then maybe you could try increasing it to the 25 mgs and give it another 4 weeks to see what happens. Since these typically take 4 to 6 weeks to reach full efficacy, you just have to guard against drawing a conclusion too quickly and stopping or increasing dosage too quickly as a result.

 

In our experience, the good news is that if you inadvertently take the dosage up too high, seeking the "sweet spot" where it helps as much as it can, you can step it back down again quickly and any activation the SSRI might have caused will fade quickly -- within a day or two.

 

Good luck to you!

[mama2alex]

Zoloft comes in a liquid form for kids, so you could start very low and work up very gradually.

[Wombat140]

Late reply, but I looked all this up a while ago, so I know the figures. Apparently the dosages for SSRIs fall into two groups - the standard dose range for Prozac, Paxil and Celexa (in America, at least) is 20-60 mg, whereas for Zoloft and Luvox it's 50-200 mg (well, actually 50-300 mg for Luvox). The consensus in older postings on here seems to be that for PANDAS kids a cautious level to start at is 2 or even 1 mg for Prozac etc., and 25 or even 12.5 mg for Zoloft etc., depending on the child's weight and whether they have a history of reacting dramatically to things. Do a bit of searching on here and you might find more.

 

Edit: Having checked the case history I had in mind, I actually meant 2 to 1 mg of Prozac, not 5 to 2.5.

Edited May 18, 2016 by Wombat140

[EAMom]

PPN says 1/4 of regular starting dose or less.

"BUT, the medications MUST be started at an extremely low dose (e.g., 1/4th or less of that used for a typical child) and tapered upward very slowly to avoid activation, agitation, akathisia, and other adverse effects of the drugs." https://www.pandasppn.org/ssris/

At the West Coast PANDAS conference a few years ago Swedo said:
"SSRI-start with 1/10 of the regular dose"
http://latitudes.org/forums/index.php?showtopic=22653

[Ladymavs]

We just started on 6mg of zoloft for DS (age 15...130lbs). Is it normal to start this low? It has only been a few days and we have seen very nominal changes, if any. The good thing is that it has not gotten worse. I was wondering when is a good time to talk to doctor about upping to 12.5mg.