Tics and Prozac - A Letter To The Doctor

We are at 40mg of Prozac now. Ewen said he would rather have a little anxiety and not as much tics, than to have no anxiety and severe tics.


What I wrote to Ewen's doctor today:

Dear Dr. Davids

Ewen is at 9.5 weeks of Prozac and is “feeling good” again. He felt best when we put him up to 5ml’s but Mike and I were alarmed at the tics and behaviors that became severe after 4 days at 5ml’s. Ewen has always had mild tics that come and go. But with the sudden onset of his anxiety/panic/ocd disorder the tics appeared again, and as we increased the dosage of Prozac the tics became worse. 

We brought the dosage down to 4ml’s (which is where we are at now) and the tics are not as severe, but they are still there. Ewen copes with the tics during the day and says he barely notices them. But when he goes to sleep at night he:

Tics at night:

1. huffs a lot

2. swishes saliva in his mouth

3. repetitively tightens his leg and arm muscles

4. Taps repetitively with his legs and arms

He doesn’t relax then fall asleep at night. He has these tics badly until he finally passes out. Melatonin helps speed up the process of falling asleep. 

Tics during the day:

He huffs a lot, sometimes more than other, he also tightens his muscles repetitively at times. He doesn’t have the saliva tic during the day. He does have restless leg during the day if his mind isn’t occupied.

He can’t sit still at home if he isn’t distracted and has to twist himself into a pretzel on the couch.

The concern is that the prozac is treating him well for the anxiety and depression, especially at the prescribed dose of 5ml’s. But the dramatic increase of tics and the constant agitation makes us worry about the prozac harming him long term. He has always been unusually sensitive to medications, I worry about him being very susceptible to serious side effects of medication.

I have been thinking a lot about what to do. I was wondering if we should look seriously at rTMS? 

Also I was wondering if we should start him on very low doses of buspar (like what his sister now takes and it is very helpful for her). Then maybe slowly wean him off the Prozac? I read that Buspar is officially helpful for generalized anxiety (which Ewen also has), and unofficially helpful with OCD and tics, with little to no side effects. 

Our number one concern is that Ewen doesn’t plunge back into the hole of panic and depression. He was in very, very bad shape before the Prozac and I prefer tics to him loosing all interest in activities and not wanting to leave his room. But if there is a better way, I want to take it. I’m not sure if Zoloft is the answer as I have read that it doesn’t help with tics at all either. I don’t want to add another anti-tic medicine with lots of side effects to the mix either. I was thinking about Buspar because it has few to 0 side effects, it helps his sister and it helps me so genetically it is more likely to help him too. 

Here are two articles about Buspar and children.

http://www.pni.org/neuropsychiatry/attention_deficit/buspirone/

http://www.jaacap.com/article/S0890-8567(09)63043-4/abstract

http://www.pni.org/neuropsychiatry/attention_deficit/buspirone/

http://www.jaacap.com/article/S0890-8567(09)63043-4/abstract

Here is an article about rTMS in children but I didn’t have access to it. You probably do:  http://www.brainstimjrnl.com/article/S1935-861X(14)00181-8/abstract

Here is one about Buspar and kids on the spectrum (it does help with anxiety and depression and Owen is likely somewhere on the spectrum) 

To summarize, these are two options of what I think we would like to do but we need your guidance and expertise:

1. rTMS

2. Add Buspar and wean him off the Prozac if possible, but put him back on it if he gets anxious and depressed again.

3. Add Buspar and reduce the dose of Prozac and see if that helps.

Thank you,