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hopeful_mum

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Reply with quote  #1 
Just wanted to get your thoughts on how you notified schools about your children going on meds. Did you tell them risk of suicidal thoughts? My d school is totally flatline dealing with most issues but I'm just worried this might freak them out into an overeaction n start watching her like a hawk. Or did you all just notify them n not really mention side effects? Thanks
mnmomUSA

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Reply with quote  #2 
I didn't notify the school.  I started them over  a break from school though, so I was able to have a pretty good sense over that 10 day period how she was reacting to them.  

Not sure what I would have done had I not had this "luxury" of observing her at home for a spell.  

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D, age 16, first diagnosed March 20, 2013, RAN, at age 13 Hospitalized 3 weeks for medical stability. FBT at home since.  UCSD Multi-family Intensive June 2015.  I see light at the end of the tunnel!
OneToughMomma

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Reply with quote  #3 
From the perspective of a teacher, I don't think you NEED to notify them as long as the meds are administered at home. (I'm in Australia and maybe there are other rules or protocols where you live.)

You might choose to tell them for any number of reasons.

  • You really do want/need them to keep watch on her for SI.
  • Them knowing she is on meds might make them support her better.
  • The meds might impact on her learning/behaviour other than the SI.  So if you think she might, say, be extremely sleepy or agitated or whatever, then they should know.

From the perspective of a parent, I pretty much kept the school up to date with all that was happening. I felt they would be more supportive of her and her little sister if they understood the seriousness of the illness and challenges of treatment.

However, I don't remember telling them about medication at all.  I wouldn't have been shy about that (so NOT my style), but I must not have thought it was relevant or important.

Here's hoping the 'fluvox', as we call it, gives your d some relief from her anxiety.

FWIW, it did help our d.  After WR she (in consultation with her Dr) took herself off, and then decided to get back on. 

One word of advice.  I suggest you make taking the tablet part of your routine so that you always see it go in.  We allowed our d to manage the tablets herself during refeeding and she stopped taking them suddenly.  It was hellish.  Truly horrible.  You'd want to avoid that.


xoOTM

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D in and out of EDNOS since age 8. dx RAN 2013. WR Aug '14. Graduated FBT June 2015 at 18 yrs old. [thumb]
Psycho_Mom

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Reply with quote  #4 
OK. The danger of increased depression or suicidal ideation with fluoxetine is nearly always IN THE FIRST FEW DAYS only. Or when changing the dosage. Therefore you should have been advised by the prescriber to start the medication when you will be able to observe your child closely for a few days. To start it on a weekend, for example. Or take your child out of school on Friday and start it then, or wait for a school break.

The things you need to watch out for are changes in mood (elevated or depressed or suddenly changing) odd or unusual or out of character behavior, lower mood, and some other things I forget but that the prescriber should have told you or they shouldn't be prescribing. Watching for these changes, I think, is not something a busy teacher is going to be capable of. Start the med at home.

If there are no concerns after 2-3 days, going to school, especially if the school has a clue what's going on, should be fine. Just definitely watch out for a change of dosage (which is what suddenly stopping would be--a big change of dosage.)

I believe that schools require being informed if a student is taking a prescription medication. Even if the medication is not normally taken at school, they need to know this in case of emergency (if your kid breaks an arm and the EMT's come, they are going to want to know what meds he's taking. Or if there's a lockdown or something and the kid misses a usual dosage, or if there's a school camping trip or whatever.) Also, if a school knows a student suffers from an anxiety disorder (you don't have to specify ed, you can just say "taking a med for anxiety") it can DEFINITELY help caring and educated instructors to work better with your child. I also have worked in a school, and believe me, fluoxetine (and many other meds) is not unusual. 

best wishes,

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D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
Torie

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Reply with quote  #5 
Quote:
Originally Posted by Psycho_Mom
OK. The danger of increased depression or suicidal ideation with fluoxetine is nearly always IN THE FIRST FEW DAYS only. ...


I'm curious to know your source for that. For my d, the increased suicidal ideation continued as long as she was on fluoxetine (about a month). Not sure what happened in the first few days, and not at all sure I would have been able to tell the difference. During that horrible period of time, I got most of my information from the guidance counselor calling (or a friend's mom calling) to tell me d was talking suicide so there was usually a time lag before I knew how bad things were.

It was during that time period, but I'm pretty sure not the first few days, that D begged us to let her die.  Other than that, she tries to convince us she's doing better than she is actually doing. So she was obviously feeling really desperate to say that to us.

I talked to the GC, the school nurse, and the principal ... in part because the guidance department knew already. But mainly because I wanted to give them some information. (Not sure it mattered, but I tried.) I don't think her teachers knew.

Don't know if any of that helps. Hang in there.

xx

-Torie



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"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
linefine

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Reply with quote  #6 
I take Fluoxetine, and although I didn't have suicidal thoughts, the side effects I had (heightened anxiety, deeper depression, mouth so dry I couldn't eat, insomnia) were worst after about 3 days, and lasted a good 2 weeks before tailing off.  I felt worse for a good 3 weeks, then very gradually started feeling better, with the complete feeling back to normal by 6 weeks.  I think it's a brilliant drug for me, but I needed a great deal of support during those first weeks.
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Heather

Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It does not dishonour others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always PROTECTS, always TRUSTS, always HOPES, always PERSEVERES. Love never fails.
PuddleduckNZ

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Reply with quote  #7 
I told my Sons school what meds he was on and any changes, just in case they noticed anything odd.
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Son 9yrs when he became unwell 2013, ED slide from April 2014, dx at 10yrs July 2014, 2 hospitalisations - dx so many times Behavioural Anorexia, EDNOS, ARFID. FBT from August 2014. Anxiety, Emetophobia. 11.5yrs old now. Reaching for recovery, we're so close....
Psycho_Mom

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Reply with quote  #8 
Quote:
Originally Posted by Torie
Quote:
Originally Posted by Psycho_Mom
OK. The danger of increased depression or suicidal ideation with fluoxetine is nearly always IN THE FIRST FEW DAYS only. ...


I'm curious to know your source for that. 
xx

-Torie




Well, the FDA and our t.

The black box warning says:
"Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. "

Our t told us that in her experience, it was the first few days that close monitoring was most important for adolescents. If the first few days went OK, going to school would likely be OK.

And yes, "patients who are started" is much less specific than what I said, and therefore allows for individual variation even unto not developing or showing side effects until several weeks later. (How long does 'starting' last?) So I shouldn't have made it sound like if the first few days were OK, everything would necessarily still be OK three weeks later. My bad.


I think actually also that it can be useful for the person TAKING the medication to be advised of what side effects could (in a very tiny percentage) happen, including explaining at an appropriate developmental level what suicidal ideation or thoughts  are. My 15 yr old d didn't really have any vocabulary for such things, she just knew they sounded scary. She was helped (and I was helped by knowing how to ask her about it) by knowing that it could be be thoughts like "everyone would be happier if I weren't here". Providing a framework for talking about it, and normalizing talking about it before starting the med, was useful for us.

My d has been taking Prozac for two years. Her mood, anxiety and depression are good. We notice an increase in depression for a few days if she misses more than a dose or two. 

best wishes,

__________________
D diagnosed with EDNOS May 2013 at age 15, refed at home Aug 2013, since then symptoms gradually lessened and we retaught her how to feed and care for herself, including individual therapy, family skills DBT class, SSRI medication and relapse-prevention strategies. Anxiety was pre-existing and I believe she was sporadically restricting since about age 9. She now eats and behaves like any normal older teen, and is enjoying school, friends, sports, music and thinking about the future.
Playball40

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Reply with quote  #9 
Completely agree with PsychoMom - It's at the very beginning of taking the medication and increasing the dosage that the biggest risk of side effects occur.  My 12 yo daughter has been on it since June and is doing very well with it.
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Caroline
hopeful_mum

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Reply with quote  #10 
Hi all, sorry I just saw your replies now. I thought noone had responded. My emails didn't come through notifying me of a reply. Well I hesitated informing them in the 1st few days and but decided to tell them yesterday. Like OTM and Psycho_Mom said I really want them to be aware so they a) take my d social anxiety more seriously b) hopefully will be more sympathetic to her difficulties c) not discipline her for anything that may be due to medication such as lack of concentration, yawning etc.

I always feel like I'm betraying my d confidence but I do really feel it necessary for the school to be given the full picture. All last year they just treated her like any ordinary kid and disciplined her as they would anyone without consideration for the reasons behind her 'acting up' or the psychological difficulties that she has. I am fighting for the school to support and understand her better this year. So for that reason I feel that we should fully disclose such issues so they can't blame us for not keeping them informed should something go wrong.

Her dose is only 5mg for the first 10 days so no side effects thus far. End of Jan her dose will go up to 10mg. No effects, good or bad so far so I'm happy with that.

I haven't highlighted the SI risk but may reconsider this when her dose is upped at the end of this month.

Thanks all again for your input. Good to know SI is usually only in first few days of taking for 1st time or new dose. Although like Torie explained there are exceptions to the rule so will be vigilant.
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