Medication?

Possum said:

Anyone have any experience of meds for this high anxiety in someone under 21? Circumstances? Type? Effectiveness?

Though I don't have experience specifically relating to your circumstances, I do take medication to manage some symptoms.

I have both ADHD and Aspergers (ASD, to be correct for my diagnosis). While waiting to be seen for my autism spectrum assessment, I had some unpleasant episodes, so my GP prescribed Olanzapine which has reduced the mood swings, anxiety and self harm. I also take a methylphenidate for my ADHD.

Possum said:

(The siblings are physicists by the way.)

So, is the whole household pedantic, particular, picky and critical? I don't mean this in a bad way, it's just the way that physicists (e.g. myself) often approach the world. How self aware are they of their impact on the YP in question?

Thank you everyone. So useful. Our YP has sought out counselling etc independently. Tries but difficult to control recurring unpleasant thought patterns.

I read about autistic folk behaving differently outside a routine environment - it was good to be reminded of this. Also the thing about sport.

(The siblings are physicists by the way.)

Pleased to see there might be a *** of light with meds too. I didn't know side effects could be different from those of neurotypicals. Thanks to that poster for increasing my knowledge. I won't say "no-one gets those blotches from using X!" again.

Best wishes.

Possum said:

It happens when back at home with mother and siblings - perceived 'ignorings', people not being (showing visually) enthusiastic enough about their interests and thoughts.

That clarifies things a lot. I seem to have grabbed hold of one end of the stick and run with it - I seem to do a lot of that (go figure)

It is a recurring theme that a school student's behaviour is remarkably different between home and school. The well regimented environment of school or college seems to suit some people and the perhaps more chaotic home environment is harder to handle. So, how many siblings are there and are any other family members on the spectrum too? Some of the worst situations in my life have happened when two (generally undiagnosed) autistic people are thrown into a situation where they have to interact. People with autism are prone to over agonise about small criticisms and we do need to be coached on letting stuff go. Equally an undiagnosed autistic person is likely to be over critical and to avoid eye contact - these behaviours will antagonise another autistic person.

Jon's experience of not being helped by CBT is also not uncommon. Some people have benefited massively from this whilst others haven't. I think there may be an issue that if the CBT is imposed on someone rather than sought out and welcomed then the CBT may not work. We (autistics) resist authority and any attempt to tell us to go along and do X may well fail. On the other hand, if we do the research and believe (as I do) that it is the best way of teasing someone out of the mental state that they have fallen into then one can be much more receptive. A problem is that this decision, to accept or refuse the offered or imposed treatment, may come at a time of great stress when one is not in a receptive mood. 

I have Asperegrs and have taken Fluoxetine and now Citalapram for Depression and Anxiety. I think they have helped but it is hard to quantify. I too found no use in CBT or Mindfulness. Exercise such as running or digging in the garden has been very helpful though. Running is great because you can do it on your own and at any time you like. i prefer running off road in the countryside.

Many thanks for your reply. I should have added that this isn't happening while away at uni. Only at home. Exactly as it was before going to uni - all the way through 2ndry school and foundation degree.

It happens when back at home with mother and siblings - perceived 'ignorings', people not being (showing visually) enthusiastic enough about their interests and thoughts.

Enjoying uni and doing well with course and on target for a 1st. Always on time with everything both personal and practical. Over fastidious if anything.

It's this business of how people are perceiving them and trying to be 'good' so they're never 'in trouble' and no-one gets angry.

Hope this clarifies.

I totally support Zitami's account of their actual personal experience. Zitami clearly has a maturity advantage compared to the OP's YP. An OU course is also possible from more familiar surroundings and, I suspect, has lass time pressure as OU degrees are more modular and can be spread over a longer period.

Drugs are not recommended in the treatment of autism and I would also add the words of the psychiatrist that diagnosed me "the morbidity [illness] of an autistic person is largely determined by their environment" If you put an autistic person in a congenial (for them) environment then they can thrive, if you put them in a toxic (for them) social/physical environment then they will come to harm.

My own experience of university was as an undiagnosed person. Diagnosis, some years later, introduced additional stressors (there is a distinct stress related to having the label and the knowledge that one is different), and I have only experienced anxiety since then.

At university I had a number of very close friends attempt and succeed in committing suicide. I never understood this at the time but in hindsight, and since it was a Physics course, issues around autism were probably not far away. Suicide is a very real thing to me, the subjects are not faceless and anonymous. Nothing can be worth that sacrifice.

Education is useful stuff but it is not the only way to have a happy and contented life. "Education, education, education" is utter bunk for a significant number of people who should not be put through that particular mill.

I obviously don't know the YP concerned and I don't know what the right answer is in their individual case so I can only give you my experience and let you and them make up their own minds.

I feel compelled to reply only because your son?/daughter? sounds so very like myself in this emotional experience.  I am much older (37) and have yet to find a solution to the problem, although I do share the common stressor of being partway through a degree course at present (however mine is with the Open University which is somewhat more flexible and less socially oriented).  The very intense anxiety can lead to severe depression and emotional instability at times, dramatically impacting on my ability to function.

As far as medication is concerned I think I have tried most classes over the years.  The ones I have personally found most helpful have been the more sedating antipsychotics (olanzapine and quetiapine specifically) and the benzodiazapines.  However both of these have considerable drawbacks.  The former tend to cause quite considerable weight gain and sleepiness and the latter are addictive so can only be used for short periods (approx. 4 weeks at the absolute maximum).  I have not had a great deal of success with the SSRIs or even SNRIs  (which I guess are probably what you are referring to since you mention suicidality) - I have found they tend to make me quite unstable and impulsive when I begin taking them or after a dose increase, worsen my sleep and don't improve my anxiety or depressive symptoms significantly.  That being said, everybody reacts to medication differently so it is impossible to say with any certainty how an individual will respond.

A general point to bear in mind (and one that is well reported if you have an interest in ASD but often does not seem to be taken into consideration by professionals) is that those of us on the spectrum are more likely to experience side effects, increased sensitivity or idiosyncratic reactions to medications.  Therefore if this is a route your young person decides to go down start on the lowest dose possible, only increase it if it is necessary and not causing any problems and be prepared to insist that you change or come off a medication that is not working for you even if the prescribing doctor insists that it couldn't possibly be causing the side effect you are experiencing (I have actually found papers reporting the exact side effect I have previously reported linked to a specific combination of medications I was taking after two doctors had told me it wasn't possible for it to be medication related).

In terms of the mindfulness etc.  I would not necessarily rule these out as possible options if they are available.  Mindfulness requires practice and talking therapies can be more or less effective at different times depending on a whole host of factors; these things need not be a one-time-only deal.  I have been forced down the medication route largely due to the total unavailability of any form of therapy thus far, however it would not be my preferred choice of treatment.

Your YP needs to resolve the imbalance between the intensity of the demands of the course and their ability to deliver sufficient output to keep up. Unless the meds can somehow help with that balance then I'm not sure how they will resolve the underlying problem. The reaction of tears and meltdowns tells me that this person is highly stressed and that they are not actually keeping up with the demands of the course and independent living.

There may be some benefit in providing coaching with their executive function skills. Is this person efficient and effective at keeping and organising their notes and tasks? Executive function issues are common with people on the spectrum and some effective guidance and help with getting the right stuff done in the right order is going to do their esteem more help than the drugs.

I suspect that the GP may believe that medication is not the solution to this problem and rightly fears that continuing to leave the person in a high stress situation is not a recipe for success.