I have a 12-year-old DS who was diagnosed with ADHD, anxiety and migraines two years ago. From April 2003 to September 2004 he was on 27 mg Concerta; last September it was raised to 36 mg Concerta. He is also on 10 mg Inderal twice a day to prevent migraines. This January his doctor added 2.5 mg Focalin in the late afternoon because he was having trouble settling down to do homework. Then this February we discontinued Concerta because DS developed a facial motor tic (mouth grimace). DS also said he no longer wanted to be on Concerta because it made him feel "flat." We tried Strattera, but discontinued it when it gave DS terrible migraines (two in three days). We tried Adderal XR, but discontinued it when his motor tic worsened to the point that his friends at school were asking him what was wrong with his face. So we are sticking with Focalin 5 mg twice a day (DS refuses to go to the school nurse to take a midday dose) until long-acting Focalin is available, hopefully in August in time for the new school year. It's not a perfect solution, but we feel as if we don't have many options left in the ADHD department.
The bigger problem is treating his anxiety. DS is having major problems with school avoidance. A lot of mornings, but particularly on Mondays or after a school break, he stomps around the house, slamming doors, throwing books and getting physical with his younger sisters (and sometimes even with us). He has been seeing a psychologist since December, who feels that DS should be taking medication to calm his anxiety and referred us to a psychiatrist for medication management. We tried two weeks of 5 mg Celexa, but stopped when it made him so apathetic that he couldn't do his homework even with Focalin. This morning we gave him 5 mg Prozac and he became incredibly weepy, irritable and agitated for three hours this afternoon. He threw books in his room until he broke a window. He started throwing other objects in the house until my husband physically carried him out onto the driveway until DS could calm down. Of course, we cannot in good conscience give him Prozac tomorow morning and send him off to school. We are increasingly nervous to try another SSRI because of the side effects DS has already experienced. Quite frankly, we are also losing confidence in this psychiatrist because, even though we know medication management is a lot of trial and error, we feel the doctor doesn't "get" DS. We also feel he is too perfunctory with us and doesn't give us enough information about medication options that might help DS.
My questions are these: First, does anyone have advice on finding the right doctor to handle medication management for ADHD and anxiety? (We happen to live in a major metropolitan area, but there are too few child psychiatrists to meet the demand.) And second, while I realize each kid is different, has anyone found a good combination of drugs to treat both ADHD and anxiety?
Thank you in advance for any insight you can offer.