Managing Medication Side Effects in Teenagers with Anxiety and Depression

Q: Managing Medication Side Effects in Teenagers with Anxiety and Depression

Hello Ms. <br>Chiu： A small number of children taking Abilify may experience drowsiness. <br>You might try adjusting the daytime dosage to the evening. <br>Additionally, encouraging the child to go to bed earlier could also be helpful; consider aiming for a bedtime before 10 PM.

Medication Consultation

Hello Dr.
Sun, my child is 13 years old and in the first year of junior high school.
In November of last year, he was evaluated and diagnosed with Asperger's syndrome combined with generalized anxiety and depressive symptoms.
He has been continuously taking psychiatric medications.
Since February, the medication regimen has been adjusted as follows:
1.
In the morning: Abilify (Aripiprazole) 2.5 mg + Cymbalta (Duloxetine) 30 mg
2.
After dinner: Cymbalta (Duloxetine) 30 mg
3.
At bedtime: Abilify (Aripiprazole) 5 mg + Xanax (Alprazolam) 0.25 mg + Eurodin (Nitrazepam) 0.5 mg
Over the past four months, my child's anxiety and depressive symptoms have improved, but I have noticed severe drowsiness, making it almost impossible for him to attend school and engage in daily activities.
For example, this week, he went to sleep around 12:00 AM and woke up at approximately 7:30 AM.
After arriving at school by 8:30 AM, he usually sleeps until 10:30 AM before he can wake up.
In the afternoon, he sometimes sleeps from 2:00 PM to about 3:30 PM, totaling around 10.5 hours of sleep per day (sometimes even longer), and he often complains of being very tired after waking up.

After discussing this situation with his attending physician, the doctor first attempted to reduce the medication by decreasing Eurodin (initially 2 mg, now gradually reduced to 0.5 mg).
The doctor also reduced Abilify by half in the morning and evening and decreased Xanax.
However, I have noticed that my child's drowsiness remains severe! I strongly suspect that this could be a side effect of Cymbalta.
I have checked and found that the general recommended dosage for Cymbalta is 60 mg per day.
Would it be feasible to reduce it to 30 mg per day? Additionally, how can the timing of the medications be adjusted to minimize drowsiness? (Previously, I tried taking the entire 60 mg of Cymbalta after dinner for two weeks, but it didn't seem to make much difference.) I would greatly appreciate your response, thank you very much!

Qiu Xiaojie, 40~49 year old female. Ask Date: 2019/06/05

Dr. Liang Sunyuan reply Psychiatry

Hello Ms.
Chiu: A small number of children taking Abilify may experience drowsiness.
You might try adjusting the daytime dosage to the evening.
Additionally, encouraging the child to go to bed earlier could also be helpful; consider aiming for a bedtime before 10 PM.
Ultimately, the best approach is to discuss this with the physician during the next appointment.
Wishing you all the best.

Reply Date: 2019/06/05

More Info

Managing medication side effects in teenagers with anxiety and depression can be a challenging task, particularly when dealing with medications like Abilify (Aripiprazole), Cymbalta (Duloxetine), Xanax (Alprazolam), and Eurodin (Zolpidem). It’s great to hear that your child has shown improvement in anxiety and depression symptoms, but the significant drowsiness and sleepiness you describe are concerning and warrant careful consideration.

Firstly, it’s important to acknowledge that medications for anxiety and depression can have a range of side effects, and drowsiness is a common one, particularly with medications that have sedative properties. Cymbalta, while primarily an antidepressant, can cause drowsiness in some individuals, especially when starting the medication or when the dosage is adjusted. The sedative effects of Xanax can also contribute to excessive sleepiness, particularly if taken in conjunction with other medications that have similar effects.

Given that your child is experiencing severe drowsiness, it’s wise to consider the following steps:
1. Consult with the Prescribing Physician: Since your child’s doctor has already begun to adjust the medication regimen, it’s crucial to maintain open communication. Discuss the ongoing drowsiness and express your concerns about the impact on your child’s daily functioning, including school attendance and overall quality of life.

2. Medication Adjustment: Reducing the dosage of Cymbalta may be a viable option, especially since the current dosage of 30mg is below the typical therapeutic range for many patients. However, any changes to medication should always be made under the guidance of a healthcare professional. The doctor may consider increasing the dosage to 60mg, but this should be evaluated based on your child’s specific symptoms and response to treatment.

3. Timing of Medications: The timing of medication administration can significantly influence side effects. Since Cymbalta can cause drowsiness, taking it in the evening instead of the morning may help mitigate daytime sleepiness. However, this should be discussed with the prescribing physician to ensure it aligns with the treatment goals.

4. Monitoring and Documentation: Keeping a detailed log of your child’s sleep patterns, medication times, and any side effects can provide valuable information for the healthcare provider. This documentation can help in making informed decisions about medication adjustments.

5. Lifestyle Modifications: Encouraging healthy sleep hygiene practices can also be beneficial. This includes establishing a consistent sleep schedule, creating a calming bedtime routine, and minimizing screen time before bed. Regular physical activity can also help improve sleep quality and reduce daytime drowsiness.

6. Consideration of Other Factors: It’s essential to consider other factors that may contribute to your child’s drowsiness, such as sleep disorders, lifestyle habits, or even the psychological impact of anxiety and depression. A comprehensive evaluation may be necessary to rule out other underlying issues.

In conclusion, while it’s understandable to suspect that Cymbalta may be contributing to your child’s drowsiness, it’s crucial to approach any changes in medication with caution and under the supervision of a healthcare professional. Open communication with the prescribing physician, careful monitoring of symptoms, and consideration of lifestyle adjustments can all play a role in managing medication side effects effectively. Your proactive approach in seeking solutions for your child’s well-being is commendable, and I encourage you to continue advocating for their health and happiness.

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