Our son J……, who is now 5 and will begin K this fall, has shown signs of SM for two years during preschool. He just began therapy sessions with a child psychologist who has had experience with SM children. He is recommending an SSRI along with behavioral therapy; which we are all for. I have two questions:

  1. What has been your experience with Celexa. That is what I’ve been taking for the last 2 years to help with my life-long battle with social anxiety. I find it very helpful. Does it come in a liquid form? Have you tried other SSRIs besides Prozac with your patients?
  2. What is your opinion on whether a parent should administer a medication with or without the child’s knowledge. Our thinking is that if the child takes the meds without knowing, they will view the transformation to talking as something they achieved themselves and it will build their confidence for future social interactions. On the other hand, if they are aware of the meds helping them, this might create a dependency on the drug, almost like a crutch, where, once it comes time to wean them off they may regress back to not talking. I read one posting where a child begged to be put back on medicine when the parents took him off.

Answer

1) Celexa has been used with much success for children with anxiety. However, I have not used Celexa since I have had tremendous results with other medications, such as Prozac and Paxil. A clinician often gets ‘comfortable’ with a medication and sticks with it when it works well with minimal problems. I have used Prozac the most and Paxil secondary. Since Prozac has gone generic I have been forced to use other medications for parent’s insurance companies to reimburse. I have therefore used Paxil.

2) This is a very ‘individualized’ question. Depends on the age of the child and the individualized child’s personality. i.e., Some children are afraid to take MEDICINE, cause they attribute medication to being sick. Plus some children are afraid that if they take a medication to help them TALK (which is what some people tell kids), some children will rebel thinking the medication is going to make them talk and they will therefore FEEL scared. Other children BEG for help and are open to trying anything that will END THEIR suffering. Some parents with similar age children as your child, tell their YOUNG child they are taking a VITAMIN that will help them feel more comfortable (I have used this technique often). I do not recommend telling the child it will make them TALK, simply because TALKING elicits feelings of being scared and if you tell them they are taking something that will help them SPEAK, in their young minds they are assuming they will feel SCARED OR ANXIOUS. It is hard for them to understand not feeling afraid or scared, when that is all they have ever felt. Inevitably, the majority FIGURE OUT quite soon that the ‘vitamin’ they are taking HELPS them feel NOT SO SCARED

Your concern about dependence is not something that has ever come up. You can get around that by saying that when you take this vitamin (or medication) is will help replace what your body needs. Keep in mind that for younger kids saying VITAMIN is appropriate cause some children will think something is WRONG with them if they are taking a MEDICINE. So I have used the vitamin approach for most of the younger kids (your child’s age).

You will be doing behavioral therapy, so hopefully, while your child is taking meds he is building the coping skills necessary. So that, when he comes off of the medication he will be innately less anxious. Also, understand that one of the keys to treating our children young is so that they SEE themselves as a speaker and less anxious person. They do not have the years of ingrained behavior so that is very positive for our kids.

Dr. Elisa Shipon-Blum