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Are there specific guidelines for giving medication that we should know?

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We had e-mailed you a couple of weeks ago regarding some concerns we had about our 4 year old daughter and the starting dosages of her Zoloft. Thank you for your quick response. Her Dr. had started her on .5ml (10mg). Within a couple of days, we started seeing the negative side effects (insomnia, nervous agitation, etc.) and cut her dose to half of that .25ml. We completely agree with your philosophy of starting slow and low and discussed our concerns with her doctor. He's been very agreeable to working with us and what we're comfortable with. We attended the San Diego conference in January and I unfortunately did nottake enough notes during your medication lecture. I know you have discussed it in previous posts, but I was wondering if you could give us some specific guidelines as to what doses we should be aiming at. For example, at what increments do you increase the doses, after how many days do you increase and what factors do you base your final treating dose on? Her doctor has spoken of using 25-50 mg as a treating dose which I know you think is quite high. I know as parents, we are ultimately in charge of our daughters health care, but when dealing with a treating professional, what is the best way to maintain control without showing any disrespect to them and their professional advice. Thank you so much for your time and dedication to this cause.

Answer

Glad things are working out with the medication and you were able to apply the knowledge you gained from the California Conference! Although I would love to be able to help you dose your child by the use of tables and 'procedure' I simply cannot. Experience dictates my treatment.

For Zoloft, Dosages range from 2.5 mg to 25 mg. Starting at 1.25 or 2.5 depending upon weight are usual starting doses that I use and then guided by side effect profile. I do not use a time frame as much as side effect profile and response to Communication Anxiety Therapy. Meaning if a child is on only 5 mg but making wonderful progress with the tactics/techniques I do not go up in dosage. If the child is making minimal progress, but having side effects I do not go up in dosage.

I believe you are beginning to understand that although a dosage schedule would be a great way to go and would certainly make life easier, I just don't use one and my determination is based on experience.

However, I never go up more then 2.5 mg at a time. NEVER...why? Simply because that is a small enough dosage that if side effects are seen, I can back up or remain. If you jump more then 2.5 mg I find that if side effects due occur they are more severe and harder to manage.

Re: Dosage adjustments - spans range from 1 week to months depending upon tolerance and progress. I take the route of caution 100% when using SSRI's in children. And I have never had a need nor desire to use another type of medication.

Also understand that although meds can help tremendously, I find that the KEY to working with children is Communication Anxiety Therapy and viewing SM as a Communication Anxiety where treatment is geared towards the WHOLE Child and helping him/her in the REAL WORLD. With meds alone, progress comes to a standstill unless a child can learn how to COPE and progress communicatively. Parents and teachers to help the child progress communicatively. PLEASE be sure you are working with someone to help you progress communicatively so that your child can get the most out of treatment and when meds are finally weaned, she has built the necessary coping skills.

Dr. Elisa Shipon-Blum

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