My Peregrinations

Winging my way through life

Tag: anxiety

An uneventful doctor’s appointment.

Girl #1 saw her psychiatrist Dr A today. He was happy to hear that she feels that her OCD symptoms are non-existent, and that she actually did fairly well in school considering that she’d missed several weeks of the first semester. Since she appears to be stable on her current dose of fluoxetine and is happy with where she is, he will see her in three months’ time.

However, he did write a referral to the endocrinology department for her. She’s been reporting hair loss, feeling cold all the time, having dry skin…basically all the symptoms of hypothyroidism except for the weight gain. Girl #1 last had her TSH levels measured in June last year, at which time they were normal, but Dr A says there’s no harm in having an endocrinologist take a look at her again. There was one day last week when she was so cold that she could no go to school, and her body temperature was between 35 to 36 degrees Celsius, which is definitely not normal. Below 35 degrees Celsius is considered hypothermia!

I pointed out that her issues could be either due to thyroid problems, anaemia, or simply the continuing side effects of fluoxetine, and that sometimes it’s hard for us to decide whether it’s a true problem, or her just being dramatic as some teenagers are wont to be. Dr A agreed, but said that the approach should be to do due diligence, and if everything turns out normal, to assure her that her concerns are being addressed or managed and that she should continue with daily activity as usual.

On balance, I think it was a good review. Let’s hope the next three months are OK and that the endocrine doctors are able to give us some answers when we do get an appointment to see them.

Resources for parents with anxious kids

I didn’t expect so many friends to send me private messages to share their struggles with their own kids, after my last post. It just goes to show that many families struggle privately – and alone – with their children’s mental health.

I thought I would compile a list of things that have helped the girls (and me) since we started on this journey. Some have worked better than others, but all are worth a try if you’re at your wits’ end.

Do progressive muscle relaxation
Girl #2’s psychologist introduced us to AnxietyBC, which is an excellent resource for all kinds of topics related to anxiety. The site has scripts for progressive muscle relaxation for children and teenagers, which is helpful to teach them how to be aware of the effect that being anxious has on their bodies, and what they can do to relax. Girl #2 and I used this script for a few weeks, just before bedtime. Although she was reluctant to follow the instructions in the script at first, she actually started to practise the relaxation technique when she was anxious in school. So it works – you just need to give it some time and reinforce it consistently so that it becomes ingrained.

Explore supplementation*
I’ve always been skeptical about the need to take supplements, because we really should be getting most required nutrients from a balanced, nutritious diet. But my kids don’t eat very well. Their appetites and eating habits are mainly mood-driven despite our best efforts to regulate mealtimes. Which is to say, if they don’t feel like having dinner, they just don’t. And then they go downstairs at 2am to make themselves a snack. They like to say their stomachs are the size of their fists, so I shouldn’t expect them to be able to eat that much. I’ve given up fighting them on this.

I give them a daily multivitamin to ensure that their micronutrients are accounted for. This is all the more important now that they are on fluoxetine, because the medication does deplete nutrients such as magnesium from the body. Fluoxetine also suppresses the appetite, which makes eating more challenging.

I give both girls a good probiotic because there is increasing evidence of the impact of the gut-brain connection on anxiety. Healthy gut, healthy brain. It helps keep bowel movements regular, too.

I mentioned magnesium – magnesium is a calming mineral, so it should be taken just before bedtime to promote restful sleep. Magnesium oxide is the most commonly available form of magnesium on the local market. It’s also the form that will give you the runs if taken in too-large quantities. If you want to try magnesium supplementation and your child is not currently on medication, look for magnesium l-threonate if you can, as research indicates that this form of magnesium is best for anxiety. I just went with magnesium oxide, though it’s not so well absorbed, and gave tiny doses so the girls wouldn’t get diarrhoea. I’ve tried ChildLife calcium and magnesium (these two minerals go together for better absorption) and the orange flavour from Natural Calm. Between the two, the girls like the latter better. But they would prefer not to have any magnesium at all, if they can help it, because it doesn’t taste particularly nice. If you don’t want to supplement with magnesium, or if your kid hates the taste, give them natural sources of magnesium such as spinach, yoghurt, cheese, and almonds.

Omega-3 fish oil
Omega-3 comes in fish and non-fish versions, but we are not vegetarian, so we go with the fishy capsules. There are combined EPA+DHA forms, and there are also forms which have more of one or the other. I’ve read a few articles like this one suggesting that a higher ratio of EPA to DHA is beneficial for anxiety and depression. But I think that if you’re starting at a deficient baseline, a combination supplement would be more than good enough. The girls take Nordic Naturals’ Ultimate Omega 2X Mini. I freeze the capsules and they swallow them, to prevent any nausea or fishy burps. I’ve also tried Barlean’s fish oil but that didn’t go down so well. It’s not that the taste is bad; I think the girls just have very vivid imaginations and imagine that what they’re swallowing is syrup with essence of fish or something. So the Nordic Naturals capsules work best for us.

This should only be given if your child is not currently on any medication for anxiety or depression. You can read more about l-theanine here. If you like Taiwanese Chun Cui He milk tea, you may remember that they were removed from shelves shortly after launching in Singapore because they contained l-theanine, which is not an approved food additive here. That is not to say that it is unsafe. The US Food and Drug Administration classifies l-theanine as “Generally Regarded as Safe” but countries such as Singapore don’t allow it in food even as they allow its sale as a supplement. GNC sells this as mint flavoured chewables, and four a day is the most that a child should be taking if you buy this. You can also look at Source Naturals though the dose per chewable for this brand is much higher. I gave Girl #2 l-theanine for several weeks but she didn’t feel like it did much for her anxiety. When the husband and I tried it, we both felt very relaxed and sleepy less than half an hour later. So your mileage may vary.

*Note: Please consult your doctor and do extensive research before trying any of these for your child. I have to say this because I’m not a doctor and your child may have other health considerations that may make supplementation of any kind without prior medical advice risky.

Join an online support group
There doesn’t seem to be a Singapore-based support group for parents of children with anxiety, but there are thriving communities on Facebook. Check out Parenting Kids with Anxiety which has members from all over the world. There’s also a group called Parenting Kids/Teens with Social Anxiety Disorder, which discusses holistic and alternative treatments such as using essential oils. These groups make it less of a lonely journey.

Read books, watch shows
There are plenty of books out there on living with mental health disorders. I bought a couple of books on OCD for Girl #1, who found them helpful because she could relate. Titles you can check out are The Man Who Couldn’t Stop and Being Me with OCD. I also bought a copy of Brain Lock, which teaches a simple but effective four-step method of managing OCD. For anxiety, there are books for younger children, such as What to Do When You Worry Too Much. I haven’t bought this last book, but the reviews are good. Since Girl #2 is into manga and anime, I tried looking for titles with themes to which she could relate. A Silent Voice was a big hit with her. She watched it in the cinema not once, not twice, but four times.

Don’t focus on the cost of treatment
I know the general impression of mental health treatment is that it is very expensive. Yes, it is, if you decide to go private. However, if you’re a subsidised patient at a restructured hospital, the cost is moderated significantly because of government subsidies, and the fact that you can use some of your Medisave to pay for doctors’ consultations (psychologist’s consultations are not claimable). If you have an older child, you can also look to places such as Shan You Counselling Centre, which charges no more than $50 for a 50-minute counselling session. Fees vary according to the client’s income level. Help is definitely out there, so don’t feel like you shouldn’t get help because you can’t afford it.

Find the right time of day for therapy
Girl #2 is generally much more receptive to her psychologist and psychiatrist in the morning. It’s understandable, because the afternoon appointments are after the school day is over, which means she’s tired, hot, and thinking about all the homework she has to do. Knowing the best time to take your kid for therapy will make it less painful for all involved. Unfortunately, we don’t always get to choose morning appointments. When it’s an afternoon appointment, I keep Girl #2 happy by enticing her with things like ice cream, bubble tea, and waffles.

Manage the side effects of medication
Every medication for depression and/or anxiety has its own laundry list of side effects, sometimes running into the hundreds. A list of side effects for fluoxetine can be found here. While both girls mainly complained of headache, dizziness, and nausea, fluoxetine appears to also have an impact on the menstrual cycle, making periods heavy and/or irregular. We dealt with the headaches by taking paracetamol (you shouldn’t take ibuprofen or other non-steroidal anti-inflammatory drugs on fluoxetine), used Sea Bands for nausea, and made lots of peppermint tea. At one point, I also used ginger capsules from Gaia Herbs which were very effective for nausea, but I stopped when I found that ginger interacts with fluoxetine. Which brings me to…

Download drug interaction checkers
If you’re like me, you probably have a handful of over-the-counter medications that you give your kids whenever they are down with garden-variety sicknesses that don’t necessarily require a visit to the GP. Once you start on antidepressant and anti-anxiety medication, however, self-medication becomes a lot more tricky. For example, I’ve learned that Clarityne for a runny nose is OK, but not Clarinase. Paracetamol is OK, but not ibuprofen unless the pain is intolerable. Whenever the girls see our family doctor, he pores over his drug guides to double-check that the medication he’s prescribing is safe to take with fluoxetine. You can do the same at home by downloading apps such as Epocrates, Medscape and I err on the side of caution – if any of these apps throws up a possible interaction, I don’t give the medication. I also ask the duty pharmacist at Guardian and Unity – they are super helpful.

I’ve just typed over 1,500 words. Phew! I hope you find something in this post to help you, if you’re parenting a child with anxiety. Let me know if you do!

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