Shirah Vollmer MD

The Musings of Dr. Vollmer

Prozac Wonders

Posted by Dr. Vollmer on July 15, 2011

   Emily, seven years old, has had a life characterized by social, emotional and academic struggles. She has no friends; she never has. A previous physician diagnosed her with autism, but she wanted to make friends, she had a good imagination and she understood social cues, so that seemed unlikely. She tantrums often; she has very little frustration tolerance. She seems smart when you talk to her, but academically she does not sit long enough to finish her work. Her attention span is very short, although stimulants make her more agitated and uncomfortable.   Emily does not seem anxious; she does not report any worries or concerns. Yet, her mom wondered, maybe she is so anxious that she cannot focus; maybe if she were calmer she could learn better and pay better attention to her friends.

   Emily’s mom, Shayna, made a good argument that Emily might benefit from a medication that reduces her anxiety, so, with a bit of uncertainty, we, meaning Shayna, Tom-Emily’s dad, and I, agreed to give Prozac a go. 1.25 mg of Prozac for little Emily, where the typical adult dose is 20 mg, and the typical child dose is 5 mg. Starting low seemed right given that Emily had such a bad reaction to the stimulants. Emily took to Prozac like a dehydrated plant takes to water. Within weeks, she was learning better at school, more affectionate at home, and beginning to make friends. Her tantrums stopped. A placebo, one wonders. It is hard to see how a placebo acts in a child. Emily knows she is taking medication, but she does not understand what it is for-at least she can’t tell me that. Maybe Shayna is seeing things differently because she wants the medication to work so badly. Maybe, but her teachers also report dramatic improvements. My theory is that Shayna was spot on. Emily, for reasons probably relating to an immature nervous system, was anxious trying to learn and she was anxious trying to make friends. Treating her anxiety with medication, opened the world to Emily, at least so far, that is true.

2 Responses to “Prozac Wonders”

  1. Shelly said

    Excellent blog, Shirah. My only question is why it took Emily’s mom to suggest the Prozac (no offense)? What were you inclined to try instead of Prozac? What were your thoughts about Emily before Shayna suggested issues of anxiety? If Emily didn’t appear anxious to you and she didn’t report worries or concerns, then why did you give in to Shayna?

    • Shirah said

      No offense taken. Some parents are very intuitive about their kids. Of course, retrospectively, we can say that that is true in this fictional case. It could have been luck, but my hunch was that Shayna had good insight with regards to Emily’s anxiety. If Shayna had not suggested a medication to treat her anxiety, I would have suggested a trial of a different stimulant, since Emily’s issues also have to do with a weakness in her working memory.

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