Sertraline

Take the syringe, watch the calibration carefully as you pull the clear, bitter liquid out from the bottle. That bitterness is why you need lemonade. Orange juice works too. The acidity will offset the bitterness. Wipe the bottle clean before you place it back in the cupboard. Any medication that spills along the sides will be sticky.

J is 5 when we start this regiment, hoping that the sertraline prescription will do enough to keep his anxiety and OCD-like symptoms manageable. We were nervous to start. Anti-anxiety medication for a five year old? But the anxiety is debelitating for him. We feel like we don’t have any other choice.

“Don’t forget to stop by CVS for the refill. Don’t forget to keep the lemonade stocked in the fridge,” become recurring thoughts for both Steve and me. When we have to do an overnighter anywhere, we have to make sure that we bring the bottle with us and that there’s lemonade somewhere at the destination. Anytime we stay at a hotel with a continental breakfast, we hope that there’ll be orange juice as part of the package. You can mix the sertraline with water, but it’s a bitter liquid pill to swallow. J will grimace and complain, but he will still take it. After all, it’s part of the routine, and with J the routine is everything.

We try for years to teach J how to swallow a pill. The doctor gives him a little canister of mini M&Ms to practice swallowing pills but that doesn’t work because he just wants to eat the M&Ms.

We go back to the syrup.

After a few years, we try the pills again. He’s older so he can follow instructions better. I teach him my behind the teeth trick. I drop the tiny M&M right behind his bottom incisors and for a minute it sits cradled behind his new adult teeth. “Hold it right there,” I say. I give him a glass of water and tell him to drink. It goes right down. We graduate to pills. It’s a $30-$40 savings per prescription pick up. Who knew liquid anti-anxiety medication was so much more expensive than the tablet kind?

We investigate dosages, always upping a little more at a time. It happens a lot while J is in middle school. In fact, we get very close to the maximum threshold of dosage for his height and weight while we try to mitigate the increasing anxiety and panic attacks that seem to have come just as suddenly as the hormone changes and marks of puberty. We add methylphenidate for ADHD symptoms, because those seem to suddenly have come up too during the middle school years. We get to high school and his anxiety seems to get better–for the most part. He still has panic attacks over fire drills and other things that come up from time to time. As he keeps growing, so do the dosage sizes to accommodate the new physical growth. We do this routine for the next few years.

Until now. We change doctors in November and at our introductory appointment, she asks me the question we have discussed at almost every visit we’ve had for the last 12 years, but in a way that makes me think a little bit differently about the sertraline and J’s anxiety. “His chart says he’s been on the sertraline since he was five,” she says. “Do you feel like the sertraline makes things better?”

Makes things better? We’ve ridden this sertraline train for 12 years and have talked about his behaviour in school and have been adjusting it accordingly. It sounds strange, but “does it make things better” has long but disappeared from my mind. And when I think about it, I can’t remember if the anxious J at 5 is any more or less anxious than the 17 year old J now.

“No,” I say, stunned by my own answer. “I’m not sure if it does.”

The doctor suggests a different medication for treating J’s anxiety, and we wean him slowly down off the sertraline and totally wean him off the methylphenidate. We introduce the new drug, clonidine, and wait five months to see if the clonidine makes a better difference.

“Do you think the clonidine makes the anxiety better,” she asks, this time over our Facetime office visit. We’re in the last few weeks of virtual school. We’re now in the throws of the pandemic.

I want to say hes, but the answer is no. And so we decide to wean J off the clonidine too. Fractions of fractions of doses, until it’s whittled down to nothing.

For the first time in 12 years, J is on no prescription medications to help with his anxiety or inattention. It’s been one full month since his last pill.

What have we seen?

Absolutely no difference. If anything, J is less jittery, and for the most part, more pleasant, even with his anxiety of the pandemic and everything else going on. A few weeks ago, we went to the North Shore, stayed in hotel rooms without continental breakfasts (because of the pandemic), without lemonade, orange juice, syrup, or pills. Often travelling and trips triggers J’s anxiety. He’s anxious over hotel room numbers (is our hotel number on the “tainted numbers list?”. He’s anxious about where we’re going to eat, when we’re going to eat, how long we’re going to be away from the hotel. The list goes on. And yet this North Shore trip went perfectly fine–without pills and minor anxiety waves that he could navigate on his own. Not one meltdown. Not one panic attack.

We’re at a strange place in all this now. We’re in the middle of a pandemic. We’re switching doctors again (our new doctor is moving out of Fargo). J’s no longer considered a pediatric mental health patient according to Sanford (they’re bumping all the 17 years olds now to adult mental health). But with one of the biggest uncertain event the world has faced in our lifetime happening right now–with all of J’s activities and possible last year of high school up in the air, right now, J’s sitting fine.

We still work on social stories, coping strategies. We still have mental health talks every day, so he’s not left to his anxiety and mental health struggles high and dry.

That seems to be enough support for now. Will it always be that way? I’m not sure. But for now, it seems the J on sertraline seems no better or worse than our J without the medication.