Question: My 14 year 11 month old son has had a recent diagnoses of Attention Deficit Disorder after not being able to focus on his classwork. His psychiatrist initially prescribed him Fluoxetine 10mg several weeks ago. After we shared that we did not see any improvement, the psychiatrist increased the dose to 20mg and added Concerta 18 mg three days ago.

Today he indicated that he awoke at 2 am and could not get back to sleep, and has not slept all day.

At 7 am he noticed his heart was beating rapidly.

Around 1 pm (when he relayed what was going on), his heart rate was between 120 and 132 bpm while sitting (SpO2 has always been 98-100%).

Around 8:30 his heart rate was down to 105 bpm.

He shared that he sometimes feels nauseous and exhausted with upset stomach (Lately I have noticed changes to his normally ravenous appetite.)

I was happy to hear from he that he has noticed that he has had more positive thoughts about school and in general. He indicates that he has had less daydreaming and said that he has been choosing much less violent video games.

Can you provide (1) your opinion of the two medications that he is taking, (2) provide some insight on the apparent side effects and (3) any additional concerns (other than what I've shared) we should take back to his psychiatrist?

I appreciate your help