Dr. Theodore Henderson, MD, PHD

Hi Rose. First, you are very resourceful and smart to have come on this forum. I will answer your question and I want you to share it with your folks.
Problem #1 is that your fluoxetine is not doing the job. It is not the greatest for treating anxiety. Talk with your doctor about buspirone as a second medication that is specifically made to treat anxiety. It can be added to the fluoxetine. If your doctor is not a child psychiatrist, then it is time to see one. They are more knowledgeable about these things and may be more comfortable with medications like buspirone or gabapentin to treat anxiety. As for what you can do.
#1 wear socks and change them at least twice a day
#2 - treat your skin on your feet with a cream for athlete's foot - this will help them heal and soften them so there is not so much to pick at
#3 - wear gloves - like winter gloves or mittens. This will serve as a reminder not to pick.
#4 - get a fidget toy or some beads on a string to fidget with when you are feeling anxious.

As I wrote about in a recent publication (McLean et al, Increased Asymmetric Perfusion of the Cerebral Cortices and Thalamus Indicates Individuals at Risk for Bipolar Disorder: A Family Cohort SPECT Neuroimaging Study Frontiers in Psychiatry, 2022): Bipolar disorder is a significant mental illness affecting over 4 million people in North America and approximately 46 million worldwide.

Yes, sleep disorders in children are very much something that a psychiatrist can help with. You would want to choose a child psychiatrist if possible.

This condition is called Obsessive-Compulsive Disorder or OCD. It is characterized by intrusive thoughts (about being dirty in your case) or "obsessions" which cause increasing anxiety until behavior is done to reduce the anxiety (in your case, hand washing). This pattern of intrusive thoughts, rising anxiety, and relieving behaviors repeat over and over. The repetitive behaviors are called "compulsions". OCD responds well to cognitive -behavioral therapy and to serotonin-reuptake inhibitors. However, the doses of SSRIs required to treat OCD are generally higher than those used to treat depression.

The best "at-home" treatment for anxiety, which I recommend to virtually all of my patients, is meditation. You don't have to be able to sit in a lotus position, but you do have to be persistent. Meditation feels awkward and pointless at the beginning, but keep practicing. It often helps to start with a meditation or mindfulness app on your phone. There are dozens to choose from. Commit to spending 15 minutes per day for at least three weeks. I have patients who have been able to work their way off of medications by using daily meditation. Good luck and good health.

Please tell the clinician that is prescribing your medications about these experiences.

There are two major approaches to OCD - cognitive-behavioral therapy (CBT) and medication. A psychiatrist is the best choice for handling the medication piece because OCD can be tricky to treat. Often the doses of medications need to be higher than that used to treat depression. Also, combinations of medications are often needed to fully control OCD symptoms.

Panic attacks at night are not uncommon in Panic Disorder. An adjustment to your medication might be helpful. If you are not on medication, it might be worth considering. Doing things that are calming before bed, such as using a meditation app on your phone may also be helpful.

There is no question that hormonal shifts with the menstrual cycle can play havoc with the brain. We did an internal study at an imaging center for which I served as the medical director. We did functional brain scans (SPECT scans) with female volunteers among the staff at mid-cycle and right before their menstrual periods. The brain scans at mid-cycle looked normal and healthy and the scans before the menstrual period looked like the brains had been chewed on by rats. I am completely convinced that the brain is under attack by these hormonal shifts and have no doubt of the experiences women have reported to me about their thinking and their moods before the period. That said, I have found a number of things that can be helpful. Of course, first is the FDA-approved use of SSRI's (particularly fluoxetine) for 3 days before the menstrual period through the end of the period. This on and off use of an SSRI underscores that SSRI's increase serotonin almost immediately - within hours. Another approach is acupuncture. Some acupuncture practitioners understand these female issues and know how to help. I have not found supplements that are helpful. Another alternative is oral contraceptives. They tend to level out the swings in hormones that can reduce the assault on the brain.

Absolutely - if it includes a mindfulness component. Mindfulness, either in meditation or yoga, is very helpful for improving concentration and focus. It is also very calming. I have 8 and 10 years olds doing mindful meditation with their mothers or fathers every morning and they no longer have as severe anxiety or ADHD symptoms at school.