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Question 31: My son is on clonidine and has been for almost two years. It seems to me he is becoming more and more irritable and prone to tantrums over trivialities (brushing teeth, foods, etc.) He is almost twelve. Is there much evidence that this drug exacerbates irritability? We are already familiar with the drowsiness and weight gain side effects. It's mostly at home that he becomes nasty and irascible. Thank you for the help and inspiration. You have helped me and Kevin more than any doctor we have seen.

Hello!

I'm sorry it took me so long to respond..........I am settling into my new clinical life and that makes for long days!

As you mention, the most common side effect for clonidine is sedation -- irritability is nevertheless listed as a possible (though less common) side effect though. So are anxiety, decreased memory, headache, dry mouth, and hypotension.

One thing to keep in mind is that EVERYONE'S neurochemistry begins to change around age 12 at the onset (onslaught??) of puberty. This may be altering the prior effectiveness of the drug. Also, new issues may simply be arising that need to be considered. These new issues could be around the disorder -- obsessive-compulsiveness, for instance, has a later onset than attentional or tic symptoms. Increased rigidity or perfectionistic tendencies can increase explosive outbursts. On the other hand, these new issues can be entirely 'normal' -- teenaged surliness or desire to exert one's new independence may be at fault, "amplified" by the disinhibition of TS.

You mention that these problems are predominantly seen at home......that makes me lean against the 'side effect' idea and more towards the 'this is an amplified teenager' or 'some new neurology may be on the rise' ideas. It also makes me wonder if, given that appearance gets more important around this time of life, he might not be suppressing more at school than he used to (resulting in more of a 'rebound' effect at home). If some new neurology may be on the rise, this may be resulting in increased effort required to maintain the SAME LEVEL of suppression he always had.

In terms of dealing with explosiveness, the best resource I can recommend is The Explosive Child by Dr. Ross Greene (a psychologist).

I hope some of these suggestions help! Your comments to me are very kind -- in these days of increased responsibilities and shortened days it does me enormous good to know that my website is still managing to provide what I unfortunately can't always provide in-person anymore!

cheers,
Dr. Dunc.

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