Q. My 16 yr old daughter is currently on 300 mg. Luvox taken at bedtime, 200 mg Tegretol and Zyprexa (can't remember dosage) also at bedtime. She has been complaining of skin pain so sensitive that clothes hurt, muscle pain, pain in side, chest pain and trouble breathing. Have taken her to emergency room first, where diagnosis was "viral syndrome". Two GP's we've seen say reported symptoms don't "jive" and appear to be false or greatly exaggerated, and therefore say psychosomatic. She insists it is real, but amazingly it "comes and goes", and mostly "goes" on weekends. Could any of these meds cause these side effects, or should I find an auto immunologist and take her there?

A. There is a mode of diagnosing called parsimony of diagnosis. Basically, we assume as physicians that everyone has one disease with a lot of symptoms. On face value from the information you gave me, I would agree that the symptoms are psychiatric in origin. That does not mean ignore them. She really has the pain, there is just no findings on physical examination. The nerves firing in her brain indicate pain, so these need to be treated.

I would think about changing medications or increasing them if things are not getting better. Tegretol can lower the level of Luvox in the serum, so she may not be getting an effective dosage, as one cause. There are so many possibilities that she needs more than the simple answers I can espouse here. Talk with your treating doctors, and if the answers are not satisfactory (e.g., she is not getting better), get a second opinion.