Q. My daughter has been suffering with diagnosed depression, anorexia, and self injurious behavior. She is 13. She currently takes 30mg. of Paxil daily, and Trazodone 100mg. as a sleeping aid. She is seen by a clinical social worker, and is part of the eating disorders program at the C.C.F. She is not improving, and is currently saying she is suicidal. She was hospitalized at the onset of her problems, and seemed to "learn" even worse behaviors during that week. Do you have a recommendation for a counselor specializing in these problems, and what is your opinion of the medications? The Dr. agrees it is time to reevaluate medication, but is suggesting impatient treatment to do this. we hesitate because of her resistance, the fact she has been making an effort through her program/therapy attendance, and taking her meds with no hesitation. The Dr. is also not sure about readmittance due to her experience the first time. These disorders are destroying our bright daughter.

A. The doctors at CCF are pretty good. It may be your daughter is a rapid metabolizer, and requires higher dosages of paroxetine (Paxil). I had trouble getting Paxil to work below 60 mg/day and usually 90mg-120 mg, even in kids.

It is a tough situation for you and your daughter, with no quick fix. Prozac is still my favorite in many kids, and I usually go to 80 mg/day and see how it works.