Medication and children
If you're a New York Times reader, you probably saw that scary recent front-page story about the teenaged girl taking 10 psychiatric medications.
The feature is part of a twoyear Times effort to better understand and explain the adolescent mental health crisis, which was building long before the pandemic. With nearly one out of six adolescents reporting a major depressive episode in 2020, the crisis has reached inside all too many of our homes, with parents having to scramble to find help in a hurry. Deciding whether to try medication for a child's mood disorder is one of the hardest decisions we must make.
Before I go on, I want to protest that this story is unnecessarily scary. My blood pressure rose on reading that “psychiatric drugs … can have severe side effects – including psychotic episodes, suicidal behavior, weight gain and interference with reproductive development, according to a recent study published in Frontiers in Psychiatry.” If you link to that study, you'll see it concerns not all psychiatric drugs but only two relatively rarely used antipsychotics.
That said, the story still offers a cautionary tale for parents considering medication for a child in pain.
These drugs have never been more prevalent. Nearly one in six U.S. adults report taking at least one. And while they can save lives, when prescribed correctly, they indeed can also have some serious side-effects, and we still don't know enough about their effects on young minds. What's more, as the Times article highlighted, we can't always count on the competence of doctors and psychiatrists. The therapist who prescribed all those medications for the teen was clearly not following best practices.
What all this means is that meds or no meds, you're still on the hook for doing all the hard work of educating yourself about your child's problem, being mindful in your relationship, choosing a professional with care, and making sure that medications, if taken, are one tool in a kit that includes the fundamentals, such as good sleep, a healthy diet, and no excessive stress. Aerobic exercise and resistance-training can also do wonders for mood, as has been widely reported.
Should you decide to seek professional care, I have a few more specific suggestions:
For mood problems that don't pose imminent danger to the child or others, start with psychotherapy. Granted it's not easy: COVID has aggravated what's shaping up as a historic scarcity of mental health counselors, especially those trained to treat adolescents. But talk therapy remains the first line of recommended treatment, and well worth the investment to help your child learn coping methods other than popping a pill. Start your search with the school counselor or your child's pediatrician, and don't be shy about asking other parents. You may be surprised by how much company you have.
Even if you trust your child's pediatrician, it's preferable to see a psychiatrist, and ideally one who specializes in adolescents, when it comes to medication. Pediatricians increasingly are writing prescriptions, but most have confessed in surveys that they feel unprepared.
Be wary of the digital therapy services that have proliferated during the crisis. This is no time for a therapist by text.
Prepare to participate in that first appointment. The doctor may ask when your child's symptoms began, how often they occur, and how severe they seem. And do any siblings, parents, grandparents, aunts, or uncles have similar issues?
Bring records of any other medications and supplements your child may be taking, and a list of questions about any new prescriptions, including:
• Why are you recommending this medication? Is it approved for minors? What behavioral changes should I expect? Possible interactions? When is the best time of day to take it? How long should my child take this medication? Is this the lowest possible dose to achieve a benefit?
Most importantly, do not be intimidated by jargon or a doctor's impatience. You have a right and responsibility to ask these questions and more.