To Medicate or Not

Your child is struggling with behavioral or mood problems and non-pharmaceutical interventions aren’t enough. Your pediatrician or therapist suggests a psychiatric consultation. Natural concerns arise, like whether your child will become addicted to this medicine? Can I trust the research or is the pharmaceutical industry manipulating data? Will there be any long-term adverse effects? Can my child do more to play their part in getting better—maybe just a little more exercise, meditation, or more therapy. Will the medicine do more harm or good? Is this an off-label use of a medicine without supporting data? Is your adversity to psychotropic medicine trumping your child’s self-determination? At what age should you empower your child to make the decision of what to put in their body?   Will the decision affect your relationship with your child?

In making this decision, being well informed and listening and knowing your child is crucial. Examine the global impact of your child’s symptoms on their functioning and quality of life. How does the mental health problem affect their school work, their social life, their self-esteem, their ability to reach their long-term goals? Is the increased risk of suicidal ideation that several anti-depressants are associated with outweighing potential benefit?

Potential Issues

One issue I see in my practice relates to compliance. Is the child willing to take the medicine daily and have a parent who will remind and facilitate the process? Suddenly stopping medicine can be very painful and worsen mental health problems. Sometimes children are able to convince adults they do not need medicine due to their caretakers’ own ambivalence about it. Due to the slow acting nature of common psychotropic medicine, children and parents often stop before therapeutic benefits. This can leave children with the feeling that they are helpless and incurable.

Stoppage often occurs because lack of results, but this is not to say a different medicine or dosage will not work, but often patience runs thin.  Another issue I have run into is weight gain as a side effect, leading the child to have insecurities around body image.

The stigma and discrimination about people with mental health problems can result in medication refusal. Children frequently hear the terms “she is so bipolar;” “did she forget to take her meds today?” and the loose use of the word crazy.

Lastly, the prescribing physician’s bedside manner makes a big difference in symptom improvement and medication compliance. Does your child feel comfortable talking to the doctor? Do they feel understood and valued? Does the doctor respect self-determination or are they preachy and patriarchal?

 

Source: Cheung, A., Emslie, G. J., & Maynes, T. L. (2004). Efficacy and Safety of Antidepressants in Youth Depression. The Canadian Child and Adolescent Psychiatry Review13(4), 98–104.

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