To Medicate or Not to Medicate?

This is a big question that often comes up when I’m consulting with parents about their kids:  should they be on medications?  Firstly, let me say that as a psychologist, I do not prescribe meds and this is not my area of expertise.  However, I do work closely with psychiatrists to coordinate the psychotherapy aspects of treatment, and I can speak to the dilemma that many parents face on this issue.

There are a lot of mixed messages floating around these days with regard to medications.  On the one hand I commonly hear the sentiment that kids are over-medicated, and that many kids who don’t really need meds are on them.  On the other hand I often hear the sentiment that the right kid on the right medication benefits tremendously in certain cases.  Most of what I hear, however, is that it’s a mixed bag where positive effects are sometimes found, and sometimes seem to ebb away again, while side-effects sometimes seem either a necessary evil, or in some cases a disaster worse than the original problem.

So, what’s a parent to do?  A good place to start is by conceptualizing your child’s well-being as the center of a team of people (not necessarily shrinks and specialists, but rather family, teachers, coaches and friends).  When issues arise, such as attention-difficulties, struggles with learning, impaired social relatedness, depression or anxiety it serves a child to be seen in an entire context.  What do teachers report at school?  What you you observe at home?  How much is situational, how much is inherent to the child?  Thus before we can intelligently decide the best course of action, a thorough understanding of what’s actually the matter is in order.

Problems are multi-determined, therefore behavioral issues in a kid might reflect a combination of nature and nurture.  For this reason a good first line of response is for parents to take their own inventory:  is there strife in the house?  Are there stressors such as money worries, losses, illness or life changes such as moving that contribute to a child’s anxiety or otherwise impede their functioning?  If parents can be truly at their best (sober, in therapy if needed, able to manage anger), we have a much clearer picture of what is more purely a child’s innate struggle.

Next, a thorough evaluation of the entire child is highly useful.  The first step there is the pediatrician; many conditions that might appear psychological could have a biological basis, and a clean bill of health is important to establish before meeting with a child psychiatrist.  Additionally, an evaluation of cognitive and emotional functioning can be requested, at no personal expense (you’ve already paid for it with your taxes) by requesting an evaluation from your local public school.  Funds are always tight and this service is not generally broadcast, which is why I mention it here.  For more on this see a prior post about IEPs (individual education plans— http://tiny.cc/MGRnG ).

Keep an open mind.  If your team of helpers ends up suggesting a medications consult (and that is all anyone who is not a psychiatrist or specialist trained in medications really ought to say), you then must search not just for a psychiatrist, but for one who you feel you can talk to, trust and work with.  Friends who say they have worked with a given psychiatrist and had a good experience is an excellent place to start.  And call sooner than later—it often takes quite awhile to get an appointment, which can be frustrating, but also speaks to the strong demand for such services (in other words, you are not alone).  Once you’ve gathered several names, call them all and see how each one strikes you.  Things like this are partly about a match, and not just a reputation.  You should feel free to ask questions and expect mutual respect and a team effort around your child, and not just an expert who is never to be questioned.  And remember, it is possible that you may consult with a psychiatrist and determine that medications are either not needed, or optional and a wait-and-see approach supplemented by other interventions can be tried.  Different psychiatrists are at different places with alternative approaches, but I know of one recently who suggested fish oil for attention issues, given that the science is showing up in favor of it.  In other cases a psychiatrist may feel that medications are essential to help a child, or keep a child out of harm or further deterioration; keep in mind that sometimes progress can be measured in things simply not getting worse, if they had been in steady decline.

An important thing to keep in mind is respect for different attitudes and approaches.  I would say that roughly half of the clients I see end up taking medications and half either don’t need them or choose not to take them.  There is evidence, for example, that mindfulness practices such as yoga or meditation are valid interventions for a range of conditions including depression and anxiety.  If a family works together and comes to a unified decision, a child is in better shape than if the parents are at war about either position.  Also, we are best off respecting other families rather than judging them.  It is a very personal and complex decision to medicate a child, and no one is ever thrilled to need to even consider it.  While people may say flip comments to the effect that we’re just medicating kids because we don’t want to deal with them, I can’t say that I’ve ever met a parent for whom this was actually the case.  Parents love their kids and want the best for them.  More education on issues, from ADD to bi-polar, might enhance greater compassion and a kinder culture, and while this might sound unrealistic, our culture is the net effect of all of us, so anyone who chooses less judgment and more compassion could well be benefitting all our collective children.

A few final comments on medications include what’s called a “drug plateau” in which we see a benefit, but it levels off and doesn’t take a person, child or adult, all the way to well-being.  This is where things like yoga, therapy, nutrition and self-esteem enhancing activities must also be employed—and as mentioned above—where parents taking good care of themselves, physically and psychologically, contributes to the well-being of children.  Ultimately, the question of what to do, be it medications, changing schools, trying a homeopath or eastern medicine approach, etc. distills down to the how of going about it; right attitude in many cases is right action.  After all, a child may “have” a diagnosis, but they are never to be defined by that label; all children (and everyone else as well) are sacred beings, and we all have our areas of challenge or limitation.  Sometimes we have to deal with reality, such as an unhappy and over-stressed culture, and in turn do what we must to help kids adjust to a world that, in actuality, needs the adjusting.

While a blog such as this cannot possibly tell you what is best for your child, it can encourage you to take a deep breath, not turn away from whatever the problem is, gather all the information that you can and then make the best informed and loving decision that you can—and then monitor from there; we try things, see the result, try a different thing.  In the end, we don’t need to be right so much as effective.  Beyond that, this blog perhaps can also offer a little human compassion and understanding for just how scary and uncertain, not to mention heart-breaking, it can be when our kids are struggling and unhappy.  So today, maybe we can send a good thought into the ether for all parents and children who are struggling to find the right approach to whatever ails them, challenges or discourages them, or seems to impede their family’s growth and happiness.

Namaste, Bruce