If a child developed diabetes, few parents would reject a physician’s recommendation that she needs insulin injections to stabilize her condition and allow her to lead a normal life. But when a psychiatric disorder is the culprit—and symptoms are mental rather than physical—the idea of having a psychoactive drug prescribed is more likely to meet with resistance.
“As with many things, this area is surrounded a lot more by myth than by fact,” says Dr. Timothy Wilens. A pediatric psychopharmacologist at Boston’s Massachusetts General Hospital, he’s heard all the reservations that parents express about incorporating medication into their child’s treatment. But as Dr. Wilens points out, “Most emotional and behavioral disorders in kids are probably biological insomuch as they begin with an adverse experience that leads to biochemical changes in the brain. Therefore it doesn’t surprise us that medications can control a number of the different symptoms.”
Medication should not be looked to as a substitute for psychotherapy, nor should it be looked down upon as a measure of last resort. In appropriate cases, it is a complement to talk therapy, which is intended to hone selfawareness and teach coping skills that will help patients to function out in the world. But results from counseling can be slow in coming. Medication, carefully prescribed by a psychiatrist or pediatrician familiar with pediatric psychological conditions, can usually lighten symptoms now and give boys and girls back their childhood.
Two and a half million young people in the United States use psychotropic drugs. However, the frequently heard accusation that doctors are too quick to prescribe psychoactive medications is not supported by the facts. A 1999 study from Yale University suggests that as many as nine in ten people suffering from depression go unmedicated.
Parents’ resistance to the idea of drug therapy is often based on outdated information and images of the stupefying effects of psychiatric drugs. “We’re much more selective about the medicines we use now,” says Dr. Wilens, “and there’s a broader repertoire of drugs available to us.”
Admittedly, these medications have not been evaluated extensively in children, and some not at all, but according to Dr. Wilens, the studies conducted to date and years of experience prescribing the drugs “strongly suggest that the new generation of medications are safe and effective, with far fewer downsides than the older generation.
“The other point that parents need to know is that we usually start psychotropic medications at inordinately low doses and increase them over time, so that the body and brain can get used to them. But in doing so,” he adds, “it takes longer for the full therapeutic effects to be seen. Selective serotonin reuptake inhibitors (SSRIs) sometimes have to build up in the brain for two to six weeks before bringing relief.
Because conditions wax and wane, after a year or so the doctor may suggest taking a “drug holiday” to get a sense of where the young patient stands without medication. He might fare just fine. Or he might require a reduction or an increase in dosage, or to be switched to another drug. Patients should never discontinue a psychopharmaceutical without a doctor’s supervision; several of these drugs require that the dosage be tapered gradually in order to avoid withdrawal side effects.