Alabama Gazette - The people's voice of reason

Some Children Do Need Psychotropic Medication

 


I would like to discuss the current trend I am seeing as a clinician in regards to medication not being prescribed to children with mental health concerns. In these same cases, the primary care doctor and/or psychiatrist refused to medicate a child after therapeutic interventions have been tried for several months with little or no success, and have been short-lived due to the fact that the child had not stabilized from symptomatology of a classifiable DSM-5 diagnoses. As a result, the child gets discharged from one counselor to the next, only to have the same issue arise of needing medication to stabilize. Frustrated parents end up having to take the child to their local ER to get temporary assistance, not long term help which they so badly need. “Recent research suggests that up to 15 percent of children and adolescents have a mental health disorder that is serious enough to cause some impairment, unfortunately, only one in five of these children with mental illness receive services by appropriately trained mental health professionals” (Meyers, 2006, p.26) via talk therapy. On the other end of the spectrum, I have been at institutions in other states where I have been fortunate to have a child psychiatrist in-house who had the knowledge and the confidence in prescribing psychotropic medication to children combined with therapy, effectively stabilizing the child to receive services elsewhere.

This commentary does not suggest that the medical profession does not have the skills or the knowledge to address mental health issues as a whole. One of the main reasons for non-medicating is the actuality that it is a child and not an adult, which weighs heavily on the medical professional’s psyche, as most of us do not think children require or need pharmaceutical assistance when they are at the beginning stages of their lives. I do understand that children have developmental stages they must go through that occur over the child’s life span. I think the problem really arises when medical professionals, specifically primary care doctors and certain psychiatrists, have not been given the appropriate training in medical school or during residency in working with children with mental health issues. The primary care doctor/psychiatrist view the child’s or adolescent’s behavior as normal intermittently returning during developmental life stages. From this de facto, they feel uncomfortable treating a child with depression, trauma, anxiety, etc. There are also parents who are rightly afraid that their child may be inappropriately labeled, with multiple diagnoses, medicines, and therapies which will be initiated without being agreed upon by the all specialists who are providing the services to the child or adolescent, as reported by Parent Advocacy Coalition for Educational Rights (2015, October). I have worked in many arenas and the unwillingness of practitioners to medicate a child goes against the child’s best interest. When it is medically indicated that a child meets the criteria for a medical diagnosis and can benefit from medication regimen, this option needs to be explored more extensively. I have observed, in many instances, where children need medication to stabilize from depression in order for therapy / counseling to be effective, only to be prevented because the doctor feels that the child is too young for the medication.

Most of the research studies of psychotropic medication, intended to guide prescribers, have been done mostly with adults and fewer with children, which limits the information that is being utilized to guide the medical doctor in the form of practice parameters for assessment purposes around medication for children and adolescents. The National Alliance on Mental Illness (NAMI) reports that research gaps are hampering the ability to adequately treat a number of serious mental illnesses that impact the lives of children and adolescents(2007, May ). This gap of research knowledge creates a dilemma making psychiatrists and primary care doctors apprehensive in prescribing medication to a child. I would recommend that the psychiatrist or primary care doctor get additional training on child psychiatric medication. I am not advocating for all children with mental health issues to be on medication, but I am saying that this is a noticeable trend. Primary care doctors need to be aware that there is strong evidence of efficacy of cognitive behavioral therapy for issues such as anxiety in children; however, few doctors utilize SSRIs that may be effective for children who do not show improvement with behavioral therapy alone. Research has found that, at least with adults, a combination of medicine and psychotherapy work better than either treatment alone. “Studies on depression shows that medications and empirically supported therapies such as cognitive behavioral therapy (CBT) and interpersonal therapy are equally effective, with each modality helping about 60 percent of clients. Combined treatments produce even better results: In a literature review in the April 2005 Journal of Clinical Psychiatry (Vol. 66, No. 4, pages 455-468)” (DeAngelis,2008). There are those who do not fit this category and Fluoxetine (Prozac) is the only medication that has been approved by the Food and Drug Administration to treat depression in children age 8 and older. It may increase the risk for suicidal behaviors in some children, again making it difficult for a psychiatrist or medical doctor to prescribe medication to a child because of the risk (“Antidepressants Medications,” 2015, September).

Food For Thought

In general, medicating children and adolescents can be a divisive topic--whether or not to turn to pharmaceuticals to cope with mental health issues such as depression and the symptoms that arise from depression or other mental health issues which cause parents to debate with school administrators, mental health professionals, family friends, politicians, caregivers and even themselves. There is no one-size-fits-all answer when dealing with mental health issues. A doctor's recommendation to use medication often raises many concerns and questions in parents and the child/ adolescent prescribed medication may change how a child/ adolescent interact, play, sleep, eat, and deal with everyday events. Professionally, I feel medication can be an effective tool in the treatment of several psychiatric disorders of childhood and adolescence when all therapeutic attempts have failed. The psychiatrist or primary care doctor who recommends the medication should be experienced in treating psychiatric illnesses in children and adolescents. He or she should fully explain the reasons for medication use, what are the pros and cons, as well as possible risks, adverse effects, and other treatment alternatives.

Anti-depressant medications for children and adolescents: Information for parents and caregivers. (2015, September). National Institute of Mental Health (NIMH), U.S. Department of Health and Human Services. Retrieved September 25, 2015 from http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml

DeAngelis, T. (2008) When do meds make the difference? Monitor on Psychology, 39 (2), 48.

Meyers, L. (2006 ). Medicate or not? Monitor on Psychology 37 (10), 24.

Minnesota Parent Training and Information Center. (2015, October).

Retrieved October 5, 2015 from http://www.pacer.org/cmh/does-my-child-have-an-emotional-or-behavioral-disorder/

NAMI is the National Alliance on Mental Illness (2007, May). Choosing the right treatment: What families need to know about evidence-based practices.

Autobiographical Summary

Oswaldo H. Chavez acquired his Associates of Science in Pre Medical Studies from Dodge City Community College. He obtained his B.S. in Health and Human Performance and a Minor in Chemistry from Fort Hays State University. He went on to receive his Master's Degree from Texas A&M University- Corpus Christi in Marriage and Family Counseling and Community Counseling. He received a full scholarship from the National Institute of Health for Biomedical Research to study Hispanic issues in Washington, DC. He completed his National Board Certification post-graduate certificate in counseling from the National Board for Certified Counselors in Greensboro, NC. He completed a six month selected deployment as a Clinical Research Counselor for the Army Combat Stress and Addiction Recovery Program Moncrieff Hospital, Fort Jackson, SC. He was selected due to his exceptional clinical and organizational skills. He has also served as a Clinical Counselor for the Navy Fleet and Family Support Center, Naval Station Ingleside, TX. Mr. Chavez is currently in private practice providing Trauma Therapy to children who have been sexually , physically, and emotionally abused. Additionally, he provides crises therapy for the American Red Cross during weather disasters. He concurrently provides post deployment briefings and workshops on mental health issues to the Services of the Armed Forces via the American Red Cross.

 

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