Pamela P. Siller, MD

Your daughter is sick…she has a runny nose and a cough. At first you think it is only a cold, but you take her to her pediatrician anyway. He tells you that it is just a virus but it keeps getting worse. A blood test is ordered; it shows an infection, necessitating an antibiotic for seven days. This makes her feel better almost immediately.

If only it were so easy when dealing with difficulties related to the mind. There is no simple blood test to diagnose Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), depression or anxiety. In addition, medication does not always cure the symptoms in a short seven days. These difficulties also carry a stigma, which is often the result of rumors and misinformation.

Sometimes children and parents do not realize that there are difficulties. As they have no basis for comparison, they do not realize that things can be different. Many parents first find out that their child is having problems when alerted by a teacher, friend, or relative.

Often more questions than answers arise after the child is brought to a mental health provider for an evaluation. Can the child do better with increased support? Therapy? A smaller class size? And often the scariest question of all: Does my child need medication?

Unfortunately this is not a question that can be answered simply. Because each person has a unique mind, a distinctive personality, and differing circumstances, this question needs to be answered on an individual basis.

However, when making decisions like this, it is always helpful to be well informed.

How do psychotropic medications (medications used for the mind) work?

All thoughts and brain activity are the result of a series of connections between brain cells. These connections occur via chemicals travelling from cell to cell. Sometimes a person has too few or too many of these chemicals, which can cause an abnormality in thoughts or difficulty with functioning. These difficulties can include depression, anxiety, ADHD, OCD, and psychosis depending on the type of chemical and the part of the brain affected. Most psychotropic medications do not increase or decrease the actual chemical. Rather, they change the amount of receptors available to catch the chemicals as they travel between cells.

When is it necessary to put my child on medications?

Usually, medications are necessary when a child is unable to adequately function while performing age-appropriate activities. School age children and teenagers need to be able to maintain their grooming, go to school daily, and perform academically and socially. Appetite and hours of sleep should be sufficient but not excessive.

What should I ask my doctor?

If possible, both parents should be involved, informed and in agreement about their child's medication. Here is a sample list of basic questions to ask your child's doctor about any medication being recommended:

Why are you suggesting this medication for my child?

What are the risks of this medication - short term? And long term?

What are the expected benefits of this medication for my child?

What are the alternatives for this medication?

Are there any recommended interventions that do not require medication?

What changes in my child's behavior should I be looking for?

Does the medication come in liquid form (if your child does not like to take pills)?

How often should I bring my child in for a follow-up visit?

How often and at what time of day should this medicine be given?

How long does my child need to be on these medications?

This depends on the type of medication and the nature of your child's difficulty that is being treated. Generally, once an appropriate dosage is determined, the medication is continued for six months. Once you and your child's doctor decide that the medication dosage can be safely decreased, it is important to do so at the rate recommended by the doctor. Withdrawal symptoms can occur if the dosage is decreased too quickly.

Conclusion:

All medications, whether they work on the brain or the rest of the body, come with side effects. Some may be mild, while others may be more dangerous. One must always weigh the risks and benefits, and consider whether the consequences of not taking the medication would be worse than the potential side effects, in order to make an informed decision. Generally, it is best to share all of your concerns and raise these questions with your mental health provider, and to report the results of the medications your child is taking, including both positive gains and setbacks.

Pamela P. Siller MD serves on the Executive Board of NEFESH International and is a representative of the Greater Long Island Psychiatric Society. She is an Assistant Clinical Professor at New York Medical College, and an attending on the adolescent inpatient unit at Westchester Medical Center. In addition, she sees children, adolescents, and adults at Interborough's Crown Heights Center, as well as at her private practice in Great Neck, LI. She can be reached at 917-841-0663.