By Dr. Wayne Martinsen, Psychiatrist/Medical Director, Dakota Boys and Girls Ranch
Psychiatric medication may be helpful for your child if they have been diagnosed with:
- Depression & Mood Disorders
- Bipolar Disorder
Will Psychiatric Medication Change My Child's Brain?
The simple response is “No.” However, traumatized children have an oversized amygdala that causes them to feel more fear and anger. When it works, medication will shrink the amygdala in traumatized kids, but it won’t damage the brain.
Potential Benefits of Medications for Mental Health
Medication has many benefits, depending on the child’s diagnosis. Here are a few examples:
Reduce Emotional Pain
If you had so much physical pain you wished you were dead, you would treat the condition causing the pain. Emotional pain is like any other pain. Treating depression with medication decreases the risk of suicide (the 2nd leading cause of death in North Dakota children ages 10-18.)
Help Children Focus
In ADHD, there is a mismatch between intellectual ability and ability to focus. They can’t use their entire intellectual ability because they can’t focus long enough. Medication maximizes their ability to learn up to their cognitive ability.
Reduce Risk of Chemical Dependency
Children with ADHD have at least five times the risk of chemical dependency. When they are treated with a stimulant like Ritalin or Adderall, the risk decreases to one times greater than their peers.
Anxiety is common in kids, and can cause them to dread going to school, going out in public, or spending time with friends. Medication, combined with therapy, is proven to be effective in reducing anxiety.
Potential Risks of Psychiatric Medications
Medication comes with two types of risks—reversible side effects that stop when the medication stops, and body side effects that may have a longer-term impact on the body.
Reversible Side Effects
Most side effects, like stomach upset, will go away when the medication stops. Another side effect parents worry about is that medication will turn their child into “a zombie.” While this can happen with certain types of medications, it is very rare, and will stop when the medication stops.
Body Side Effects
Some medications have potential side effects that can be harmful to the body. For instance, medications to treat psychosis or bipolar disorder can increase cholesterol, prolactin levels, and blood sugars. For these medications, your medical provider will take regular blood draws to make sure the medications aren’t impacting the body. Another potential body side effect is weight gain. Again, if you use a medication that stabilizes mood or fights hallucinations, your child’s physician will monitor weight to make sure the medication doesn’t cause a weight problem.
One thing I always tell parents when we start a medication is that they aren’t making a lifelong commitment, but simply trying something to see if it helps their child without side effects.
Stigmas About Medication
While stigma about mental health in general is less than it was before, it remains a big barrier to mental health care in both adults and children. The National Institute for Mental Health (NAMI) says,
Children are not immune to the stigma. If they are afraid to talk to their parents about their worries and feelings, they won’t get care for a treatable mental health problem.
Learn more about Stigma at NAMI.org.
Administering of Psychiatric Medication to Your Kids
How do I speak to my child about medication?
Talking about medication with children starts in the doctor’s office. As a physician, it’s my job to talk to them about how their behavior causes problems. For instance, “How many times have you gotten in trouble with your teacher for blurting something out, or felt embarrassed because you are failing or not turning in homework?” Then we talk about the things we can try to help make them feel better. I assure kids the decisions we make don’t have to be forever. They can try a medication for a few weeks to see if it makes a difference and if they can tolerate any side effects.
If your child is resistant to taking medication, get curious. Ask them to help you understand how they feel about medication. Show your child that you value their perspective. Listen first, and then share your perspective. An open, honest discussion will be much more effective than starting a power struggle.
Can I make my child take their medication?
If a child refuses, you can’t make them take the medication. But, you can bargain with them. For instance, I’ll say, “Let’s try it for two weeks.” I don’t believe any child should be made to take medication, but that’s not to say that you can’t reward them. Maybe after two weeks you reward them with a favorite activity.
Do I need to tell my child’s school?
Tell your child’s school if you have a trusting relationship with school personnel and you don’t think your child will be judged by the medication they take. Most schools will respond with compassion and an eagerness to help, but this is not always the case.
How to Know if Medication is Working in Children
Whether or not the medication is working is subjective. I gather information from children, along with their parents and teachers, to determine the effectiveness of a medication.
With depression and anxiety, the child will usually be able to say, “I’m happier.” If they aren’t able to identify themselves as better, you have to question whether or not the medication is helping. With ADHD, we ask the parents because they are usually the first to notice their child is calmer.
And, with bipolar disorder, we ask, “Are they less angry and aggressive?” “Are they able to sleep?”
I use this information, along with my own observations, to determine the effectiveness of the medication and to make decisions moving forward.
Finding the Right Medication and Dosage
It takes specialized expertise to find the right medication management for your child, and to determine the dosage that works best for them. Medical providers use “Treatment Algorithms”, which are standards of care decision trees that guide decisions about medical care. In psychiatry, treatment algorithms guide the type and dose of medication prescribed.
Genetic testing is another tool some medical providers use to guide their decisions. While not as promising as we first hoped, genetic testing can provide some insight into the psychotropic medications mostly likely to be effective; and guide dosages.
Can my child stop taking medication when they start to feel better?
They can, but I don’t recommend it. The risk with depression and anxiety is that if someone stops taking the medication within the first nine months, they have a higher risk of the depression and anxiety returning—the brain goes back to the same place it was. For that reason, I like to keep children and adults on mood-stabilizing medications for at least nine months.
ADHD medications are a little different in that 30-40% of children outgrow their ADHD medication. Your child’s physician will monitor this and adjust as appropriate.
Psychotherapy and Lifestyle for a Child’s Mental Health
Medication works best when used in conjunction with psychotherapy and lifestyle changes. Seeing a therapist will make your child more likely to stay better longer. As will a healthy diet, plenty of sleep, physical activity, and healthy relationships.
When to Seek Help
Parents are usually the first to notice when a child is struggling with emotions or behaviors. Learn more about some common signs of mental illness in children. If you suspect a problem, or have questions, act now. Talk to your child’s physician or contact a mental health professional. Learn as much as you can about mental health and your child’s specific issues. And give them the support and love they need to move forward with treatment.
Intervening early can lay the groundwork for your child’s behavioral, social, and academic success as they progress through childhood, adolescence, and into adulthood.