Shirah Vollmer MD

The Musings of Dr. Vollmer

Mood Meds For Kids

Posted by Dr. Vollmer on May 4, 2016

 

http://www.vistadelmar.org/wp-content/uploads/2015/10/Reiss-DavisBrochure_2015-16_v4_lr.pdf

 

Friday morning I venture off to Reiss-Davis to talk about mood meds in kids, and actually, more broadly speaking, medicines for the child’s mind. This is a three-hour presentation to non-medical colleagues about the positives and negatives of treating children with medication. My first objective is to emphasize the need for a thorough evaluation, meaning a minimum of three hours, consisting of a history from the parents, an interview with the child and a feedback session. Although this three-hour evaluation is hardly ever done before placing a child on medication, I will say that it should be done and we, as professionals who care deeply about children, should insist on. My next objective is to separate out the notion that making a diagnosis does not mean treating with medication. Although this is obvious, in today’s world, the expectation from a psychiatrist is a prescription, as opposed to non-medical types of intervention such as psychotherapy or new school placement. I will then launch into the details of medicating children, with particular emphasis on the notion that this is a two-parent consent process, such that the job of the psychiatrist is to create consensus and without this, the child will feel confused and split between his parents. The last part of my presentation will be reviewing the various categories of medication, reinforcing the notion that the decision to medicate, in children and adults, is based on a risk/benefit analysis. In the end, medicating patients is a challenge of clinical judgment, knowing that close monitoring is essential, since each patient is different, and as such, we never know what will happen. As I conclude, I will feel like I have removed the curtain of psychiatry, because my message is we are guessing when we medicate children or adults, but with children the stakes are higher and the meaning of the medication runs deeper. By that I mean that a child’s brain is developing so we must be aware that we in no way want to inhibit that brain from its developmental course. In adults, we obviously do not have to worry about that. Further though, on a psychological level, children who receive medication might also receive the message that their brains are defective, and hence the impact on the developing self-esteem is something we need to think long and hard about. So, I will end my talk with more questions than answers, reminding my audience that I trained before Prozac so I bear witness to how we now have tools to help kids that we did not have in the past, and for some children, they are very fortunate to be born in this era, but for other children, they would have been better off to be born before 1991.

2 Responses to “Mood Meds For Kids”

  1. Shelly said

    What about dealing with kids who refuse to take the medication, even if you and the parents agree that medications would help them? What can be done to convince the child that it is in their best interest to do so? Nobody can force the children to take the meds and it is often a terrible fight to get compliance, even if both parents agree that it is necessary, and the school insists upon it.

    • If antipsychotics are indicated for children, there are long-acting IM (intramuscular injections) which can be given and they will last 2-4 weeks. For non-compliant kids and adults, this is one option available. Although the patient does have to comply with the shot, this, often times, is easier to agree to than taking a pill every day. Generally speaking though, short of providing large incentives (rewards) for taking medication, the child or adolescent does need to agree with the need for medication. So, as you suggest, it can be a very tough situation.

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