Psychotropic Medication for Children – A Doctor’s View

 

pillsIt’s no secret that I have concerns about the use of atypical antipsychotics in children and young adults. My apprehension is based on my son’s ordeal with these medications, others’ experiences, and the well-documented potentially dangerous side-effects of these drugs.

Dr. Allen Frances, a world-renowned psychiatrist and Professor Emeritus at Duke University, recently wrote this important article for Psychiatric Times, which begins with this sentence:

“A perfect storm of interacting detrimental factors has resulted in the recent massive overuse of psychotropic medication in children.

 

I highly recommend reading this easy-to-understand article, even though it is primarily written for psychiatrists. Dr. Frances makes excellent points and cites a checklist meant to help doctors evaluate whether or not a child should be prescribed these drugs. He says:

Doctors have swallowed the misleading sales pitch that typical problems in children are really underdiagnosed and undertreated “mental disorders”—very easy to diagnose and very easy to treat with a pill. Just the opposite is true. Children change so much in response to environment and development that their diagnosis and treatment always require the greatest care, patience, and time. I can’t picture ever starting a child on medications after a brief evaluation, but this is often done.

 

And below is my favorite paragraph of the article – even more meaningful because it comes from such a well-respected doctor:

“Parents far too readily follow doctors’ advice about medication for their children. I recommend always becoming a fully informed consumer and getting second and third opinions before allowing your child to take any psychiatric medicine. This is an important decision that requires careful deliberation and full parental input.

 

When talking about OCD and these drugs, studies have shown atypical antipsychotics to be no more beneficial than a placebo for those already taking an SSRI. Exposure and response prevention (ERP) therapy continues to be the treatment that works best, and it can also be utilized in an age-appropriate manner for young children.

If you are considering using an atypical antipsychotic as part of your child’s treatment plan for OCD, please read Dr. Frances’ article. You might just change your mind.

 
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8 Responses to Psychotropic Medication for Children – A Doctor’s View

  1. Christine walker says:

    My daughter as severe anxiety and OCD. She has not found any therapist in our area doing ERP and she doesn’t like talk therapy. She is on medication and really cannot be without it. She becomes non functioning and the meds certainly do not “cure” all of the compulsions. She also has ADD and cannot take stimulation meds.

    • Hi Christine, Thank you so much for sharing. I think the bottom line when it comes to meds is to answer the question, “Do the benefits of the medication outweigh the risks?” The answer, of course, is very individual, as is each person’s treatment plan. As far as psychological therapy (as opposed to drug therapy) goes, traditional “talk therapy” is not typically helpful for OCD:

      https://ocdtalk.wordpress.com/2015/07/12/talking-about-ocd-is-it-always-a-good-thing-2/

      Also, you bring up an excellent point that ERP therapy can be difficult to find. If there is nobody close by who can help your daughter perhaps she could look into some of the great workbooks out there, as well as websites that can help her get started with ERP. I have suggestions in my Resource Section of my blog as well as in my book. Another option which has been shown to be helpful is Skyping with a therapist who specializes in ERP. In this case location isn’t an issue. I wish you and your daughter all the best as she moves forward!

  2. 71 & Sunny says:

    Sigh. I’ve heard both sides of the argument about the use of antipsychotics for OCD and these days I’m more confused about it than ever! Personally, I would not use antipsychotics because I’m very wary of the possible side effects. I guess it’s just super important for us to do our research (from reputable sources) and make the best decision we can with our doctor’s input. I do really appreciate Dr. Frances’ advice to conduct a very thoughtful and careful analysis before making the decision to treat children with psychotropic drugs. (I think this should apply to adults too!) I totally agree that ERP is the good standard to treat OCD in adults and kids. Aureen Pinto Wagner’s great book does a very good job of explaining ERP for kids. Thanks for always providing good food for thought, Janet!

    • You’re welcome Sunny and I always appreciate your thoughtful comments. It’s certainly not a black and white issue so I agree that the best thing we can all do is be as informed as possible and weigh the pros and cons carefully. Of course my opinion is skewed by my son’s experience as I saw these drugs wreak havoc on him, both mentally and physically, with no benefit whatsoever. But I blindly followed the doctors’ advice. I guess I’d like to see others avoid the same mistakes my family made!

      • 71 & Sunny says:

        So that was supposed to say “gold standard” not “good standard” ha! Oh I hear you – I never blindly follow anyone’s advice anymore. I had an experience of being over medicated in the late 90’s and I always told myself, “never again!” So I’m a very educated consumer these days. And my experience was not nearly as bad as what your son went through.

      • I knew you meant “gold standard,” Sunny :). I’m so sorry you had a bad experience being overmedicated, but maybe it helped you become the educated consumer you are today. Gotta look in the bright side, I guess :).

  3. joni roland says:

    My 10 year old son suffers from severe OCD. It was to the point he couldn’t ride in a car or walk down certain hallways. He is currently taking medication. My thoughts are to use the medication to help therapy be more successful. Eventually, no medication just behavior modification. I have been shocked at the very few resources for childhood OCD. Therapists and psychiatrists are so overloaded that it is hard to get appointments. We live near St. Louis so I wouldn’t think it would be so hard!

    • Hi Joni, I always say that one of the most difficult things about OCD is getting the right treatment. It is so unacceptable that your son is not being offered ERP therapy on a regular basis. I hope you have better luck in connecting with a good therapist. You could try contacting the IOCDF for additional assistance. Good luck and I wish you and your son all the best. The right treatment makes all the difference in the world.

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