When we go to the doctor to get treatment, one thing we expect to walk away with is medicine. Medications have become a cornerstone of the healthcare industry, especially in the landscape of psychotropic medication, where problems are not always tangible. Within a congested healthcare system, medication is prescribed with an immediateness not always discerning or careful – sometimes within minutes of providing a diagnosis, and without proper education about its use. In the case of children and adolescents, psychotropic medications are often seen as the “first-line of defense” when it comes to certain disorders such as ADHD, anxiety, and depression. While there are many marked benefits to taking these medications wisely, there are also significant dangers associated with blending powerful medications and the developing mind. Parents approaching psychiatric medication as an option for their child should examine their options when speaking to a psychiatrist on behalf of their children, to understand and navigate the risks associated with the drugs prescribed. This paper will examine the common medications used on children, their side effects, and seek to find positive alternative or concurrent methods of treatment.
A drug’s ‘therapeutic effect’ is the desired action of the drug when used therapeutically. Actions aside from these effects are known as ‘side effects’ and often ‘adverse effects’. Adverse drug reactions include: toxicity due to overmedication, common side effects, and allergic reactions that are not related to the dose. Severity of side effects range from mild to life threatening and may develop overtime or occur quickly and spontaneously after taking the drug.
There are four main medication groups that are often prescribed for children. These are antidepressants, antipsychotic medicines, anti-ADHD medicines, and mood stabilizers. Some common side effects with antidepressants include nausea, vomiting, and stopping the medication due to its side effects. Examples of antidepressants prescribed for children are Escitalopram (Lexapro), Lurasidone (Latuda), and Sertraline (Zoloft). Antipsychotic medications, used to prevent psychosis, are also commonly prescribed to children. Side effects include drowsiness, abnormal muscle movements that can increase over time, and rapid weight gain. Examples of antipsychotic medications include Paliperidone (Invega), Risperidone, and Olanzapine. Anti-ADHD medication, used to improve focus, inside side effects such as insomnia and loss of appetite. Examples of Anti-ADHD medications include Methylphenidate, Atomoxetine, and Guanfacine. Finally, mood stabilizers, often used to treat bipolar disorder, will cause drowsiness and weight gain. Other side effects include behavioral side effects (aggression, suicidal ideation, impaired memory, hostility), cardiovascular effects (hypertensive reaction, orthostatic hypertension, cardiac conduction delays), and endocrine and metabolic effects (hyperprolactinemia, hypothyroidism, hypercalcemia). Examples of mood stabilizers commonly prescribed to children are Lithium, Divalproex Sodium (Depakote), and Lamotrigine (Lamictal). It is important to understand the type of medication being prescribed, the differences between the options available, possible interactions between sets of medication, and the adverse effects associated.
Children are the least studied demographic when it comes to psychotropic medication, but research done shows that children are significantly more sensitive to the adverse effects of psychotropic medication than adults. According to a 2014 article published in the National Library of Medicine, “In a study of antipsychotic medications, it was found that extrapyramidal adverse effects occur more commonly in young people than adults. Adverse effect severity may cause clients or their parents to refuse the continuation of pharmacologic therapy, thereby increasing the risk of re-experiencing their original symptoms.” (Steward et al., 2014) A risk associated with medicaton is that the severity of the adverse effects may cause the child to stop taking their medications, leading to an increase in original symptoms and the onset of painful, lengthy withdrawal symptoms. “Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions.” (Paul, 2019) It is important to monitor a child’s reaction to their medication, taking care to adjust and regulate negative effects.
When accessing medications for youth, it is of the utmost importance to advocate for the child at every step of the way. This involves learning available information about the drugs, exploring other existing options, and conceptualizing a flexible timeline for the duration of the medication use.
In what ways does this medication directly treat my child’s symptoms? Parents should do their part to understand the diagnosis requiring treatment, along with what specific symptoms are meant to subside with its use. Beyond a thorough discussion with the doctor, parents should look up supplemental material on the drug and become acquainted with its literature.
Is this the only medication option available? Every psychotropic medication is unique, with its own adverse effects and benefits. Per treatment category, the types of medication differ greatly. Selecting the safest drug or combination of drugs involves inquiring about alternative options should the cons outweigh the pros.
What are the potential side effects? This question helps parents to understand what adverse effects to prepare for as a result of taking the drug. Creating a game plan on how to navigate, communicate about, and support the child through these effects will provide a safe and informed environment for the child to start their regimen. In creating this game plan, recruiting the assistance of the doctor, counselor, and especially the child is key.
How long should my child stay on this medication? Finally, this question should begin to create a timeline for parent and child about the ideal duration for the intake of the medication. Figuring out how to adjust to the medication long enough to form good behavioral and emotional habits that continue without medications is desired. A child should never come off the medications cold turkey, as that increases the risk of suicide and intensifies withdrawal symptoms. A doctor can monitor the gradual tapering of medication in a way that attempts to avoid the withdrawal. On the other hand, should a child require long term or permanent stay on a medication, it is important to discuss with the doctor the type of issues that may arise with long-term use. As well as to communicate with the child in an encouraging way about the importance of maintaining their regimen.
When psychotropic medications come into play, it is important not to rely on them alone to treat a child’s problems. While medication can be a tool in assisting psychological difficulties, a thorough system of social support is key to sustaining positive growth. Children who require medication often adhere to a concurrent therapeutic relationship with a counselor or therapist. This adult can help the child manage the symptoms and feelings associated with their diagnosis, and navigate the side effects of their medications. Children should feel safe to explain how the medication makes them feel. Having a strong network of communication helps to foster those opinions, which should be honored by the doctor and the child’s family. Children on medications can often be at odds with themselves due to adverse side effects. Having a supportive family system and concurrent therapy is essential for a child taking medication.
Psychotropic medications can have a severe impact on a child’s life. Children are especially sensitive to psychotropic drugs and can endure harsher periods of transition and withdrawal. Parents should understand the heightened prevalence of side effects and potential adverse effects when searching for the right medication for their child. Asking difficult questions, remaining skeptical, and doing outside research should never be overlooked. Parents should make sure they know exactly what prescribed medication is addressing, what the potential side effects are, how long the medication should be taken for, and ultimately if this is the best option available. Parents should also be prepared to supplement their child’s medication with ample talk and behavioral therapy, helping to mediate any adverse side effects. Concurrent therapy and an informed family support system can help the child form positive habits that support healthy attachment to a medication for long-term use, as well as potentially tapering off of a medication in the future. The developing mind is a delicate vessel, easily influenced by the harsh reality of pharmaceutical drugs. When looking for solutions for a child, it is our responsibility to make sure these agents are used carefully and effectively.
Bibliography:
- Ninan, A., Stewart, S., Theall, L., Katuwapitiya, S., & Kam, C. (2014, September). Adverse effects of psychotropic medications in children: Predictive factors. Retrieved November 07, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197522/
- Hyun Jung Kim, M. (2020, August 06). Children, teens, and the safety of psychotropic medicines. Retrieved November 07, 2020, from https://www.health.harvard.edu/blog/children-teens-and-the-safety-of-psychotropic-medicines-2020080620715
- Paul, S. (2019, April 22). When psychiatric medications are abruptly discontinued, withdrawal symptoms may be mistaken for relapse. Retrieved November 07, 2020, from https://medicalxpress.com/news/2019-04-psychiatric-medications-abruptly-discontinued-symptoms.html
Melanie Pozas Wolf 