WEIGHT GAIN IN KIDS TAKING PSYCHOTROPIC MEDICATIONS

May 20th, 2015

What to do about weight gain in kids on psychotropic medications seems to be one of the leading concerns of parents. Some antipsychotic medications and antidepressants cause weight gain.

First, I want to make clear that these medications in many instances are very helpful in treating children with mental health disorders. Weight gain does not occur in all young people who take them. In some cases, the medications are life-saving. As a parent, you have to weigh the benefits. Usually, the benefits outweigh the risks of side effects including weight gain.

Having treated thousands of children in my career, I know that gaining weight itself comes with its problems — self-esteem, social acceptance, and of course one’s physical health.

If your child has been prescribed a medication that is known to cause weight gain, here are some things you can do. The first is to consult with your pediatrician to establish what a healthy weight is for your child. Keep track of your child’s weight. If weight is being gained, then a common sense cutback in calorie consumption is necessary. Work with your child to create a healthy lifestyle of eating and exercise and try to limit calorie content of foods as much as possible. It has been my experience that high fat and sugar snacks are often the culprits for kids on medications. Help your child to cut down noshing, and only nosh on low-calorie foods and decrease overall intake of calories.
The best thing to do is to work with children to teach them better eating habits. Encourage them to be hands-on in the decisions about what they eat. Have them help you in the kitchen. Take them food shopping. More importantly, be an example. If you are eating junk food, of course, they will want it too. Make outings more about doing things rather than about going out to eat or going for ice cream.

In the end, when your child is on antidepressant or antipsychotic medications weight should be watched. There is no magic here and no magic mechanism. As parents, we have to watch what we and what our children eat. Parents need to set a good example and help their children make good choices.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT ARE THE LONG-TERM EFFECTS OF THE MEDICATIONS MY CHILD IS TAKING?

January 30th, 2014

Naturally, parents worry about long-term negative effects of psychotropic medication on children. We have very little data since most of the psychotropic drug explosion has been relatively recent, and not enough time has passed to see any long-term effects on the brain or development in general, but even for very common psychotropic drugs like Ritalin, which has been used for fifty years, there has been no evidence that there are long-term dangers. At this time, there is no documented reason to worry about psychotropic drugs causing death or long-term damage to our children. While some of the side effects like drowsiness, mood changes, or other symptoms can affect our children, these are easily recognized and treated if the medication is being monitored correctly. Even for drugs that have been used for fifty years there is no evidence of long-term damage to children except for relatively minor issues like a very small height diminution in children who have taken some of the ADHD medications and even in this case it is not known if the decrease lasts into adulthood.

Lastly, there are always the newspaper headlines about famous or not so famous people dying from psychotropic drugs. This is very different from dying from proper prescribing. In these cases, there is usually an overdose of the drug, either intentionally or otherwise, a combination of drugs, or an interaction with illicit drugs or alcohol.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

CAN MY PEDIATRICIAN PRESCRIBE PSYCHIATRIC MEDICATION?

January 28th, 2014

In the United States, doctors without special psychiatric training write the great majority of prescriptions for psychotropic medications. Although it is difficult to quantify, it appears that psychiatrists write only about 20 to 25 percent. It would be preferable to have all of these prescriptions written by a psychiatrist and particularly with children and teenagers it be done by a child and adolescent psychiatrist. Why? Because the practice of prescribing these specialized medications requires specific knowledge of children and teenagers that is only gained by those who have completed special training in child and adolescent psychiatry in approved residency programs.

A general (adult) psychiatrist goes to medical school and then completes postgraduate specialty training of four years of general psychiatry. A child and adolescent psychiatrist goes on for an additional two years receiving additional training in child and adolescent psychiatry.

In a child and adolescent residency, one learns about the details of child/teenage/family development in all areas: biological, neurological, educational, psychological, emotional, and physical realms. One learns about the field of pediatrics and is able to integrate physical illness and its effects into diagnostic and treatment expertise. There is detailed exposure to the diagnosis of all the mental disorders that occur in the formative years, both in outpatient and hospital settings. One studies feelings, behaviors, and thinking patterns. In addition, there is exposure to all the various modes of therapeutic intervention including individual, family, and group talk therapy.

In a child and adolescent psychiatry residency, one scrutinizes the use of psychotropic drugs for the many disorders of childhood and teenagers; not only the helping effects of medications but the side effects, the use of multiple medications, the emotional repercussions of taking medication on the child and family, and the introduction of medication to school personnel when necessary. Most importantly, one learns about the unique metabolism of medication by young people.

Only about eight thousand doctors are trained in child and adolescent psychiatry in the United States. This is a small amount, and the field is considered very understaffed. Because of this, it will not always be possible to see a trained child and adolescent psychiatrist, especially if you live in a rural area. Pediatricians, clinic nurse practitioners, and general psychiatrists are the other major prescribing groups for the child and adolescent psychotropics and, although the great majority has the skill in this area, it is best to find out how much experience in prescribing to young people in particular they have. You can simply ask your doctor directly about their education, continuing education, and of course, direct patient care experience. Additionally you can search the Internet, consult with local mental health associations, and with the referring person (pediatrician) to learn more about the doctor in question.

ANTIDEPRESSANTS AND THE NEW YORK TIMES

August 28th, 2013

A recent article in the New York Times stated that there was an excessive prescribing of antidepressants in the United States and that the reason was probably that there was an over-diagnosis of depression in the first place. Putting aside the many different trends which might lead to excessive prescribing of psychotropic drugs in general I think what the article misses is that the approval of antidepressants by the FDA was for Major Depression, while in most practices patients present with depression problems which might not exactly fit the criteria for a Major Depression but fit what might be called “Minor Depression” or what is referred to by the clinical term Dysthymic Disorder. It has been my experience that the majority of depressed people I see have a minor depression and not the more severe and dramatic form of Major Depression. It has also been my experience that these people respond to antidepressants but the response might seem less dramatic because the original clinical condition was less severe. These patients have depression which might be a bit less severe and not as long lasting but still suffer greatly. Their condition not only affects their mood but the ability to work, love, parent and to enjoy life. Untreated it can also lead to drug and alcohol abuse. While the drug companies could probably only afford the approval of medications for Major Depression or were only willing to spend the amount needed, it does not follow that people are being given meds when not even depressed. If anything it appears to me that there is an under-diagnosis of depressive disorders. But worst of all the recent trend to use medication in the absence of talk therapy-still the golden standard of treatment-seems to go on unabated.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

Dr. Henry Paul, MD

Psychiatrist, Author and Educator