Dr. Henry Paul, MD

Psychiatrist, Author and Educator

Tag Archives: medicating my child

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.

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.

HOW MUCH RESEARCH SHOULD I DO WHEN THE DOCTOR PRESCRIBES DRUGS FOR MY CHILD?

January 21st, 2014

It is natural for a parent to worry when a medication is prescribed for their developing child. That’s why it is very important that the prescribing psychiatrist takes time to discuss all aspects of medication at the time of prescribing and on an ongoing basis. Goals of treatment, as well as common side effects, should be explained. Questions should be fielded cooperatively. Informed consent should be routine, but even after that, many parents who live in our information age still have worries and further questions. They often turn to written material they find on the pharmacy drug sheet or the Internet.

In theory, this is a good idea, but, unfortunately, it often leaves parents scared as they read highly technical data and sometimes even plainly wrong information. I often get urgent calls from parents after they have read about a particular side effect that was not discussed.  Often the side effect is so rare to the point of clinical insignificance that it was not discussed in our meeting.  So many side effects are listed for every drug that if they were all believed to be serious or common many people would take nothing, not even aspirin. The experience and wisdom of the doctor prescribing should help you weigh the benefits and risks of a drug for your child. Many patients call me with these questions, and I usually say that a particular effect is true but rare and should be put aside compared to the benefits of the prescribed drug. Nothing substitutes for clinical experience and the doctor’s ability to understand and evaluate what is meant by the written word.

One caveat I have for parents who use the Internet to research medication is that there is often fallacious material posted by overemotional parents or others who frankly misstate facts. The Internet is full of false claims as to the dangers of medications. Dangers are often made up, reported out of context, exaggerated, distorted, and discussed from a one-sided point of view. The websites that some parents tend to stumble across are often written by nonprofessionals and testimonials are usually filled with generalizations, distorted anecdotes, or even false rumors having little to do with proper prescribing. I spend a great deal of time explaining to concerned parents how to interpret something they have read into a less anxious context, and directing them to more reliable websites or other sources of correct information. This is part of the art of prescribing medication, and doctors must remain patient as these calls are from worried parents who want the best for their children.

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.