meds/diagnoses for teens

[teenmom2111]

Dr. Bradley

I would like your opinion on diagnosing and treating mood disorders for teens. I have a 15 yr old girl. I'd like to give you a bit of background on how we got where we are.

We have very little contact with her Dad which at this point is her choice. He abandoned her right after our divorce when she was 7 and rarely saw her. During the past couple of years, he wanted to see her but now she doesn't want to see him. I have tried many therapists since the divorce to try to help her work through her feelings about this, but until recently we hadn't found anyone that she was ready to talk to. She has been diagnosed with adhd and takes stimulants which helps quite a bit academically. She has a difficult time controlling herself--impulsivity, anger outbursts, anxiety and trouble making and keeping friends. When she was 8, a dr. put her on paxil and she was up to an adult dosage which ultimately ended in disaster. She became violent and needed hospitalization for 3 days. After that she was taken off of all medication and we pursued therapy. Things quieted down at that point, save the same difficulties making friends, keeping them and just general peer group acceptance.

We are now at the point where our therapist has suggested a full psychiatric evaluation. I have read the negatives about medicating children with SSRI's and the fact that because they are essentially experimental in children, we don't know the long-term effects--including suicides and violent outbursts. In general i am loathe to put my child on anymore medications, but rather wait until she is a few years older because I understand it is difficult if not possible to diagnose mood disorders in a child. There are so many changes going on developmentally already.

This brings me to my question for you, Dr. Bradley. What are your thoughts/opinions on children being diagnosed with mood disorders and treating them with meds. I am fairly sure that this will be the dr's recommendation when she hears of the mood swings, periodic violence, anxiety, etc. Is it worse to allow them to struggle through these crises or "help" them with medication.

I am anxious for your response. I have read your book and found many insights. Thank you Dr. Bradley.

Teenmom2111

[Mike Bradley]

Dear "Mom,"
Boy, do I hate these medication dilemmas. It's much like running from some threat in a fog over unknown terrain where every step you take is a risk, and no clear course is visible. And yet, standing still can be a risk as well.

You are, of course, correct in all that you say about the risks of these medicines with kids. But doing nothing can hurt your child as well. I think the key is to get as much information as possible from as many experts as possible and then look the "risk/benefit" equation. If a child's family, social, and/or academic life is dramatically hurting, and non-drug treatments aren't getting it done, then you must consider meds. Unfortunately, the brutal truth is that much of this medicine stuff is guesswork on the part of the experts, sometime requiring that kids try different meds that don't work before they find the one that does work. And some meds do work dramatically well, allowing kids to then make the progress in talk therapy that eluded them before. You and your daughter must weigh all of this out together to decide if the risks here are justified.

A point of good news is that your daughter's terrifyingly bad reactions to the first med will help the next shrink to look a lot smarter in picking the second. I suspect that the doc might suggest at an entirely different group of drugs which could make a huge difference in your daughter's life. These might be mood stabilizers (versus antidepressants) or, hold onto your hat, anti psychotic drugs. Please don't get upset with that label because your daughter is not psychotic. These meds help kids' brains function better.

I'd get the evaluation, and possibly a second one and then sit down and decide. Getting the eval does not commit your daughter taking anything. Just view the trip as a data gathering exercise for now.

Good luck and please keep us posted.