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Dr. Anandhi Narasimhan, a Los Angeles
psychiatrist who serves children, adolescents and adults, recalls a 12-year-old
patient who was so anxious she couldn't speak outside her home. Any other
communication was written on a notepad.
She said the first course she tried was
"exposure therapy," placing the girl in situations where she could talk, and
helping her with her anxiety. She also tried recording the girl so she could
become familiar with the sound of her own voice. When it looked like all the
behavioral tools and therapy wouldn't work, she suggested to the girl's parents
that she try antidepressant medication.
"She had incredible amounts of anxiety, and, in a case like that, it's useful to use medication when she didn't improve,"
Medication is never the place to start when a
teen is having issues, Narasimhan says. Psychiatric
meds may be prescribed for a variety of reasons, including depression, anxiety, aggression and
attention deficit hyperactivity disorder. Narasimhan mentioned another
patient, a girl who had trouble sleeping. The prescription for that wasn't for drugs but, instead, for 20 minutes of exercise a day and eliminating caffeine.
"There's a lot of misunderstanding out there
that when you go to a psychiatrist they're going to be quick to prescribe
medication," Narasimhan said, adding that the goal is not to use medication first, but to do a full history and get a comprehensive picture of
the teen's situation from the teen, his parents and possibly the
school. "I try to find out why kids act out. What's happening at home?" If
there's abuse at home, then the kids are likely to abuse other kids at school. Disruptive behavior,
sleeplessness and aggression may appear due to depression or anxiety, physical
changes, trauma or a death of someone close.
If the parents do opt for medication—and
this is always a voluntary decision—the doctor will explain possible side
effects and how to get the most from the drug. For example, a stimulant is
sometimes given to a patient with attention deficit disorder, which can result
in loss of appetite. A doctor can help navigate when to give the drug (after
breakfast) and what other risks might be.
Some parents don't want to start a kid on
meds for fear they'll never be able to get off them. Narasimhan says that brains continue to develop well into adolescence, so in time, symptoms
might not be as extreme—or the kid learns to compensate with behavior.
"It depends on the severity of the illness," she
says. Some individuals require medication for a long-term illness, like severe
bipolar disorder. "Sometimes the risk of taking them off of taking them is too
great. They go off, they end up back [in the] hospital."