Medicine: An Important Component

October 31, 2016

Medicine is an important component of the treatment plan for many children with behavioral illness, just as is for many other illnesses. It is much more common for families to resist the idea of using medicine for their child's ADHD, anxiety or depression than it is for other chronic illnesses such as asthma or diabetes. It is easy to oversimplify the reasons for this reluctance and say that it is due to the stigma often attached to behavioral illness, or negative experiences of a friend or family member with treatment, or denial, when in actuality the reasons are often complex and not easily articulated. For many parents, the bottom line is a concern that medicine will be harmful to their child. Many state that they are worried that medicine will change their child's personality, or "turn them into a zombie."

Medicines always come with the risk of side effects, and those that are used to treat behavioral disorders sometimes cause behavioral side effects. Medicines that treat severe, life-threatening mental illnesses that involve psychosis or high risk of suicide often do have meaningful side effects, both physical and behavioral. Doctors often have no choice but to ask patients to tolerate these toxicities as the risks of the untreated illness are greater than the severity of the problems the medicines can cause.

For the vast majority of patients who need treatment for ADHD it is possible to develop a treatment plan which involves a medicine that is effective without side effects that are difficult to tolerate. ADHD causes children affected by it a significant amount of dysfunction, and left untreated it increases the risk of school failure, anxiety, depression and substance abuse. Stimulants have been used to safely treat ADHD since the 1960's, and in the decades they have been used have been proven effective and shown no evidence of long term toxicity when used appropriately under careful observation.

Anxiety and depression are a somewhat different story as the evidence is muddier, but it is clear that many young people derive great benefit from treatment of these disorders with a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine. Level of function and quality of life is often markedly improved, and serious side effects are extremely rare.

Medicine for behavioral illness is not a panacea, but it is often an essential component of a carefully constructed and monitored care plan which helps some of our children to be their best selves.