By Mohab Hanna, MD, Child and Adolescent Psychiatrist
I have been a practicing Child and Adolescent Psychiatrist in full time clinical practice since 2002. As the founder of MedPsych Behavioral Health, I get an intimate look at what is happening in the world of Child and Adolescent Psychiatry- especially here in Northern New Jersey and Bergen County. As the years go by, I get more and more concerned about the number of kids, teens, and college students who are going on psychiatric medications. I am saying this as a psychiatrist who specializes in the diagnosis and treatment of child and adolescent mental health problems and as an expert in prescribing psychiatric medications for kids and teenagers. It is my clinical psychiatric experience that makes me concerned.
I am very aware of the all the negative things that can go wrong if psychiatric medications are prescribed too quickly or are prescribed too aggressively. I am frequently asked to provide second opinions and consultations for both children and adolescents who are already being seen psychiatrically by other providers. It is not uncommon for me to come across situations where children have been on ADHD medications for more than 10 years continuously with no time spent off medications to evaluate how the child would do off ADHD medications. This is a scenario that I also see with both children and teenagers on other classes of psychiatric medications such as anti-anxiety medications, anti-depressants, anti-psychotics, and mood stabilizers.
At times, I see teenagers who come in on 4 or more prescribed psychiatric medications and occasionally, I see this in younger children as well. I understand how this happens. For those of us who specialize in child and adolescent psychiatry, we want to help our patients get well. We want them to not hurt themselves nor hurt anyone else. We have compassion for struggling parents who are drowning and demoralized with the intense level of struggle their children are suffering with. There is frequent fear of removing psychiatric medication since “things can always get worse”. The path to over-prescribing psychiatric medications is full of good intention, compassion and fear. No one wants to see patients struggle and we are all committed to helping them get well, thrive and function to their best potential as much as possible.
There are multiple and complex factors that drive over-prescribing of psychiatric medications in both kids and adults. One of the primary drivers of over-prescribing is unrealistic expectations that psychiatric medications are going to address all or most of the emotional or behavioral struggles that are going on. This applies regardless of what is being treated, whether it is depression, anxiety or ADHD. It is essential to have realistic expectations that psychiatric medications will not treat all symptoms and that there are plenty of other things that can be done to help the situation; this obviously includes counseling/therapy (especially CBT and DBT), parenting training, coaching, nutrition, supplements and good sleep hygiene.
As a psychiatric practice that specializes in treating children and teenagers, MedPsych is a strong proponent of a holistic comprehensive approach that helps all of our patients. It is very tempting to look to psychiatric medications to solve all problems, but that will rarely occur if ever at all. Psychiatric medications are designed to address underlying biological problems. We believe our patients are much more than their biology or genetics. There are always multiple factors that contribute to the emotional or behavioral struggle. This applies to almost everyone we treat including our adult patients who also struggle. For example, addressing the school environment can frequently make a huge difference for good in addressing anxiety in kids who are struggling. It is essential to remember that the holistic approach that we advocate at MedPsych helps patients thrive in their journey to getting well from whatever psychiatric or psychological problems they are experiencing.
