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," Narasimhan said.
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 medicationโand this is always a voluntary decisionโthe 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 extremeโor 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."
The first step, she advises, is by reading up and asking for help. She recommends the American Academy of Child & Adolescent Psychiatry, and the website for the Children and Adults with Attention Deficit/Hyperactivity Disorder organization.
"There isn't one blanket answer. You meet with a psychiatrist, you get all the information, and you do your own research," she says.
