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January 2011



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By Nancy Rappaport, MD

What Is Psychiatric Treatment?

Although we occasionally read about psychiatrists who are accused of overprescribing medications, and antidepressant usage is hotly debated, in most cases a patient’s quality of life is a psychiatrist’s number one priority (as it is with all medical doctors), and restoring a patient to optimum health is our goal. Parents whom I see for the first time are often rightfully concerned about treatment; they want to know what I can offer their child and how they can convince their child to see me.

Teenagers are understandably reluctant to see a “shrink” or talk to a stranger about their problems. At a time when they are incredibly self-conscious and want to blend in, teenagers can worry that people will think “they are nuts.” How parents communicate with their child about why they are asking for outside help is critical; often a parent’s plan to seek the help of a therapist slips out in the heat of exasperation or anger, and it sounds like a punishment.

It is not uncommon for teenagers to get angry when asked if they are depressed, as if depression is a sign of weakness. But a child may be more receptive if a parent says, “I notice you are pissed off (or angry) a lot of the time and I am not sure how to make things easier. It might be helpful for us to talk with a doctor to figure out what is making things so difficult and try to make things easier for you.”

Usually when I ask teenagers why they have come to my office, they give very different responses from their parents. It’s critical within the first session to let the patient know that my focus is to alleviate stress in his life because “things are hot” — which may include failing grades, suspensions, fighting with parents, or a suicide attempt. The first interview with the child has three main purposes: I learn who the patient is, try to form some sort of relationship with him, and seek to obtain crucial information (like a detective looking for clues).

Although teenagers may initially be wary, I tell them that they are free to fire me after the first session if they don’t feel it is the right fit, partly to communicate in a fundamental way that they are in the driver’s seat about making choices about what is best for them. It is imperative that the therapist and patient are able to find a common ground and work together to figure out what’s making life so difficult and how to improve it.

A major issue to decipher is whether or not there is an existing family history of depression or bipolar disorder — if there is a biological component or mental illness. If there is trauma or a learning disorder, this may also make a teenager less motivated and susceptible to withdrawing from treatment. A careful assessment is critical, and my approach is always to inform families that I am a “consultant” to the family and they need to make an informed decision based on my findings.

I am never cavalier about suggesting or prescribing a medication; we psychiatrists are usually making diagnostic assessments on “moving targets,” as children and adolescents are constantly evolving, and the decision is not always absolutely clear. With a careful explanation of the risks and benefits, of the various options (including no medication), and of what to look for to tell if medications are helping and what kind of time frame might be needed to see improvement, patients and families will always have a chance to share their questions and concerns.

Untreated depression and mental illness is highly debilitating and very difficult to live with. Outside help is essential, and medication can be lifesaving — just as insulin is to a child with diabetes.

Editor’s note: This is part two of a three-part series about kids and depression. Stay tuned for part three tomorrow, or feel free to read part one if you missed it.

Source:  http://psychcentral.com/blog/archives/2010/02/02/kids-and-depression-parents-call-to-action-part-2/

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