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Talking to Your Doctor About Medication
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Fadi Haddad, M.D., is a child psychiatrist, a clinical assistant professor at New York University, and the medical director of The Center for Family Development, NYC Division. He has extensive experience with child emergency psychiatry and has written about attachment and adoption. We asked him about how and why doctors decide to prescribe psychotropic medications—drugs that affect your moods and mental state—and what you can do to make sure you have input into those decisions.

Q: Many foster youth are unhappy with the medications they’re told to take. When is psychotropic medication helpful and when is it unnecessary?

A: The goal is safety and normal functioning. The best way to get there is the least invasive, the least chemical way.

One factor in the decision to prescribe is the severity of the symptoms. For example, some anxiety can be good, like the kind that motivates you to study for an exam you’re nervous about. But if the anxiety keeps you from eating, sleeping, socializing, doing your job or your homework, medication might help.

Another consideration is the timeframe—is the problem persistent or is this something new that might pass soon?

We also take into account the support system around the patient. If someone doesn’t live at home, doesn’t have friends, doesn’t have help from school, I might be quicker to prescribe.

I have to take all these factors into consideration. If a young person comes to me for the first time and hasn’t seen any therapist, I would start with trying to find them a therapist before thinking about medication. But if someone tells me, “I go to therapy three times a week and I’m in a specialized school with a lot of support,” and they still are having the problem, I might lean toward medication.

Q: Does someone under 18 have any say in whether she’s medicated?

A: The young person’s desire to take medication is factored in. If you say, “I don’t want to take medication,” I make sure you know the benefits and risks of the medication. Sometimes fear comes from lack of knowledge, so it’s important to educate the patient and to explain the side effects. If I think it would help, I see the patient multiple times and try to convince them.

In an emergency room, if you say, “I want to kill myself,” we keep you in the hospital, and I’m more likely to medicate.

image by YC-Art Dept

But nobody can force you to take medication against your will. If a patient is very out of touch with reality and dangerous to himself or others, a doctor can petition a judge to mandate medication against the child’s will, but this is very rare.

Q: Many foster children are given severe diagnoses like borderline personality disorder or bipolar. What can a youth in care do to change a diagnosis she feels is wrong?

A: Be honest with the doctor—that’s the best way to get the correct diagnosis. An open communication is important even if you don’t like your therapist. You can tell your therapist, “I don’t like this medication” or “I didn’t like this thing you said” or even “I don’t like you.” A good therapist will talk about that: “OK, you don’t have to like me. Is there something I can do to be a better therapist? Let’s talk about what’s not working.” A good therapist will not be mad if you tell them something you don’t like—they’ll work with you and ask you questions about what would make you more comfortable.

If you, the patient, want to make your case by keeping a journal of your mental state and behaviors and side effects, a good therapist will work with you and say “OK, write down what you eat and how much you sleep and your side effects.” But what’s in that journal has to be truthful.

A support system can also help. If you have a good therapist, a good doctor, they can help you get that diagnosis changed. [If you’re very unhappy with your doctor or therapist, talk to your caseworker or your lawyer about switching to someone different.]

Q: What do you do when a young patient doesn’t want to take medication?

A: If a patient tells me “I don’t want to take medication; I want to go to therapy” and I can find a therapist, we’ll try that. Sometimes a therapist isn’t available right away. If the young person is not going to school, losing weight, not sleeping, and has no support system, that’s when medication has to be considered.

I talk to the patient about expectations: “What do you expect from yourself as a 17-year-old?” Mostly kids agree they should go to school, maintain basic hygiene, and do some socializing. So if the patient says “No, I don’t go to school, and I haven’t showered in two weeks,” we think about medication.

Q: How long do people generally take psychotropic drugs?

A: If a person is in a stressful situation right now that will end soon, they may only be on medication for a short time, maybe six months to a year. We try to get patients off anti-psychotic medication like Risperdal, Abilify, and Seroquel much quicker, a few weeks to a few months.

Q: How do you handle a new patient who’s already on medication and wants to stop taking it?

A: When I get a new child patient who’s on any medication, I try to talk to everyone involved in the care, the prescribing doctor from before as well as the youth. It’s harder with youth in foster care, because they change doctors and other caregivers so many times. That’s getting better: In the last couple years, Medicaid has allowed doctors to see the medication history within that state, with some exceptions. But even there, it’s just the medication in the records, not why they were prescribed, so the more information the patient has the better.

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(FCYU-2015-01-08)

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