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Getting the Right Medication
You and your doctor should be partners in prescribing

John DiLallo, MD, is a child and adolescent psychiatrist. He was hired in November 2008 as director of the new Psychotropic Medications Unit in New York City Children’s Services (also known as ACS). We interviewed him in his downtown office.

Q: Tell me about your job.

A: I direct a team of people who oversee the use of prescription psychotropic medication among children in foster care. [“Psychotropic” means the drug works on your mind, like antidepressants or mood stabilizers.]

We review cases when we’re consulted by a foster care agency to make sure that (1) the use of medication is safe and appropriate and (2) that the legal rights of the child, the child’s parents, and whomever else might be involved are respected.

At the Psychotropic Medications Unit, we advocate that accurate medical record information gets transferred whenever a child changes doctors, and that the doctor has at least 30 minutes to discuss medication with the child. Ideally, it would be longer than that.

Q: Why was your job created?

A: Many people are worried that kids are over-medicated. Lots more drugs are being prescribed these days. Kids take more stimulants, antidepressants, and other psychotropic drugs than they used to. Polypharmacy (prescribing more than one psychotropic at a time) has increased a lot. Some kids abuse their pills or share them with friends, which is not safe.

Other people worry that children in foster care aren’t having their mental illnesses treated properly. So ACS formed this unit to respond to these two concerns.

People often exaggerate both positions: “Medication saves lives!” vs. “Drugs kill!” We try to find the reasonable middle and focus on what’s the best care for each child. When we’re reviewing cases, we make sure there’s not too much medication and that treatment is up to the standard of care that children who are not in foster care receive.

image by YC-Art Dept

Psychotherapy can help people work through problems while medications help control their symptoms, so we normally recommend psychotherapy for kids who take medication. Most often it’s not the best idea to get meds alone with no talk therapy.

Q: Who will the doctor tell about what I talk about?

A: The doctor must keep everything confidential unless you tell him or her that you’re at risk of hurting yourself or someone else. You should always tell your doctor about other medications you’re taking and if you’re taking illegal drugs or alcohol. You have to be honest with your doctor about that.

Q: If you don’t like your medication, what should you do?

A: Keep in mind that some medicines can take weeks to work so don’t give up if you don’t feel better right away.

But it’s the doctor’s job to make sure you feel OK on the drug. And in the long run, you’re the one who gets to decide, “Is this medicine going to help me with a problem I want to change for myself?”

Be sure you tell your doctor about any medication problems. It’s much better to talk to the doctor than to just stop taking the medication. Be honest; tell the doctor, “I haven’t taken my meds for six weeks.” You won’t get in trouble and the doctor needs that information to make sure you are safe. There can be dangerous side effects from just stopping, so it is always better to tell your doctor and to stop medication gradually.

If you feel that the doctor won’t listen to your concerns about your medication, then you should get the adults in your life—your foster parents, your caseworker, etc., to help advocate for you.

Nobody can force you to take medication unless a judge decides you must take a certain medication after you did something dangerous or criminal. There can be serious consequences to not taking it though. If not taking the medication makes you more likely to get in trouble at school or at home, you might need to take it. If you lose your temper too much unless you take a medication and that gets you kicked out of a school or a foster home, you should take that into account. But bottom line, you make the choice whether to take a medication or not.

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