christian counseling today
Vol. 20 no. 2
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medications for a variety of reasons. Some may “cheek” and
then covertly discard, rather than swallow, the medicine. For
this reason, it is necessary for the clinician to impress upon
the patient the importance of taking the medication exactly as
prescribed. Noncompliance of medication treatment can lead
to uncertainty, the worsening of psychiatric symptoms and
unnecessary additional treatments. Members of the treatment
team must closely monitor a patient’s compliance to ensure
optimal results.
Another problem regarding medical management involves
changes in a medication’s effectiveness over time. A patient
may develop a tolerance for a particular medication, meaning
the same dose no longer produces the desired effect. As chil-
dren and adolescents grow (dosages are often tied to body
weight), develop, and gain life experience, their response to
medication may change. Additionally, lifestyle alterations
such as diet, exercise, and changes within the home environ-
ment may impact the patient in such a way that medication
no longer appears to be effective. Conversely, some patients
feel they have recovered and no longer require medication, not
realizing how instrumental it is to their continued daily func-
tioning, overall well-being or recovery.
For these reasons, it is essential for the older patient and
his or her parents to thoroughly discuss all desired changes in
medication with their physician, especially to avoid adverse
effects. Withdrawal symptoms can be reduced or eliminated
by gradually tapering the dose of a medication over time.
The patient may also require additional support during the
transition.
At times, a minor receiving psychiatric medication may
require other medical treatments, including medications from
other healthcare providers. Since medications and treat-
ments may interact with each other, all providers must have
full knowledge of the treatment regimen to determine if any
adjustments are necessary. Prescribers and pharmacists have
access to drug interaction databases to guide recommenda-
tions. For example, surgeons and anesthesiologists must
know all medications taken by patients preparing for surgery
(including dental surgery) and then advise them of necessary
changes, including temporary suspension of taking a medica-
tion before, during, and/or after surgery.
A number of medications are useful in treating children
and adolescents with psychiatric conditions including:
n
Stimulants
such as methylphenidate (Ritalin) and
amphetamine, and non-stimulants such as atomoxetine
(Strattera), clonidine (Kapvay or Nexiclon), and guanfa-
cine (Tenex) may be helpful for ADHD.
n
Antidepressant medications
are prescribed in the treat-
ment of depression and anxiety disorders (generalized
anxiety, school phobias, panic attacks, obsessive-compul-
sive disorder, post-traumatic stress disorder, and other
anxiety disorders), ADHD, bedwetting, and eating
disorders. Selective serotonin reuptake inhibitors (SSRIs)
include fluoxetine (Prozac), sertraline (Zoloft), paroxetine
(Paxil), citalopram (Celexa), escitalopram (Lexapro), and
fluvoxamine (Luvox). However, these medications have
also shown to increase suicidal ideation, so they require
monitoring. Other medications used less often for anxiety
include benzodiazepines (e.g., Ativan, Restoril, Librium,
Valium, Xanax, Klonopin, etc.) and buspirone (Buspar).
n
Antipsychotic medications
may be helpful for psychotic
symptoms including delusions and hallucinations, disor-
ganized thinking, muscle twitches (“tics”) or Tourette’s
Syndrome, severe aggressive behavior, and possibly severe
anxiety.
n
Mood stabilizers and anticonvulsant medications
(valproate, carbamazepine and oxcarbazepine, lithium,
and lamotrigine) may be helpful in treating bipolar
disorder, severe mood swings, aggressive behavior and
impulse control disorders.
Medication, while often a necessary element of a patient’s
comprehensive treatment plan, is not a substitute for posi-
tive lifestyle changes and a supportive environment. Research
indicates that medication, when utilized with psychotherapy,
produces the best outcomes. Some patients and their parents
expect the medication alone to solve their problems, but often
it only helps up to a certain point. All patients, especially
children, suffering from a mental illness will require additional
support to overcome the limitations of their condition and
improve their quality of life.
✠
Edward John Kuhnley, M.D.,
is a Child
and Adolescent Psychiatrist in Lynchburg, Virginia.
He has a community practice at Horizon Behavioral
Health and provides services to Centra Virginia
Baptist Hospital and Piedmont Psychiatric Center. Dr.
Kuhnley teaches “Counseling: Psychopharmacology and
Neuropsychology in Clinical Practice,” an intensive graduate course, at Liberty
University.
Medication, while often a necessary element of a patient’s
comprehensive treatment plan, is not a substitute for positive
lifestyle changes and a supportive environment.
