Recent reports that drug prescriptions for kids and teens have spiked noticeably in the last few years have renewed a debate over whether and when it’s best to medicate children’s mood or behavior disorders.
Into the conversation, Katherine Sharpe is bringing a new perspective — a former medicated teen’s perspective.
Sharpe’s book is not a polemic; it doesn’t plant a foot in either the medicate or don’t-medicate camp. Instead, it offers a bookful for a parent to consider. Her examination centers on her own experience and the experience of so many of her peers who began to rely on mood-altering drugs before they felt they had finished maturing.
She and I engaged in an e-mail conversation about her journey, her research and the pros and cons of medicating teens.
She also offered some clear-eyed advice to parents about how they might better teach teens what she calls emotional “literacy” — a skill that we sometimes forget is not altogether obvious to kids growing up today.
An edited version of our Q&A is below:
JD:The debate over children and medication often focuses on younger children and side effects, but you examine the issue from a different angle. Can you talk a bit here about your premise?
KS: I started out being interested in what the subjective experience of taking antidepressants is like for the young people who do it, not just how medication makes people feel, but how people feel about being on medication. I talked to many about how using medication from a young age can affect a developing identity.
We’ve long had a conversation in this country about how antidepressants and other psychiatric drugs might affect the self, a debate about whether they change personality and whether that’s a bad thing, etc. Part of my premise is that adolescents, who haven’t yet come to a refined, adult sense of who they are, often struggle more poignantly with these existential questions that medication can raise. Developmentally, asking “who am I?” is a key task of adolescence.
JD: What did you find?
KS: I found that many, if not most, adolescents incorporate the fact of using medication/having a mental health diagnosis into their identity in some way. For a significant number, that impact is negative. Some dwell on the idea that taking a consciousness-altering medication can prevent them from knowing who they are or what they truly feel — can block off an authentic experience of self and self-exploration that may feel particularly important at that age. Others focus on the diagnosis itself, dwelling on how the idea of being a person with a mental disorder, instead of being freeing, makes them feel lost, illegitimate or “broken.”
I definitely think that antidepressants can be valuable drugs and that they have a role to play, especially with young people. Drawbacks like the ones I just mentioned won’t tip the balance against them for everyone. But I do think the emotional experience and possible negatives of taking these medications is important to understand, in light of how common the drugs have become. We’re no longer just reaching for them in cases of severe impairment, or after other treatment methods have been tried and failed.
JD: So, do you think they are over-prescribed?
KS: Despite these medications’ value, I believe that they are now over-prescribed, on the whole. I think that aggressive marketing has a lot to do with this. Such marketing has helped lead to a widespread confusion about where “ordinary”’ negative feelings, teen angst, etc., end, and real psychopathology begins....When we become too ready to chalk various emotional problems up to biological causes, we can start to overlook the real-world roots of our feelings, and not to notice (or in the case of developing adolescents, never learn) the many ways besides taking medication that we can influence and manage our state of mind. We may also become excessively intolerant of and/or frightened by negative emotions, surrounded as we are by ads informing us that “anxiety, irritability, fatigue, trouble concentrating” and so on are signs of a serious disorder. (They can be, but the subtlety is lost in advertisements that are trying to open up a new market).
JD: In your book’s conclusion, you mention that you’ve met many parents who have been torn about the decision to agree to medication for a child’s emotional struggles. What would you suggest they consider, beside physical side effects, when evaluating the choice?
KS: It can be a really tough decision for parents to make. My sense is that parents sometimes feel they’re walking a gantlet: they don’t want to make the mistake of giving a medication that isn’t needed, and they don’t want to deny their child something that could alleviate pain or help them to be successful....
Obviously, I am not a doctor and not qualified to offer medical advice. But speaking as a onetime medicated teen and as someone who has talked to a lot of medicated young people and experts, I’d say:
●It’s helpful if parents understand the psychological consequences of using medication, such as the ones I’ve mentioned. They should know that using medication isn’t always a simple, straightforward or neutral experience.
●If a child is old enough to express his or her own wishes in regards to wanting to take, or not take, medication, and if she’s functioning adequately and doesn’t seem to pose an imminent danger to herself or others, parents might consider honoring those wishes. Some of the people I spoke to who had the best experiences with medication were those who actively wanted to use it, and vice versa.
●Parents should know that there are other interventions that can help. Psychotherapy has been proven effective in adolescents, both on its own and in combination with medication.... Physical exercise is potently anti-depressant. If depression is situational and it’s possible to make changes to the child’s situation, that can make a big difference, too.
●Finally, whether or not they choose to medicate, parents should remember that the big picture of mental health is about so much more. Even when medication is part of the picture, it’s just a beginning. Learning to live well is a big job, and parents are probably the most valuable resource. So often we talk about disorders, illnesses, very significant problems. It’s important that parents look out for these kinds of serious problems. But there are humbler kinds of parental input that make such a big difference in quality of life, for everybody.
Kids aren’t born with perspective or coping skills. Parents have a huge role to play in modeling basic self-care habits. Teens may not always want to hear it, but keeping a reasonable sleep schedule and eating regularly and decently well are vital for emotional well-being, as is having a level of physical activity.
We all need to build in some time to unplug and relax, as well as to socialize. Emotionally, parents can help kids build the “literacy” that isn’t always forthcoming from our culture. Kids need help understanding how the things that happen to them and the choices they make affect the way they feel, and identifying the stressors they’re under. They need to learn that it’s okay to feel sad or angry or insecure from time to time, and that others also feel the same way, even if it isn’t always obvious. Some kids will need clinical intervention. But a voice of adult understanding and reassurance can be surprisingly powerful.
Have you faced the medication decision? What criteria did you consider?