Notes and Mentions
National Network of Child Psychiatry Access Programs https://www.nncpap.org/ American Academy of Child and Adolescent Psychiatry Child and Adolescent Psychiatrist Finder and Parents? Medication Guides
Like us on Facebook!
Find us on Instagram @noneedtoexplainpodcast
Follow us on Twitter @mhmamas
We love to hear from you! Email us: email@example.com
Tina: Hey everyone, I'm Tina
Serena: And I'm Serena, and we are the Mental Health Mamas.
Tina: Welcome to No Need to Explain. We are so glad you're here.
Serena: First, as always, a quick disclaimer.
Tina: We come to not as mental health professionals or experts in the field, but rather as parents with lived experience who are on a mission to normalize the conversation around mental health.
Serena: If you or someone you love is experiencing a mental health crisis, please seek professional support. You'll find a variety of resources on our show notes and on our website no need to explain podcast.com.
Tina: Today we?d like to talk about a topic that?s a bit controversial but it?s important to us and it?s important to lots of other people as well.
Serena: Yeah, and the topic of the day is medication, and more specifically, we want to talk about that difficult decision around seeking psychiatric medications for our kids.
Tina: So, as we always say at the beginning of every episode, we are not doctors, and what we're going to share with you today is in no way medical advice.
Serena: Right, not doctors, no medical advice. However, what we'd like to do is share our own personal experiences with medication, as well as share a couple of resources with you. For anybody out there who might be contemplating this or who might find themselves on this journey.
Tina: So, yeah, let's start with breaking down some of the stigma around kids and medications. I will personally own that I held stigma around medication and my own kids.
Serena: Yeah, me too. I also held a lot of stigma around meds, and I think part of that is that we hear a lot of horror stories about medicating kids, and I think I even feel like that term medicating our kids feels like it has negative connotations. And the idea that medication is going to maybe make them zombie-like or totally checked out. But here's the thing, if your kids have asthma or diabetes or some other chronic condition, what do we do?
Tina: We would treat it, wouldn't we, because it's medical, right? We worry about them. And yeah, we would go to our physician, and we would get medication, which is the gold standard, not only for physical health, but for mental health as well. So, therapy plus medication. But let's return to that topic in a bit. Serena, tell our listeners a little bit?share a little bit about your personal story with medication and your people?
Serena: Sure. So, as you know, Tina, and also any of our loyal listeners out there, my second born really struggled from a really, really young age. But I will say that actually took us a while, maybe longer than I want to admit, as parents, to recognize this as being related to her mental health. There was a lot of stuff going on, and I just was really looking for that quick fix, the one thing that was going to sort of solve this complicated puzzle. So, she began therapy around the age of three, and has been seeing a therapist ever since while also receiving some different levels of support, In school as well. And so, the very first time medication was suggested to us was we were at a school meeting, discussing her like annual progress, and she was five years old, and my husband and I, oh, we had this very visceral reaction. I just, I can see it in my head right now that moment, and how much, how angry we were that they would bring this up. And then she just felt so little, and it didn't seem like the school should be suggesting something like this.
Tina: Yeah, I totally agree with that. And you know me, I would not have taken that well either. And I think this is especially true for families that don't feel like school is a good partner, right, that they don't have that relationship. But you eventually did seek meds, right?
Serena: We did. So, a little side note here too is the idea that when she was five, she was vomiting all the time. And one of her triggers was any kind of medication, like if she had an ear infection, right, like trying to get the antibiotics down her was a nightmare. So, it was kind of laughable, right, that they would suggest medication to fix the problem that it was going to cause a problem. But anyway, we did eventually go down that route as she got older. And I can remember very clearly the conversation with my daughter's therapist. And I would say that we had been struggling at home, and that might be putting it mildly. My daughter was having a really, really hard time. And, you know, for some reason, those sticker charts and all those other great things that are supposed to work, nothing worked. Nothing was working anymore. And so, her therapist had a heart to heart with me and said that we really needed to decide as a family, how much we were really willing to kind of, you know, keep of coping and keep managing before we went down the route of considering medication. And so, tough decision, right? And the other piece of that is that we knew that if we decided to go down that route, we would have to switch therapists because, and, you know, it's like this in other areas as well, there's so few child psychiatrists that in order to access, you have to be seeing certain therapists. And so it's, you know, for anybody to change therapists is a really big decision. And my daughter does not like change to this day. And at that time, that was, it was huge. But ultimately, we did make the decision to try medication after, again, so much struggle, just being kind of at the end of our rope and just a lot of consideration. Again, a tough decision for my family, but it was one that eventually helped improve things.
Tina: So, tell us a little bit about that, because I think it really, we need the whole picture, give an example of how you saw things improve once she was doing therapy and medication.
Serena: Yeah. So, so again, she'd been in therapy for a long time. And one of the things the therapist had said to me is that, you know, she sort of was struggling to integrate any of this because she was in such a high state of anxiety all the time. And really, you know, whether there was a connection from the beginning or not, I don't know. But certainly by that point, the vomiting was directly related to anxiety. So, anytime she got, worked up in any way, you know, good bad, whatever, she would vomit. And so, we tried some anti-anxiety meds and that brought down that anxiety enough that that daily vomiting stopped, which was, it was huge for our family, and for her. So, we felt like we could do some normal things in our lives.
Tina: Yeah. Yeah. Yeah. That's an awesome example, yeah.
Serena: Yeah. So, what about you, Tina? What has your journey been like?
Tina: So, as you know, Serena and perhaps our listeners from, we had really profound struggles. And the first time our pediatrician, I'm not kidding you, the first time our pediatrician suggested meds, I literally fired her. We did not see her again. And in hindsight, she was honestly a wonderful doctor and was correct, but perhaps didn't go about it, you know, in a way that our family received well. So, perhaps not that family-friendly way of introducing that.
Serena: Right. And I can imagine too that, because, you know, we had a very similar reaction that maybe you weren't ready for that conversation.
Tina: Totally not ready. Totally not ready. Yeah. And since we had a relationship with the therapist, we had been seeing her for about a month. And we really did love for and she was making some progress, right? I think that team effort, that collaboration probably would have been a better route to take than for us to be sitting alone with the pediatrician talking about that. So, anyway, just an aside there. So, when we finally decided to try and medicate, it was not the right medication for my child. And I know I'm going to spark some controversy here, but I'm just going to go with it because that's who I am. I'm not sure how skilled pediatricians are when it comes to prescribing this type of medication for mental health. The other issue that I have is relating to big pharma. Again, this is going to be controversial, but I'm going to say it. I had done some work in our, one of our previous communities and it allowed me to work with people from a health insurance provider just randomly. I'd hear lots of stories about the wining and dining of this particular insurance provider by the drug companies who were trying to develop relationships for what they called preferred coverage, right? We all know when we go to the pharmacy that there are drugs that doctors prescribe and they're called the preferred, you know, the insurance considers them the preferred drugs. And this was in the 2000s that the preferred drugs still happen, that that is still happening currently. And I still to this day wonder if that is because I would hope the health insurers do their research and think that these drugs are effective, but something still tells me that insurance companies still pick these drugs because they're developing these relationships and cut deals and get lobster salad on Wednesdays and whatever. So I'm going to go back to that first time my child actually took a drug that was the preferred drug. There was no discussion of what drugs to take. It was like, here's the thing, you take this drug, not approved for children under 18. It was so it's totally off label, we're using it off label. It was such a profound failure, like almost life threatening failure, that it clearly affected the future of our decision making about any medication.
Serena: Right. Yeah, there's a lot there.
Tina: That's how I did it. There you go. It's all out there.
Serena: What I do want to point out is, I don't know if people know this or not, but in general, the psychiatric meds that are being prescribed to kids are not approved for kids and that's because we don't test on kids and yet they're prescribed to them. So we don't always know what the side effects might be. And you know, very, very few of them are actually approved for prescribing to kids under 18. And again, they're needed. So I'm not saying that we shouldn't do this. I'm just saying, you know, just something to know and keep in mind as we have this conversation.
Tina: Well, and so I'll add this. For us, those future decisions about medication, in fact, when this medication didn't work, we didn't pause. We then were smarter about it and thought, okay, we know we need it. We've come to that decision. So what are we going to do next? Um, and that came with hyper awareness around, you know, making sure that we, we, we knew our staff lots of research and certainly a bit of empowerment to kind of level that playing field. So what I mean by that is doctors are people. They are not God. They are not all knowing beings. Parents can and should question these decisions and not just be the receivers of care. All that said, you are likely thinking I might be anti-med, which I've just said, I'm not anti-med. We had lots of success at one point. Um, I totally agree with Serena that the gold standard is therapy and medication. And once we got the correct mix of those two things, life improved immensely.
Serena: So can you also talk about how things are different for your family after medication?
Tina: I can. And I certainly will. I think we've talked certainly on other podcasts that OCD and anxiety were, were what we were dealing with. And these were really profound symptoms that set in very quickly and not that we didn't have anxiety before, but these were just really in our face. They were, they were things that we were noticing. And within two weeks of taking the proper medication, my child was a different person, less, less school avoidance, less tummy aches, less, just less anxiety overall, just a happier kid. And that was, again, we went from this profound symptom being profoundly symptomatic to, you know, we were really working with a therapist and that medication just kind of, it was the hurdle help we needed to have a more normal life, just like you said.
Serena: Yeah, that's amazing. So the other thing I want to mention here is this idea that we're talking about finding the right medication for our kids. But just a note that when we say that, you know, when an adult finds the right medication, that may be the right medication for years, may be the right dose, the right kind of medication. For our kids because they're always growing and changing. It's not the case, right, Tina?
Tina: Very good point. Yes. Yeah, that's a very good point, especially, and I will just add this from personal experience. I remember asking a psychiatrist when my kid was a teenager and saying, how to do hormones affect the absorption of this medication, the interaction of this medication. And there was no good answer to that, which made me really, it was not a good moment. It was not a good moment. And let me add one other thing that is really important to understand and still, we didn't have good answers about it, but I am sure to this day it affects how kids consume medication. So generic drugs when they're made do not have to be 100% match to the on label. I believe at the time I asked it was like a 78% match, which is ridiculous. And the coatings on medication that's generic are different than the coatings on medication that is non generic. So that affects how your kid absorbs those things. It is just a whole complicated, we have to be so thoughtful about all these things and don't be afraid to ask questions.
Serena: Right. Yeah, I think that's the key that we want you to go away with today is, yeah, I don't be afraid to ask those questions and to say, hang on, right? Let's look at this more. Let's talk about it more. Let me have some time to research this. So a few other things that we've learned along the way through trial and error is that there's a lot of trial and error.
Tina: That is so true. And there are so many different medications out there. Unfortunately, there is often no way to tell what is best without first trying it. So I'd say be a good observer, keep a journal, keep notes somewhere, whether it's in your phone, on a piece of paper, in your car, whatever it is, keep notes, reflect a little bit on how this stuff is affecting your child. I mean, that's true for therapy as well. It's good to reflect on therapy, whether you need to seek someone new, whether this, you know, CBT is not working for you or
Serena: that's cognitive behavioral therapy.
Tina: Oh, thank you. Thank you. Yes. Or whatever that is. So remember that you have power to get the right care. And again, if, you know, let's just take RSV because that's a huge thing right now, Serena in our country. It's really striking the very young and the very, very old and not surprising after COVID. We haven't been exposed to a lot, but here's the thing. If your child was not breathing well, not getting well after being treated by a doctor, you'd go back. You don't want your child not breathing well. And it's the same thing for these kinds of medications just because it's not a stop you and your tracks have a heart attack thing. This is important. Their well-being is super important. So go back, ask for what you need.
Serena: That's right. Yeah. Go back until the problems resolved. Yeah. So something else I want to mention here is, so we've been talking about, you know, some paying attention to the side effects of, you know, psychiatric medicine and our kids. Something we've discovered as parents and noticed is the idea that sometimes regular medications, and when I use the word regular, I mean, you know, let's say medication for asthma or medication, for an ear infection, something like that, those medications can also cause psychiatric side effects in our kids, particularly in our kids who are more susceptible, who already struggle. And it's not always something that the medical community knows or understands or, frankly, believes. So I'm just going to say that my youngest was being treated for asthma, and we saw this uptick in OCD symptoms that was just shocking out of nowhere. And, you know, so the allergist kind of said, no, no, no, no, that couldn't happen. And I thought, well, they did. I saw it happen.
Tina: So yeah, it's amazing. And that just speaks to the power of observation, the power of our knowing, our person, right, making sure that we are able to communicate, because it's hard for them sometimes. I mean, I know when you were going through that, it was hard for her to communicate all that to you. And you saw it, and it was real to you. So use your voice.
Serena: Yeah, yeah, absolutely. So there have been some advances recently in genetic testing, which I love this. See, I do that you can potentially determine which medications might work best for you. But, you know, these tests are still not widely available and are often expensive and not covered by insurance.
Tina: But don't be afraid to ask, because here's how they get covered by insurance, because people say, wow, look, this worked for me. And we need to, we need to have it more available for every person, not just the people who can afford it, right? So, so medication is not a one size fits all nor is it a magic feather? It can really be helpful. Certainly, not a happy pill. We don't need to expect that this is going to happen yesterday, give it some time. And remember, it's just one of the tools in your toolbox, gold standard therapy and medication. And yet, we know there are a lot of other tools that we can help our kids put in their toolboxes, right?
Serena: Right. Absolutely. I think, you know, we kind of wish right that there was one pill that was going to solve it all. And that's not the case. And I think it's a misconception too the idea that, you know, you take these pills and it's going to make you happy. That's not really a thing. I like to think of it as shifting your baseline. If we think about depression as an example, when you find the right medication, you will still experience the highs and lows of emotions. And if you're not, it's not good, right? You should, you know, reconsider what medication you're using. But your baseline should shift. It should become higher so that the lows become manageable. Does that make sense?
Tina: That makes total sense, which brings us back to the topic of medication and therapy. Any child who's being prescribed psychiatric meds should also be seeing a therapist regularly. It really is the best way to make progress. And the safest way to monitor your child's mental health.
Serena: So Tina, have you seen those commercials? They're for psychiatric meds. And you can just order them online.
Tina: I have seen it. And that all, for me, just comes back to the whole, you know, nothing is a quick fix. You have to be an informed consumer, read, review, don't ever buy anything online like that. First of all, and secondly, you have to be an informed consumer. You have to, you know, there is, googling can be dangerous. And I think reading reviews of what others say, it's valuable if you can put that in its, its compartments.
Serena: So yeah, we'll just think about it this way, right? It's hard enough to find a shirt online that fits right. Let alone a psychiatric med.
Tina: That is true.
Serena: Yeah, so clearly the commercials are, you know, for adults, right? We were talking about kids that they're for adults. But it still, it feels really irresponsible that you can just order those meds online without even talking to your doctor.
Tina: Yes, which brings us to the topic of who can prescribe psychiatric meds to our kids. If your child is connected with a therapist, that is a great place to start. If you're considering medication, they can really help you think about that path forward. And, you know, maybe direct you to a prescriber.
Serena: Right, because most therapists don't prescribe meds directly unless they are a doctor, which is possible. But many therapists are not. We personally in my family have experiences with child psychiatrist, seeing a psychiatric nurse practitioner. And sometimes pediatricians also prescribe medications. What about your experience, Tina?
Tina: Yes, same. And I will add that there's very knowledgeable pediatricians out there. And most of the great ones I know in practices, they consult with others with therapists with psychologists and really do that collaboration where they are not the all knowing. Or maybe and they have formal programs in place to kind of streamline mental health support within their office.
Serena: Which is amazing. I have a vision of all doctors doing this someday. I think it would be incredible. And, you know, as we've mentioned before in the podcast, we have a current challenge in the US, the shortage of therapists. And there's an even greater shortage of child psychiatrists. And there are many, many areas in our country where there's literally no one filling that role. No one you can go see. However, there is a great resource we want to share with you that's available to pediatricians across the country in New York. We call it project teach. But it goes by different names in different places.
Tina: Yeah, and it's essentially a program where pediatricians have access to child psychiatrists to consult for regular patients. This was, it was designed to help fill the gap in psychiatric services. And it is a great way to integrate behavioral and physical health care. Parents cannot directly access this resource, but we will put a link to the website in our notes so that you can find the resource in your state. And then be an informed consumer and ask your doctor about it.
Serena: Right, just ask. So something else that's important. And, you know, alluded to this before is having a strong partnership and regular communication with your child's therapist and doctor.
Tina: It's great point. So navigating all of this as we well know can be incredibly challenging. A full-time job, I would argue. And keep in mind that everyone's working together for that same outcome. We all want the child in question to be well. I would add, find your champions, find those people who support you, who you trust, find them and put them on your side.
Serena: Right. Yeah, exactly. So another resource I want to make sure we mention in this episode is the American Academy of Child and Adolescent Psychiatry. They have a really great website with lots of different resources, which you can check out. Specifically, I wanted to point out they have a child and adolescent psychiatrist finder. And they also have a parents' medication guide, different guides. So they have guides for depression, ADHD, anxiety disorders, autism spectrum disorder, and sleep disorders.
Tina: Yeah, that would have been helpful to me. But we didn't have that way back when. So these guides provide information about each diagnosis along with different types of treatment as well as the commonly used medications, you know, complete with side effects, dosages, and all the things to look out for. Another resource that I found helpful, so the National Alliance for Mental Illness, NAMI, NAMI has a website that is helpful and local chapters in many, many, many areas in our country. And they can be also really useful in helping you think about this. And the beauty of it is these are people who lived experience who are sharing knowledgeable things. They have lots of books. It's an excellent resource.
Serena: It is. Yeah, it's a great resource. Thanks for mentioning that. We want to mention that the topic for today's episode has come up pretty organically. We have had some guests this season who have mentioned medication. And well, they've had some strong opinions about it.
Tina: Like my strong opinions. We all have opinions. And it's good that we all have opinions. And we intend for this episode to spark a continued conversation. Now, let me just say that again. Our intention is that this episode will spark a continued conversation. And we want it to include family voice. So it doesn't matter who you are listening. You might be a professional listening. You might be a grandmother listening or grandfather or an uncle or an aunt. We want to spark conversation. It's our specialty family voice. So let's continue the conversation. Call us and leave us a voicemail with your thoughts and experiences. When we work together, when we share our voices and listen and seek out those trusted professionals, our children can truly be well.
Serena: Well said, Tina. And so podcast friends, we are, as always, grateful for all of you listening and supporting us. You can help us out by visiting Apple Podcast. Leave us a review. Subscribe and please share with others. You will find more content on our website, no need to explain podcast.com. And you can connect with us on Twitter, Facebook, and Instagram.
Tina: And this is your gentle reminder to take good care of yourself while you're also taking care of your people.
Serena: Thanks so much for listening.