November 18, 2020
Adolescent mental health: why we need to balance pharmacology with psychotherapy
As a child psychiatrist, I am often asked for my thoughts on the role of medication management in patient care.
Are doctors too quick to prescribe psychotropic medication to children? Should other forms of treatment, such as psychotherapy, be used instead?
Undoubtedly, these questions are as important as they are complex, and while there isn’t an easy answer, having both a medical degree and advanced training in psychotherapy, I am happy to share my perspective on the topic.
It’s not so black and white
The decision to introduce a psychiatric medication, especially to a child or adolescent, is not an easy one.
Certainly, some cases – for example, chronic psychosis, severe depression, and type 1 bipolar disorder – are more clear-cut. In these instances, most individuals and families can plainly see the rationale for pharmacology, and prescription medication is the recommended track.
Other cases – imagine a twelve-year-old child experiencing mood dysregulation or a high school senior suffering from persistent anxiety – lend themselves to a broader range of treatment options. Should medication also be prescribed in these situations, or can psychotherapy alone provide the needed relief? Well, that depends.
When working with clients, I consider several factors, including medical history, severity and duration of symptoms, prior experience with psychotherapy, family dynamics, and parental feedback. Psychotherapy and medication management both entail a blend of art and science. Moreover, every individual is unique.
Developing a personalized treatment plan, with regular monitoring and fine tuning, is key to a successful outcome. It’s also critical that parents and caretakers are comfortable with the proposed course of action, be it medication, psychotherapy, or a combination of the two.
To parents grappling with treatment options, I remind them there is no perfect answer. Being mindful and informed is what matters most.
Reasonable concerns
The introduction of medication is sometimes met with a bit of hesitation from parents and caretakers. This is to be expected, and I encourage an open dialogue with my clients and their families.
Parents often worry about medication becoming a crutch. I am asked if psychotropics impede a child’s development or make their intrinsic ability to cope less robust. “Will it make my child less resilient? Will it weaken them?”
These questions resonate deeply with me and echo similar questions raised in the course of my training.
Everything comes down to balance. Our goal is to optimize the child’s current and long-term psychological outcomes, and the inclusion of medication might be the best route to achieve this.
Often, the initial aim is stabilization, as clients tend to show up for a first session following a recent decline. Once we regain a state where the child is able to function in their daily routine, we turn to ensuring that he or she is equipped with the necessary tools to navigate their youth and transition into early adulthood years. Herein, psychotherapy can play a crucial role.
The power of psychotherapy
I believe that psychotherapy is vital to achieving optimal results.
There are advantages to psychotherapy that medication cannot offer, including opportunity for self-expression, exploration of unconscious conflicts, and examination of feared or secretive parts of oneself. Other benefits can include healthier self-esteem, enhanced self-awareness, greater resilience, improved emotional flexibility, and an expanded coping toolkit.
Psychotherapy may not always be able to replace the need for medication, but seldom does it not boost the outcome. Oftentimes, it can also reduce the extent to which medication is needed.
If you are working with two providers, a psychiatrist for medication management and a therapist for psychotherapy, make sure they are working toward the same goals. Inconsistencies in treatment approach can lead to confusion and hinder progress.
Concluding thoughts
One of the most important pieces of advice I can offer is not to delay getting help when early symptoms come on. The sooner you start looking into providers and exploring treatment options, the less stressful and rushed the process will be.
Psychological healing and restoration take time, making patience not only a virtue but a necessity for the process. At the end of the day, mental health is a journey, one with many paths and not without obstacles.
Tim Yovankin, MD
Medical Director, Greywood Health Center
www.greywoodhealthcenter.com