Does My Teen Need Treatment? Part II

Getting your teenager back to school after break is always tricky, but when your teen is suffering from a significant amount of anxiety or depression, it can be especially difficult. It’s time to take a good hard look at the types of treatment available, and whether or not your teen's problem needs medical attention. This week will be a continuation of our series on getting your kids through a divorce with part two of “Does My Teen Need Treatment?”. With the right tools, the start of a new semester can be managed.

Our daughter Sara has always suffered depression. She has her ups and downs, but because of her weekly therapy sessions, she has been able fight off the depression and live life as a completely normal 15 year old – that is until my husband and I filed for a divorce. Ever since we sat down and had the talk with her she has not been the same. She is always sad and often cries, her A’s have turned into C’s and she has withdrawn herself from family and friends.

Do you think your child, like Sara, may need to be medicated as result of new or old problems exacerbated by your divorce? Before rushing to get a prescription, know that there's a lot a parent can do to help the situation. And sometimes, no treatment at all is appropriate - after all, most adolescents can be moody sometimes. To better assess how your son or daughter is doing, start by asking these five pertinent questions:

• Does your child's problem precede the divorce?

• Does your child show evidence of extreme moodiness, extreme anxiety and the like?

• How bad has your child’s condition gotten?

• Is your child self-medicating with alcohol or drugs?

• Are you and your ex hurting your children by forcing them to take sides?

These questions will give you a good handle on what to tell your pediatrician when you go for a consultation. The pediatrician's job is to take a good history from you, and triage your teen to the right professional; or when warrented, reassure you that things look better than you may think.

It is important to triage before coming up with a treatment plan. For instance, if your teen is self-medicating with drugs or alcohol, it's difficult to consider other treatment options before this is dealt with. A drug and alcohol counselor may help you a lot. If you have an adolescent that is showing evidence of a significant psychiatric problem, like Bipolar Disorder or a serious depression, your pediatrician will probably send you to a child and adolescent psychiatrist who can provide therapy, but medicate right away if necessary.

If, on the other hand, the tension of the divorce is the major problem, your teen may not really benefit from medication, but rather should be seen by an excellent family therapist such as a psychologist or a social worker, who can do an assessment and give you an outline of what needs to be done.

Because they are caught in the midst of a divorce, your teenager may be struggling with pressures from your or your ex. If you are fighting with her father in front of her, you may be part of the problem. If you are sad and telling him that you've been miserable since mom left, you are placing an unnessasary burden on him. Adolescents are still children and need to be protected from the emotional drama of your divorce. Consider counseling for yourself or with your ex if things have gotten out of hand and your teen is suffering. While treatment may still be needed for your child, allieviating a major stress will surely help.

When the situation is really difficult, sometimes a team of treatment professionals is required. The great thing about pediatricians is that they have seen everything before, know your child and know the good resources in the community. They are invaluable.

Once a proper diagnosis is arrived at, whether it is depression, bipolar disorder, a mild mood issue, an eating or anger problem or one of the many types of anxiety (OCD, Panic Disorder, Generalized Anxiety Disorder etc.), a treatment plan will be proposed. In divorce, good treatment often consists of a combination of supportive psychotherapy, cognitive behavior therapy (CBT), family therapy or prescribed medications.

A good therapist will know how to engage the situation properly. Sometimes, a talented therapist can help parents minimize the stress on their teen by working on their divorce – as adults - behind closed doors. Teenagers must feel understood by their helping professional. In my opinion, establishing trust is the core of a successful treatment and finding the right fit for your child can make a big difference.

In supportive psychotherapy, the therapist looks at how a child is doing and offers him ways to improve. This may be just what the doctor ordered, because a teen going through divorce can feel isolated. She doesn't have to be alone tand miserable because there is no one to turn to. And living with constant anxiety can be draining. A good relationship with a therapist is a lifelong gift, even when the patient no longer needs our help. When I treat a child or a teenager, I think ten or twenty years ahead. They should see psychological care as a good resource down the road, if the need ever arises again.

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Psychotherapeutic treatment is not only focused on alleviating and coping with a youngster's unhappiness or instability, but also about dealing with the problems that trigger their mood swings, anxiety, anger or eating problems in the first place. Common triggers include a rejection, a breakup, a move, the death of a grandparent or a pet, and of course, a divorce.

Therapy alone sometimes does the job, but at times, the psychological problem is so severe or longstanding that medications may have to be considered.

It's understandable that parents often put off the decision of medicating their teenager. Who after all, wants to voluntarily put a foreign substance into your child's growing body? Doesn't she or he have enough problems already? Yet, medication can be very effective--sometimes the most effective of all treatments. And when it is effective, it's a godsend.

Yes, your doctor must monitor regularly for side effects, but when considering your options, realize that not treating a problem effectively has its risks as well. If you reach this point, become knowledgeable about medications and work as a team with your child's doctor. The goal is to be effective. Often times, medicine lightens the psychological load sufficiently, so the patient has the strength to deal with what started bothering him or her in the first place. In an effective treatment, a number of approaches often dovetail successfully together.

Remember, time spent being unhappy is time lost from the preciousness of one's life.

Common medications used for depression are Prozac, Zoloft, Celexa, Pristiq and Cymbalta. Often, these anti-depressants can be useful for anxiety as well. If your teenager’s moods are truly unstable, or presenting as a frank bipolar disorder, a mood stabilizer can help. These include Lamictal, Depakote and Lithium, among others. Anti-psychotic medicines in low doses, like Abilify, Geodon or Risperdal are useful adjuncts to treatment of more agitated versions of anxiety and mood disturbances. None of these medicines are simple to use and need to be monitored carefully. That being said, a good doctor can often minimize the risks involved or avoid side effects all together.

For those patients who are struggling with attention issues that may have worsened as result of the divorce, psychostimulants, such as Adderall, Concerta or Vyvanse are useful if closely monitored. It is critical to make sure that the doctor working with your son or daughter has a handle on any chemical dependency issues, because the cross reactivity of drugs and alcohol with these medications is dangerous. Substance abuse needs to be treated before serious psychiatric medications are prescribed.

Psychiatric disorders are real. Like anything else in life, they are best handled in a straightforward way. During the tumult of a divorce, your teen may be upset, but that upset can sometimes be a sign of deeper suffering.

Keep your eyes open. Simple anger, disappointment, or some nervousness may be nothing more than simple anger, disappointment and nervousness. But if you think your child has a real problem, ask the five questions and get a consultation.

“Sara’s depression only worsened, so her psychiatrist prescribed anti-depressants for her. As her parents we were very apprehensive about giving her mood-altering drugs, and she was scared too. We had a long discussion and gave it a try, and it worked! After a couple months Sara was back to normal and was no longer suffering the psychological consequences our divorce had on her.”

Sara's parents did it correctly. They got Sara engaged in therapy, but also accepted when therapy alone was not sufficient. The lesson here is to know your child and get her the right help. And, if your child is suffering from a psychological problem, whether it's depression, ADHD or bipolar disorder, just know that sometimes it is necessary to medicate, and it can be for the best.

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