Medication Pros and Cons
Medications are miraculous and life-saving to many children with brain disorders, but the decision to
medicate is a serious one, requiring much thought. Following are some factors for consideration.
This list is not exhaustive. Ask your doctor for further information. It is recommended that you
seek advice from a board-certified child psychiatrist experienced in treating children similar to
your child. An excellent source book is STRAIGHT TALK ABOUT PSYCHIATRIC MEDICATIONS
FOR KIDS by Timothy E. Wilens, MD, The Gilford Press.
PROS
Medication may make it possible for the child
to have normal social, cognitive and emotional
developmental milestones.
Medication may make it possible for the child
to benefit from cognitive or behavioral therapy.
Medication may improve the length and quality
of sleep.
Medication may prevent suicide (depression)
or accidental death/injury (mania/impulsivity).
Medication may reduce the long-term
chronicity and severity of the illness. (Kindling
effect.)
Medication to control anxiety and depression
may prevent deterioration of the organs in the
stress axis (hippocampus, adrenal glands, etc.)
Antidepressants may lower the risk of
cardiovascular disease.
Untreated children/adolescents with SED are
at a 40-fold risk for illegal drug abuse, school
drop out, teen pregnancy, runaway, and other
undesirable outcomes. Medication may reduce
risk.
Medicating a chronically unhappy or disruptive
child also reduces stress for the other
members of the family, especially siblings.
CONS
With a few exceptions, psychoactive medications
have not been proven safe and effective for
children and adolescents. (Rapidly changing, but
studies will take a while.)
Finding the right medications is a trial and error
process taking months – potentially up to a year or
more in some cases. Medications are somewhat
unpredictable and may stop working.
The child must be monitored very closely for
medication compliance and for side-effects,
including mania, suicidality, delusions, and
hallucinations and serious physical problems.
Other medication side effects are unpleasant, but
may go away after several weeks or be tolerable:
headache, stomach ache, dry mouth, constipation,
gas, weight gain/loss, acne.
If there are new symptoms, it is difficult to tell if they
are due to the underlying illness, a medication, or
hormonal change/maturation.
During medication trials, school performance and
attendance may fluctuate wildly. School personnel
need to be prepared for this, and special
accommodations planned.
It is embarrassing for the child/adolescent to have
to take medication, especially if a dose is
administered at school.
Dry mouth, a side effect of some medicines, may
increase dental problems.
If diagnosis of childhood-onset bipolar disorder
(COBP) is missed, antidepressants or stimulants
may trigger a manic episode. Therefore it is crucial
that childhood-onset bipolar disorder be ruled out
before ADHD or major depression are treated.
Classes of Psychiatric Medications
for Children
Psychostimulants - treat ADHD
– Improve learning, behavior in 8 of 10 students
– Remaining 20% helped by psychiatrists using
variety of medications, various combinations.
– Common psychostimulants include, but are
not limited to, Adderall, Ritalin, Dexedrine,
Concerta, Metadate.
– New non-stimulant medication for ADHD,
Strattera.
Anti-depressants - treat OCD, depression,
anxiety disorders, Tourettes, eating disorders.
 Newer antidepressants include, but are not limited
to, SSRI’s - Prozac, Zoloft, Paxil, Celexa, Luvox.
Also, Wellbutrin, Effexor, Serzone.
Anti-psychotic medications - wide range
of uses
– 1st line treatment to reduce hallucinations,
delusions,
– Treat aggression, OCD, refractory bipolar,
Pervasive Developmental Disorders (PDD)
 Commonly used “atypical” meds include Clozaril,
Seroquel, Risperdal, Zyprexa, Geodon
(ziprasidone), Abilify.
Anti-hypertensives:
– Used to treat tic disorders, ADHD, severe PDD
(self-abusive behavior), autism, sleep problems.
– Reduces aggressive behaviors, severe outbursts
 Commonly used: Clonidine, Tenex, Inderol.
Mood stabilizers:
– To treat mood swings of Bipolar Disorder,
Conduct Disorder, ADHD.
– Also for violent aggression and irritability caused
by mood.
 Commonly used: Lithium salts, Tegretol,
Depakote. Newer meds include, but are not
limited to, Neurontin, Topomax, Gabitril,
Lamictal, Trileptal.
Anti-anxiety Medications
– Used for muscle relaxant, anticonvulsant,
sedation.
– Psychiatrically prescribed for anxiety, and for
prominent anxiety symptoms accompanying
autism.
 Includes Benzodiazepines (Ativan, Klonopin,
Valium, Xanex).
Buspar used for anxiety, aggression, 2nd line
treatment for ADHD, affect-driven aggression
with oppositional symptoms.
Polypharmacy – the highly effective practice
of prescribing multiple medications in a
combination tailored to individual’s symptoms
and responses. A small dose of one may
enhance the action of another medication.
Smaller doses of several medications are
preferable with children to avoid toxicity. May
need multiple meds to manage side-effects when
medication change is not feasible.