By Dr. Patrick Neustatter
Heading back to school brings excitement and anticipation. It often takes until Thanksgiving break for some students to realize they are "in the groove" and feeling comfortable. Other students, however, will continue to feel stress from school and home equating to full blown anxiety disorders.
We left off in October talking about school counselor limitations and the need for deeper issues to be handled by psychotherapists. (See part 1 here.)
A psychotherapist is usually a psychologist or a licensed clinical social worker. You can refer to the resource lists on www.fredericksburgparent.net or www.DocsInTheBurg.com for list of counselors and an explanation of their different qualifications.
A child psychiatrist is a medical doctor who specializes in mental illnesses, as opposed to a psychologist who is a doctor of psychology but not medicine, and cannot prescribe medicines; a confusing point to many.
In this day and age it is the counselor/psychologist that will provide the talk therapy and instruction in things like behavioral modification: usually appointment time is 50 minutes. A psychiatrist may be needed to make the diagnosis and, as noted, is needed to prescribe any necessary medications but often does very little psychotherapy.
If your child needs admitting to a hospital he/she will be followed by a psychiatrist and, very likely, other types of therapists, as well. Snowden is the local in-patient psychiatric facility with a children's unit here in Fredericksburg.
Medications for Troubled Kids – and the Suicide Irony
There is something of a prejudice against medicine for "psychological" illness, especially where children are concerned. The most effective "anxiolytics" (i.e. anxiety treating medicines) are benzodiazepines including medicines like: Ativan, Valium, Xanax, Klonapin, which can cause dependency, memory loss, or sedation. Dr. Scott Young, MD and child psychiatrist with the Rappahannock Area Community Services Board in Fredericksburg is in line with most other child psychiatrists when he states, "I do not like seeing placed on these medicines, however, antidepressants, such as Zoloft, Prozac and Paxil can be very helpful in treating anxiety." Dr. Young notes, "These medications got a pretty bad rap, primarily from the media in 2003, for apparently causing an increase in suicide."
"I get on my soap box about this," states Dr. Young. "The media may have done a real disservice on this issue. The antidepressants are very effective and suicide rates were actually dropping with their use. Vigilant FDA warnings of suicidal ideation (thoughts but not actions) were 'blown out of proportion'," states Dr. Young.
The consequence? Doctors and parents/patients precipitously stopped using antidepressants which then led to 'relapse depression' and anxiety. This, consequently, resulted in an increase in suicides as the depression or anxiety worsened after being left untreated. "No actual suicides were reported before the warning," notes Dr Young, "but the tragic irony is that the warning itself killed hundreds of people."
Medicines can be a bone of contention among parents who are typically not happy about medicating their child. Sometimes one parent supports the doctor's suggestions while the other is opposed causing greater anxiety in an already troubled home. Perversely though Young says he is happy when parents are skeptical about medication as he reckons they will be super aware of any adverse effects.
Anxiety is a fairly common problem among kids, affecting one in eight children, according to the Anxiety Disorder Association of America, a non-profit organization that provides support for patients and health professionals. My experience is that people often have a poor understanding of childhood anxiety and even less of an idea of what to do about the issue. This concern can lead to parent anxiety regarding their own child's anxiety...a vicious circle.
This series on Childhood Anxiety will continue in December's issue.
Patrick Neustatter is retired from Pratt Family Physicians. He now manages the Moss Free Clinic in Fredericksburg and serves as our On Call columnist.