At a time when mental health problems are becoming more prevalent and particularly impacting our minors, as parents, ask yourself whether pharmacological intervention is most convenient for your child. There is no denying that it is one of the most difficult decisions that parents have to make when dealing with this type of illness when they are still in the process of accepting it.
To the prejudices that arise from a social stigma towards mental illness and towards professionals who dedicate themselves to this branch of medicine, there is added the fear of side effects, the fear of polypharmacy or bad previous experiences, which makes it much easier , taking an antibiotic is an infectious process.
Mental disorders are currently considered to be multicausal diseases with biopsychosocial origins. There is a growing body of scientific knowledge that focuses on genetics as a necessary but not sufficient condition for the development of these disorders, since the influence of the environment is necessary for their expression. There are many risk factors that increase the prevalence of these diseases, particularly in childhood and adolescence, the critical moments of brain development and maturation that represent stages of maximum vulnerability.
For a long time, treatment was based exclusively on psychotherapeutic strategies because these problems were almost always linked to an environmental cause and there were not enough studies on the effectiveness and safety of psychotropic drugs in children and adolescents. Great advances in knowledge have been made in recent years and there are many open research directions in this area.
The new medical specialty that has recently been recognized in our country, Child and adolescent psychiatry, today advocates for multimodal treatments, which in most cases include psychosocial interventions as the first line of treatment. However, if the mental health problems are moderate or severe, whether due to the high frequency of the symptoms, their high intensity, their long duration or due to the strong impact on the minor’s daily life, you should consider adding to these interventions the Use of psychotropic drugs after an appropriate benefit-risk assessment.
Today we know that the benefits of treating children and adolescents with psychotropic drugs outweigh the harm of not treating a psychological problem in a timely manner. Most mental illnesses are chronic and cause significant disability in adulthood, so early detection and intervention can significantly alter their course and prognosis.
In the absence of etiological treatments, the drugs used aim to reduce the intensity of symptoms or improve the core symptoms of some disorders, which in many cases leads to better psychosocial functioning of the child or adolescent, although in fact this is not one healing character. In addition, although psychotropic drugs are now safer and their use is more standardized, the therapeutic arsenal we have at our disposal for children and adolescents is still scarce and drugs are often used outside the indications provided for in the technical specifications.
When people think about taking a psychotropic drug, it is not uncommon for parents to initially refuse to take it. The moment they start thinking about this therapeutic possibility, doubts arise such as: Can these drugs be addictive? How long will my son need this medication? Will it change his way of life? Will it enable him to learn? Or will he be able to live a normal life? Both the parents and the minor must, with sufficient maturity, be clear about what they want to improve and whether the chosen drug is specifically approved for their condition or whether it is administered outside the technical specifications based on good clinical practice. Expert consensus or cautious extrapolation from adult-controlled data. Other issues to consider would be the “latency” of the drugs, that is, how long it takes for them to take effect; whether clinical control tests are necessary and what side effects can be expected.
Physicians should always try to achieve the minimum effective therapeutic dose, avoid polypharmacy (if possible) and closely monitor the proper action of the drug.
At a time when both pediatricians and child and adolescent psychiatrists should strive to practice patient- and family-centered medicine, I believe our efforts should be focused on the positive experience of the disease process. Our commitment is to inform from the evidence of the scientific literature and our clinical experience. Although it is true that as our professional practice progresses, we find that our analytical and decision-making efforts, based on so many years of study, diminish, probably due to the small gaps that remain in a paternalistic model of medicine that we accompanied for years. We must accept that time rules and modern medicine teaches us that not everything is in the books and although it is not about doing medicine à la carte, and of course in clinical situations outside of emerging risks, it is an equally important accompaniment respecting both the minor and his family, respecting their moments and involving them together in therapeutic decisions.
