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Teenagers, Divorce and When (and When Not) to Medicate: Part Two

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"She is so much less moody since we found the right prescription."

-Mother, 17 year old daughter

Medications can truly helpful for adults and teens with problems such as anxiety, moodiness, eating disorders, anger or attention issues. Millions of scripts are written every year and many people benefit. So, do we just run to medicate an adolescent when he or she starts to show symptoms during a divorce? Aside from potential side effects, medicating reflexively may cause you to miss what's really going on. Here, we try to help you get it right.

Are you worried about your son or daughter? If so, in part one of this series, we recommended that you ask four pertinent questions.

• Does your child's problem precede the divorce?
• Does your child show evidence of extreme moodiness, extreme anxiety and the like?
• Is your child self-medicating with alcohol or drugs?
• Are we--as parents--hurting our children because of our own problems or by the way we pull them into the middle of our conflict?

These questions will give you a good handle on what to tell your pediatrician when you go for a consultation. In my book, "The Intelligent Divorce: Taking Care of Your Children" (2010), we provide a charting system that can make this consultation easier. The pediatrician's job is to take a good history from you, and triage your teen to the right professional, given the situation, or reassure you that things look better than you may think.

Triage is always targeted to the problem. For instance, if your teen is self-medicating and may be chemically dependent, it is difficult to consider other treatment options before this is dealt with. A drug and alcohol counselor may help you a lot. If you are struggling with 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. 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) or prescribed medications. Often, a talented therapist can help parents minimize the stress on their teen by working on their divorce behind closed doors. This is what my Intelligent Divorce project is all about.

Therapy of all types, have one thing in common: the therapeutic alliance. 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. The therapeutic alliance teaches him that he can really trust somebody. This may be just what the doctor ordered, because a teen going through divorce can feel isolated. She doesn't have to be alone to cut herself 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.

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.

I understand 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. Time spent being unhappy is time lost from the preciousness of one's life.

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 four questions and get a consultation.

Take good care of your son or daughter. It's a job that you can get right.