Knowing When to End Medication
As you've seen, changing, adding, or stopping a medicine during the course of therapy can provide particular challenges (see Chapter 11). Research shows that many people are able to maintain control over their anxiety effectively after stopping medication, typically if they have received therapy to learn ways to combat their symptoms. Specific data on exactly how this applies to children with anxiety is less conclusive, due to the fact that children's development is dynamic and ongoing, along with the current lack of longitudinal research.
Basic Guidelines
In general, it is common practice for a child to stay on a medication for at least six to twelve months for maximum benefit to occur. However, timeframes vary depending on the class of medication. For example, it is typical to see benefits from antidepressants in around four to six weeks, while an anxiolytic will have more of an immediate effect. In addition, if it takes time to reach the therapeutic dose of the medicine, or if another is added, it may take longer to see optimal effects. Your child's age, the length and severity of her symptoms, and the co-occurrence of other mental health issues, will also determine when it is reasonable to discontinue a medication.
Question?
Are there any times when my child should not go off medication?
Yes, in fact. It may be beneficial for your child to stay on medication through times of transition or particular stress, during anniversaries of loss or trauma, or during the fall and winter months if seasonal affective disorder is a concern. It is unwise to risk further unbalancing your child when times are already difficult.
Though most medical professionals would agree that a child shouldn't take medication she no longer needs, there are just as many reasons to continue until full benefit can occur. Unfortunately, it can sometimes be difficult to determine just when to discontinue a medication, especially if it has been used for an extended period of time.
Your Child's Signals
Ultimately, of course, you might want your child to be nearly symptom free for as long a time as possible before ending medication. However, this may not be practical for several reasons, including cost, health concerns, or even the need for a trial without medication so that your child can test her wings. Though medications have been proven effective in reducing symptoms, it is often difficult to determine whether the medication has itself been effective, or whether your child may have improved as the result of positive events, extra attention, or the simple passage of time. So, what does this mean in practical terms? First, review the questions in the toolbox section above. Then, depending on your answers, approach your child's doctor and consider your options together.
Transitioning Care
It may be important for your child to stay on medication after ending therapy. As long as your child is stable, and you maintain regular contact with whoever is prescribing, you should have nothing to worry about. Once children are stable on a medication, they can often transition to a less specialized level of care, for example, from psychiatrist to general practitioner, or pediatrician to nurse practitioner. Whoever is prescribing your child's medication should offer this option if they feel it would be more beneficial or practical; raise the issue yourself if you feel a change would be helpful.
