Questions about Medications
Parents have many questions about which, if any, medications are right for childhood OCD, how long they should be taken, how medication works with CBT therapy, and what to do about side effects. All of these are important matters to discuss with your child's prescribing doctor, whether that is her pediatrician or a psychiatrist. The following frequently asked questions address many concerns parents have when considering or beginning a course of medication for a child or teenager's OCD. These questions and answers should not replace your discussion with your child's doctor.
How Long Until Medication Works?
With most of the SSRI antidepressant medications, there is anywhere from a two-to four-week waiting period before any positive effects of the medication are felt. In contrast, side effects usually become apparent much sooner, although they often fade in days or weeks. The improvement in your child's mood and a decrease in his OCD symptoms are usually a gradual and subtle process. It can take up to three months for the full benefit of medication to take hold. It's not uncommon for a child to be unaware of changes in his own behavior. You might notice and point out a positive change to him, saying, “Did you notice you only washed twice before dinner tonight?” He may be pleased to hear the feedback. At the very least, he'll be more likely to notice his own changed behavior the next time.
Are SSRIs Addictive?
Antidepressants are not considered addictive since they don't produce a euphoric reaction, as painkillers and sedatives do. Rather, their purpose is to alleviate negative symptoms. However, the process of stopping an antidepressant medication can be unpleasant for a short period of time. Some temporary side effects, including drowsiness, headaches, and a dip in mood, are common.
What Happens When He Stops Taking Medication?
The APA's consensus guidelines for OCD treatment call for a minimum one-to two-year course of antidepressant medication after a patient's OCD symptoms are stabilized. Only then should a gradual tapering off be considered. If there is not a combined CBT and medication approach, it is very common for OCD symptoms to reappear after the child stops taking an SSRI medication for his OCD. If the cessation of medication causes a severe relapse of symptoms, many adults and children suffering from OCD opt for a longer-term or lifetime use of SSRI medication.
What if Medication Doesn't Help?
For reasons not yet understood by psychiatrists, different people respond positively and negatively to different SSRI medications. This reality often necessitates trying more than one antidepressant before you find the right drug for your child. One drug may cause bothersome side effects, prompting your doctor to try another. In some cases the use of more than one medication at a time, up to three or four, will bring the child greater improvement. This process of trial and error can be difficult for your child, and can cause you additional worry. Unfortunately, until research yields more clues shedding light on why a drug works best for a given patient, there is no better way to go about treatment with psychotropic medications.
Alert!
Children and parents can fall into the trap of thinking of medication for OCD as a cure-all, when it is much more likely to be just one tool in a larger tool kit for dealing with your child's OCD. With the best results, medication doesn't eliminate all OCD symptoms, making CBT and exposure response prevention (ERP) techniques an important adjunct for the majority of children and teens with OCD.
Here's how author Amy Wilensky describes the different ways she feels after beginning an SSRI medication in her book Passing for Normal, A Memoir of Compulsion.
For me, once it finally took effect, Prozac was no miracle cure, brought no transcendent revelations, or reversals of thought. The best explanations I can provide of its do-good-ing is that it has effectively turned down my volume, alleviating my tics and especially my rituals to a manageable extent…. Such shifts sound diminutive in scale, I know, but there's no gift quite as gracefully received as additional hours in the day.
Whether or not to use a psychotropic medication is a highly personal and individual decision for a parent on behalf of a younger child with OCD. There are many fears about possible short-and long-term side effects to be carefully considered. This is one of the areas where it is most important to have an open line of communication with your child's prescribing doctor. A doctor should be available by telephone in between visits for consultations about your child's potential need for a dosage change or to discuss any side effects that may arise. Teenagers will more often make their own decision about starting or stopping medication; it should always be made with your parental consent and a doctor's consultation.
