Medication!!Medications in themselves are neither good nor bad. They simply work or they don’t and they do or don’t have side effects. The medications in current use are strong. They should produce some effect, better or worse, relevant or useless. The decision to medicate and which medication to choose is based on the best evaluation of the patient. An able psychiatrist uses not only his own observations and skills but makes best use of information from others: therapists, the school, family.! !

Although the medications are discovered and tested scientifically, there is little certainty or science in the psychiatrist’s choice of medication. If the observations are good and the psychiatrist is blessed with good judgment, the medication may well work. The next appointment should happen soon.!!If the results are negative or seem non-existent, that outcome is indicative. It means something and the psychiatrist should get on it soon. It may be a simple matter of dosage change or a more thoroughgoing problem of

misdiagnosis or misperception of need. It’s a time for reassessing — in GPS language, for “recalculating”.!!It’s important to know what effect this medication did have. If the child reports that “nothing happened” i.e. not even a side-effect, this is odd and suggests that the dosage was low or that the child is a poor reporter. Another possibility is that the child’s or parent’s expectations were misguided. If the parent, for example expects that a stimulant will reduce “bad” behavior, she may be disappointed even though the teacher may report an improvement in academic performance. A depressed man on an antidepressant reported a non-response even though he was markedly less depressed at work; his wife seemed no more interested in him than before !and this was his criterion.!!Sometimes the response may be positive but insufficient. There may be more than one problem. The second problem may be part of the first and the indication may be for a medication change. Or the second problem may be separate and an indication for an additional medication. Adding medication is a poor idea if it’s offered as a substitute for better assessment or better psychotherapy or for better choice of the first medication. If the best indication is for the second medication, it should be, once again, effective and well-monitored.!!Side effects are easy to deal with when they are more visible. Weight change or sleeplessness are not mysterious — these are easily reported and easily addressed (less of a worry).