Bonus Episode: Medication for Anxiety and Depression – Finding the Balance

Summary

The Pediatrician Next Door - Bonus Episode: Medication for Anxiety and Depression – Finding the Balance

Release Date: June 13, 2025
Host: Dr. Wendy Hunter, MD
Guest: Dr. Julia Krinkle, Psychiatrist

In this insightful bonus episode of "The Pediatrician Next Door", Dr. Wendy Hunter engages in a candid and informative discussion with psychiatrist Dr. Julia Krinkle about the nuanced role of medication in managing anxiety and depression among children and teenagers. This episode serves as a valuable resource for parents navigating the complexities of their children's mental health care.

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Introduction to Medication in Children's Mental Health

Dr. Wendy Hunter sets the stage by addressing a common parental concern: the hesitation to initiate medication for children struggling with anxiety or depression. She emphasizes that while non-pharmacological interventions like therapy and lifestyle modifications are foundational, there are instances where medication becomes a crucial component of the treatment plan.

"Medication is not about fixing your child. It's about taking away barriers so that the therapy is more effective, so that school feels more manageable, and so they can start to feel a little bit more like themselves."
— Dr. Wendy Hunter [02:45]

Understanding SSRIs and Their Role

Dr. Hunter delves into the specifics of selective serotonin reuptake inhibitors (SSRIs), highlighting medications such as Fluoxetine (Prozac) and Sertraline (Zoloft). She underscores the importance of these medications being "safe and effective in children and teens when they're used appropriately" and notes that early intervention can lead to better long-term outcomes.

"The earlier you intervene, the earlier you use these medications, especially in cases of moderate or severe anxiety or depression, the better the long term outcome is for the child."
— Dr. Wendy Hunter [03:30]

She also cautions that SSRIs are "not a magic bullet", requiring patience as they often take four to six weeks to exhibit effects. Additionally, finding the right dosage may necessitate multiple adjustments, accompanied by regular follow-ups to monitor for side effects such as headaches, upset stomach, or, in rare cases, behavioral activation.

Dr. Julia Krinkle's Perspective: Patient-Centered Approach

Bringing a complementary perspective, Dr. Julia Krinkle shares her patient-centered approach to prescribing medication. Although her primary practice is with adults, her insights are invaluable in the pediatric context. She emphasizes the importance of understanding the patient's goals and preferences before deciding on a treatment path.

"One of the most important questions that I ask of my patients is what are your goals for treatment? We are here to help them meet their goals, not our own."
— Dr. Julia Krinkle [04:45]

Dr. Krinkle discusses scenarios where patients seek immediate relief during crises and aim to use medication as a temporary aid while developing non-medication coping strategies. Conversely, she acknowledges that some individuals find sustained benefits from ongoing medication, enhancing their ability to function effectively.

"For those folks, a lot of times they're like, I never want to go off a medication, right? Like this is allowing me to be the best version of me."
— Dr. Julia Krinkle [05:50]

Finding the Balance: Collaborative Decision-Making

The crux of the episode revolves around achieving a balanced approach to treating anxiety and depression in children. Dr. Hunter advocates for a collaborative strategy involving parents, healthcare providers, and therapists to tailor treatment plans that best suit the child's unique needs.

"You work together. That’s the answer. You work with your child, their doctor, their therapist, everyone on the same team."
— Dr. Wendy Hunter [06:10]

She highlights the importance of regular check-ins and being adaptable, as there is no one-size-fits-all solution in mental health care. The ultimate goal is to ensure that the child feels supported, understood, and never alone in their journey towards mental well-being.

Key Takeaways

• Early Intervention: Utilizing medication like SSRIs can lead to better long-term outcomes in moderate to severe cases of anxiety and depression in children.

• Patient-Centered Care: Decisions about medication should align with the child’s and family's goals and values, ensuring that treatment plans are personalized.

• Collaborative Approach: Effective mental health care involves a team effort, including parents, doctors, and therapists, with ongoing communication and adjustments as needed.

• Managing Expectations: Medication is a tool to remove barriers and support therapy, not a standalone cure. Patience and persistence are essential as treatments take time to show effects.

Conclusion

This episode of "The Pediatrician Next Door" provides a comprehensive overview of the role of medication in addressing anxiety and depression in children. Through the combined expertise of Dr. Wendy Hunter and Dr. Julia Krinkle, parents gain a balanced understanding of when and how medication can be integrated into their child's mental health care, emphasizing collaboration, patience, and individualized treatment plans.

For more insights and to engage with Dr. Hunter, visit pediatriciannextdoorpodcast.com or reach out via email at hellopediatriciannextdoorpodcast.com.

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This episode was produced by Red Rock Music. Subscribe and leave a review on your favorite podcast platform to stay updated with more valuable discussions.

Transcript

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[Dr. Wendy Hunter]

I'm Dr. Wendy Hunter and I'm the pediatrician next door. I'm that doctor friend you call for practical advice about your kid's health. I mix the science of medicine with the reality of parenting. I'm joined once again by psychiatrist Dr. Julia Krinkle for an honest conversation that I know many parents have been waiting for. It's the role of Medication in children's mental health Let me start with what I've seen in clinic When a child is struggling with anxiety or depression, most parents do not want to jump to medication. They want to know what else they can try first, like therapy or coaching. And yes, those things do matter. They really matter. In fact, lifestyle changes and talk therapy are the foundation of mental health care for kids. But sometimes that's not enough. That's when we start talking about medication. And the most commonly prescribed are the SSRIs or selective serotonin reuptake inhibitors. That's medications like Fluoxetine, which is Prozac, and Sertraline, which is Zoloft. These medications have been shown in multiple large studies to be safe and effective in children and teens when they're used appropriately. In fact, the truth is, the earlier you intervene, the earlier you use these medications, especially in cases of moderate or severe anxiety or depression, the better the long term outcome is for the child and most of them don't need the medication later in life. That said, SSRIs are not a magic bullet. They take a long time to work. Often they can take four to six weeks and it's going to take a few tries to find the right dose or even the right medication. Parents should expect that they're going to need to make frequent follow up appointments. Because kids can have some side effects, we like to check on them. Things like headaches, upset stomach, sleep changes, or sometimes very rarely, they can have behavioral activation where they get more restless or irritable. And that's why we start at a very low dose and we increase very slowly. That's standard practice. What's important to remember is that medication is not about fixing your child. It's about taking away barriers so that the therapy is more effective, so, so that school feels more manageable and so they can just start to feel a little bit more like themselves. And as a parent, it's normal for you to wonder, how do I know if my child really needs medication? Are they gonna need it forever? And that's where today's conversation starts with the question, how do we find the balance? The balance between supporting a child's mental health with all the tools that are available and the use of medications, between waiting it out and acting early, between stigma and empowerment. Here's my conversation with Dr. Julia Krankel. Can you speak to the role or your philosophy of medication in treating anxiety and depression? And really just, yeah, your philosophy. When would you start? Why would you start?

[Dr. Julia Krinkle]

Well, that's a good question. You know, so I work with adults, not kids, so I'll kind of come from that perspective and, but I really drive it based on what the patient wants. So one of the most important questions that I ask of my patients is what are your goals for treatment? And I think it's really important right away to ask that because we are, our patients cheerleader, we're there to help them meet their goals, not our own goals. And so when I see someone, I always ask them that and I always ask them, do you want to take medication or would you prefer non medication approaches? So I get that sense from them right away. And I think the biggest reason to start a medication is again, if the symptoms are impairing someone's functioning. So if they're experiencing anxiety or depression and it's impairing their functioning, that's a really good reason to talk with their doctor and to consider medication. I have a lot of patients who say I think I need a medication right now because things are not going well. Like this is a crisis, things are not going well. And I've tried X, Y or Z and I'm not making enough progress. But my end goal is to be off medication. I have a lot of patients who tell me that. And so then I think it's really important to walk with them in using A medication and then helping build up those non medication coping skills along the way so that they can meet their end goal of getting off of medications. Now I have other people who take medication and they find that it allows them to be the best version of themselves. So they say, I feel like the real me when I take a medication for anxiety or depression. And that's so powerful and important, right, for someone to feel like they can be the best version of themselves. And so for those folks, a lot of times they're like, I never want to go off a medication, right? Like this is allowing me to be the best version of me. Like I have no interest whatsoever in going off of medication and that's okay too. So really for me, I think it's that individual conversation, you know, between doctor and patient that's so important to decide and it has to be in line with the patient's values. They have to feel like it's the right thing for them. So I think never pushing medication is really important. We can say this could really be helpful, but ultimately it's their choice to make. So I feel like I, I'm there to offer the solution that the patient is looking for on that individual basis.

[Dr. Wendy Hunter]

So how you find the balance? You work together. That's the answer. You work with your child, their doctor, their therapist, everyone on the same team. You make decisions based on what's best for your child. And that might mean medication, it might mean therapy, it might mean both. And it almost always means checking in often and adjusting as you go and staying open to options. There's no one size fits all solution when it comes to kids mental health. But what matters most is that your child feels like you are supporting them, that they feel understood and that they don't feel alone in what they're going through. Thank you for being here for this conversation. If you found it helpful, please share it with another parent who might be facing these same questions. For more from the pediatrician next door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to hellopediatriciannextdoorpodcast.com for a chance to hear your voice on the show. I'm Dr. Wendy Hunter and I'm the pediatrician next door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review wherever it is you're listening. I'll be back next time with more.