Pescribing psychiatric medications to toddlers, children and teens is a booming industry in the US. Even toddlers age three or younger have received thousands of prescriptions for drugs like ritalin in recent years. The numbers of children ages five to eighteen given drugs for anxiety, depression, ADHD or other behavior problems have spiked in leaps and bounds. That should give any parent or pediatrician a shudder. Especially when it’s possible that these drugs activate and exacerbate suicidal ideation in children or teens, as was true for a patient of mine whose parents had had enough after their child went on SSRIs, swiftly activated to suicidal ideation, was hospitalized, then began a year long quest rotating several medications, only to make weak progress with side effects. SSRI drugs (selective serotonin reuptake inhibitors) – Prozac and Paxil in particular – are associated with a 50% jump in likelihood of convictions for violent behavior (including arson, assault, robbery or homicide) in children as young as fifteen years old, compared to kids not using these drugs, and compared to adults using these drugs. Got that? It’s sobering: SSRIs make kids act out violently, but not adults over age twenty five.
Our children need safe, healthy options. And our psychiatrists and pediatricians are not trained in how to use them.
Even when drugs like these have a benefit, there is room for enhanced outcomes with targeted nutrition support. When these drugs fail, it’s quite possible these children could fare better with functional nutrition assessment and care. I have witnessed this hundreds of times in my practice, in young children and in teens, in kids with severe, crippling anxiety, and in suicidial teens who have failed in-patient therapy and polypharmacy. It’s not that these tools are pie in the sky or unscientific – on the contrary, they are grounded in clinical practice, peer review, and pedigreed nutrition science. The problem is that physicians are not trained to use functional nutrition – least of all psychiatrists. They know about prescription drugs; they don’t know what functional nutrition intervention and support is. Routinely, parents working with me report that they have been told by their psychiatric doctors that nutrition does not relate to mental health at all. Or, they have been offered haphazard, ineffective nutrition advice from providers who have no degree training in it and no knowledge of pediatric nutrition.
When we remember that the only reason our bodies and brains exist in the first place is because of food we eat, digest, and rearrange into the structure and function that is ourselves – it’s not only a miraculous thing in itself, but it’s ridiculous to believe that these things could possibly be dis-connected.
Our bodies are constantly renewing, rebuilding, repairing, detoxifying – and, if you’re under twenty or twenty five years old, growing.
Of course mental health, mood, and behavior are intricately and deeply linked to our own nutritional biochemistry, and hence, what we eat!
And, what we digest – which brings the microbes that reside in our intestines into this story too. Gut microbes are part and parcel of our digestion. Our microbial partners excrete cooperative molecules or subversive toxins, depending on “who” they are. Guess where many of these helpful molecules (like B vitamins from Lactobacillus species) or toxins (like organic acids from Clostridia) can land? Yup, in the brain.
Functional nutrition support means that your child feels well, most the time; that they feel happy, and engage and enjoy peers, school work, and activities to their potential, most the time. If your child is struggling deeply with anxiety or depression, assess and correct the nutrition components of this puzzle. Do this with an experienced clinician. This is something I do day in and day out in my practice. Nutrition factors are easy to identify and often easily corrected. Medication or therapy strategies go more smoothly when nutrition factors are supported; you may even find these are no longer needed, as I have also witnessed in my practice.
You may be quite surprised by the degree to which your child’s brain or body is struggling, unbeknownst to you or your psychiatrist, neurologist, or pediatrician. Until the proper lab tests are done, you may never know, and your child may simply continue to struggle, even with medication.
Factors impeding normal neurotransmitter chemistry include…
- Weak iron status. Iron is needed to make and break down serotonin. Marginal iron status will impair this chemistry before a child is actually anemic. This can be assessed by running a routine lab test called a CBC (complete blood count) with ferritin, serum iron, transferrin, and iron binding capacity.
- Disrupted gut microbe profile. Functional stool tests can capture profiles of helpful bacteria, fungal (yeast) microbes, microscopic parasites, or disruptive bacteria. Many of these microbes are linked to psychiatric features, including anxiety, hyperactivity, impulsivity, inattention, brain fog, and depression. The solution is to balance the gut biome environment. This may mean changing diet, using certain probiotics, or using antimicrobial or anti fungal herbs or medications.
- Picky eater diets. It’s so incredibly common for kids to eat white diets – dairy, milk, yogurt, cheese, bread, pasta, pizza, cereal, pancakes, sugar in juice, cereal, or processed food. These diets don’t fuel a brain well. They lack vitamin and mineral cofactors as well as a good array of the essential amino acids (protein components) that the brain uses to make neurotransmitters. If these kids are constipated, that’s even worse – because that means their intestines are not doing an adequate job of breaking down what protein they do eat, leaving their brains even more bereft. Giving them Miralax may help them poop, but it won’t help their brains get the nourishment needed. And yes, I do work with picky eaters. There are strategies to break these patterns that have nothing to do with behavior or feeding therapy, and everything to do with nutrition restoration to trigger a normal appetite naturally.
- Undiagnosed food reactions. Undiagnosed sensitivity to gluten is a well documented trigger for anxiety, ataxia, and even seizures. Get your child properly screened. Other food reactions may be involved as well. If you have had celiac screening that was negative, make sure your team checked for anti-gliadin IgA and IgG, which is often left out of celiac screening. A value above five or six is enough to exacerbate psychiatric features, in my observation clinically; but, some lab ranges report a value for this lab test as “normal” if it’s under twenty. I disagree. If a child is symptomatic, the only way to know true impact of a gluten free diet is to try a gluten free diet, and to make sure that all nutrition factors are well supported during that trial. Test multiple foods to identify other sensitivity reactions; if these are active when only gluten is avoided, a gluten free diet trial can fail.
- Undiagnosed B vitamin deficiencies. I often review blood count lab results and find that no action has been taken by the care team who ordered the blood work, even though a panel shows changes in red blood cell status. I’m not sure why that is, other than to guess that again physicians perhaps don’t have adequate nutrition training to pick up on this, but this is another no brainer. Literally. Your kid’s brain won’t work as well without red blood cells doing what they’re built to do, which is carry oxygen to the brain. Scrutinizing this routine test can direct choices for supplementing B group vitamins, including whether or not your child needs methylated versions of those nutrients. This will also tell if your child needs more iron.
- Undiagnosed imbalances in thyroid, reproductive, or adrenal hormones can wreak havoc on mood, anxiety, sleep, and reactions to stress. Work with a functional medicine expert who understands optimal and age appropriate reference ranges for these hormones, how to accurately assess them, and how to discern whether your child needs prescription or non-drug hormonal support. A single blood draw for morning cortisol or thyroid stimulating hormone (TSH) is not descriptive enough to tell if these are imbalanced. Twenty-four hour urine or saliva tests are available to chart patterns of these throughout the day and night, and detailed panels on thyroid function are widely available too. Many drug-free, herbal and nutritional options exist to modulate cortisol, thyroid function, and reproductive hormones. A number of children in my practice have benefitted from the simple addition of a cortisol lowering herb called Holy Basil, which reduced anxiety and OCD in these cases and permitted these kids to fall asleep easily at bedtime.
- Dietary exoprhins or opiates. Yes, I did say opiates. Exorphins are opiate-like compounds that can form with weak digestion – causing some food proteins to be absorbed in small, opiate-like peptide chains called exorphins. Prime offenders are gluten, dairy, and soy protein foods. This is the reason why so many children have fiercely picky, “white” diets – they are literally addicted to these foods. There are many strategies to break this addiction with nutrition support and gut cleanse tools. Dietary exorphins from casein (milk) or gluten (wheat) are bioactive compounds that affect behavior, learning, anxiety, impulsivity, memory, socialization, and pain perception. The impact of these dietary opiates is so powerful, it has been implicated as a trigger for psychiatric features seen in autism and schizophrenia. Strict avoidance of gluten, casein, and soy while replenishing with other proteins and minerals can make for astounding turn arounds in these children and teens.
These are just the basics. Any child with anxiety or depression deserves screening for all of these factors, which have potential to greatly improve quality of life, drug free. Beyond this, there are dozens of supplements children can safely use instead of drugs to enhance chemistry for more calm, more joy, more ease. These are most effective after these basic nutrition factors are secured in good stead, and under the care of an experienced clinician.
The body is always endeavoring to balance, heal, renew; on top of this, children are growing, a demanding physiological task that will be prioritized in the body’s hierarchy. Instead of making this an “either – or” question – as in, drugs or no drugs – ask your care team to give your child’s body and brain a chance to balance. Get some screening done to look for the gaps in the puzzle that is your child’s well being, and if your care team doesn’t have the expertise to do that, contact me for an appointment and I will do it. It may not be solved by drugs alone.