Book Review: Your Child in the Balance by Dr. Kevin T. Kalikow

I'm pretty tired tonight. I've been trying to keep up on the housework this week. Yeah. I'll be giving that up pretty quick.

So.

I have a book recommendation for you: Your Child in the Balance--an Insider's Guide for Parents to the Psychiatric Medicine Dilemma by Kevin T. Kalikow, MD. This was a great read for anyone on psychiatric medicine, anyone who is considering psychiatric medicine, and especially anyone considering medicine for their child.

Written by a prominent child psychiatrist, Your Child in the Balance comes at the issues from all sides. Dr. Kalikow approaches psychiatry from social, historical, economical and, of course, medical perspectives. He fills the book with anecdotes and examples that illustrate the many, many questions surrounding psychiatry and children. He avoids mincing words and doesn't give simple answers. What he does give is information. Lots of information. And even though that information is focused on children and psychiatric medicine it is easily applied to adults.

It was a frustrating book to read because it was frightening to realize how little we know about "psychopharmacology". Psychiatry is a relatively new specialization. Psychiatric drugs are even newer--Prozac was invented only 20 years ago. We know so little about the long-term effects. But it was also a great book to read because it was full of information. Considering how young the whole shebang is it seems that society as a whole and most doctors are being careful and learning from the research. There IS a fair amount that we know. The most important thing we know? Ask questions and work with your doctor.

Near the end of the book Dr. Kalikow gives what he calls
The Ten Commandments of Medicine:

1. Have your child (or yourself) appropriately evaluated by a trusted professional.

2. Before jumping to medicine as the answer, ask whether changing your child's (or your own) environment would be helpful. Understand whether psychotherapy would be helpful and how.

3. Never use medicine based simply on your neighbor's response to that medicine. Everyone is different. However, if closely related biological family members have responded to a specific medicine, inform your physician. Sharing similar genes might indicate a greater chance of success or side effects.

4. A diagnosis is not an excuse. Your child (or you) should understand that he or she is still responsible for his or her behavior.

5. Know what you're treating. Know whether you're treating a disorder or a symptom and if the medicine is FDA-approved to treat the disorder or if it's being used off-label.

6. Give the medicine time to work. Don't bail out early . . .Many side effects are mild, not severe or dangerous, and will disappear in time. Also, beware of polypharmacy (the use of many medicines or "cocktails").

7. Medicine must be monitored. Don't avoid your doctor. Make follow-up appointments.

8. Avoid the medicine rut, the use of medicine year after year without re-examining your decision.

9. Parents (or spouses) should be unified in the decision to take medicine. [To my mind, this is an ideal that may or may not be possible but it is certainly a good things to work for.]

10. Know when to quit your search for the medicine solution. Medicine is not the solution for every problem.