Hope for Youth Mental Health: Beyond Antidepressants and ADHD Meds

Bret: 
Welcome to the Metabolic Mind Podcast. I’m your host, Dr. Bret Scher. Metabolic Mind is a non-profit initiative of Baszucki Group where we’re providing information about the intersection of metabolic health and mental health and metabolic therapies, such as nutritional ketosis as therapies for mental illness.

Thank you for joining us. Although our podcast is for informational purposes only and we aren’t giving medical advice, we hope you will learn from our content and it will help facilitate discussions with your healthcare providers to see if you could benefit from exploring the connection between metabolic and mental health.

Are you the parent or loved one of a kid who is on or considering ADHD or depression medications? If so, then you may want to know more about the recent Wall Street Journal and New York Times investigative articles that brought up some serious concerns about kids and overuse of psychiatric medications.

Now, don’t get me wrong, this is not to say that meds are all bad. Absolutely not. ADHD and depression medications have helped millions of kids. For many families, the medications can be life-changing, improving focus and reducing disruptive behavior, making school or home life much more manageable. And maybe their success is actually part of the problem, right?

If some see these benefits in others, we may just assume that everyone should see those benefits, but this is clearly not the case. And the recent Wall Street Journal investigation raises an important question: Are we relying on medications too quickly and too often without trying safer first-line options?

The article details first-person family accounts of doctors reaching for medications before giving behavioral therapy a fair try or before even trying at all, really. And remember, behavioral therapy is supposed to be first-line treatment for ADHD, especially in younger kids. And it teaches kids real long-lasting skills, like how to plan, how to self-regulate, communicate, cope. Things that they’re going to need in their future.

But in practice, the parents in the article said they were offered medication immediately, sometimes on the first visit, and some were never even told therapy was even an option. Another striking thing about the Wall Street Journal story, diet and nutrition and food weren’t mentioned anywhere. And even if diet doesn’t cause ADHD, food absolutely affects behavior, energy, sleep, mood, especially in kids.

Highly processed carbohydrates, sugar spikes, nutrient deficiencies, and lack of adequate protein can all influence focus and emotional regulation. And emerging evidence suggests that for some individuals, many individuals, low-carb and ketogenic therapy may provide dramatic benefits. Yet many parents were never told that nutrition can be part of behavioral therapy.

It’s simply not part of the clinical conversation, but it 100% should be. The article also revealed a very concerning trend regarding medications. When medications don’t work as planned, which happens a lot, right? Doesn’t work as much as we hear they should or expect they should, instead of stepping back to reassess, the system tends to just add more medications.

That’s the reflex. This leads to combinations of medications that have never been studied together in kids, which can lead to unpredictable side effects, higher risk for sleep issues, anxiety, appetite suppression, mood changes. And as the New York Times article pointed out, another often undiscussed side effect of antidepressants is the potential for long-term and maybe even irreversible sexual dysfunction.

So this practice of using multiple medications when one doesn’t do the job, it, it has this term polypharmacy, and it’s done all the time in adults, and even then it’s concerning. But in kids, it’s especially troubling as their brains and bodies are still developing and likely much more susceptible to neuropsychiatric and hormonal changes.

The fact that it’s common to do this trial-and-error polypharmacy on kids without at least trying or an exhausting safer options first, like behavioral therapy and nutrition, is very troubling. It’s heartbreaking to read the many stories that the kids being put on medications after medication with escalating side effects, including some serious sexual dysfunction, and it doesn’t have to be that way. But another heartbreaking theme in the article was the pressure parents felt, not just from doctors, but from the schools and the daycare centers.

Parents reported being told, “Your child can’t stay here without medications. We can’t manage your child unless you medicate them. We need to get prescriptions fast so we can maintain your kid in school.” What’s a parent to do in that situation? Imagine the heartbreak and confusion the parents must feel, and this is just unacceptable.

Schools should not be pressuring parents into medical decisions. And as the article suggests, the problem is even worse for families with lower incomes or limited access to providers. Behavioral therapy is harder to find in those circumstances, and prescriptions are still the easy solution. So, that creates a system where the most vulnerable families are pushed towards the path with the least support and highest risk.

Now, don’t get me wrong. ADHD and depression medications have an important role, absolutely. They can help many kids thrive. But the Wall Street Journal article reminds us we need a course correction. Behavioral therapy must truly be first line, not just on paper, but in practice. That means schools, pediatricians, therapists, insurers, all must support it and not dismiss it because medications are quote-unquote, easier.

And nutrition absolutely should be part of the conversation. A child’s brain depends on stable blood sugar and insulin levels, adequate protein, real whole foods, and nutrition. And for many, shifting to whole foods can make a tremendous difference. And even more, low-carb and ketogenic therapy may provide results on par or better than medications some are finding, certainly when added to medical therapy.

And furthermore, doctors need to stay vigilant and aware of this polypharmacy. Adding medication after medication should not be the default response. We need thoughtful evaluation, not automatic escalation. And last, parents need to be supported, not pressured. No school should encourage or demand medication.

Schools need better support for kids and their families as they navigate their treatment options. And of course, focusing on and prioritizing access for low-income families is a must. Behavioral therapy shouldn’t be a luxury. It should be available to everyone. Kids with ADHD symptoms deserve real support, not shortcuts.

Yes, medication can help many children. But when it becomes the first option instead of one tool in a much bigger toolbox, we fail our kids. It’s time to rethink our approach and commit to a model that puts behavior therapy, nutrition, and careful prescribing first with an eye on serious side effects. That being front and center.

Kids don’t just need medication. They need understanding, structure, skills, and a system that protects their developing brains. And there is some emerging research in this field. Here at Metabolic Mind, we’re proud to support Ally Houston and his team as they study ketogenic therapy for ADHD in adults, and Elizabeth Errico at CMHRC as they implement and study ketogenic therapy in a pediatric population as well as the Pediatric Bipolar Network among, one of five different institutions studying ketogenic therapy in pediatrics.

We hope this work gives hope to families and encourages other researchers and scientists to explore this potential life-changing therapy even deeper. So, I hope this was helpful. You can check out links to the articles below. Please leave us a comment about your thoughts about everything that we included in this topic today.

Thanks for listening to the Metabolic Mind podcast. If you found this episode helpful, please leave a rating and comment as we’d love to hear from you. And please click the subscribe button so you won’t miss any of our future episodes. And you can see full video episodes on our YouTube page at Metabolic Mind.

Lastly, if you know someone who may benefit from this information, please share it as our goal is to spread this information to help as many people as possible. Thanks again for listening, and we’ll see you here next time at the Metabolic Mind podcast