Dear Dr. Wes and Jenny: I read your columns on antidepressants. My 15-year-old son was diagnosed with bipolar disorder (II) and ADHD. His doctor, his teachers and I all really want him to take the medication, but he is adamant that he won’t. This is turning into a constant state of argument for us. I was also told that I shouldn’t rile him up, but that is hard to do when he won’t comply with the medication the doctor prescribes. He is not a bad kid, just really obstinate about this. What do I do? — A mom

Wes: Med compliance for a serious illness is as big a problem as you are going to face with a teenager. We see it not only in cases of mental illness but also in chronic illnesses such as diabetes. For this column I am going to assume your son was a) diagnosed correctly; b) prescribed a medication by someone who was sensitive to the many struggles of teens with these sorts of problems; and c) has had sufficient behavioral problems with these disorders to worry you if he is off meds.

Diagnosis and prescription are complex, and an error in any of these issues make it 100 percent more difficult to get treatment compliance because your son will see maximum pain from medication and minimal gain. A second opinion is never a bad idea. As we’ve said before, teamwork is the key and your son has to be on the team. If he is not, then things get a lot more complicated. Unfortunately, the nature of ADHD and bipolar disorder (which actually co-exist somewhat frequently) in teens often make for a general state of oppositional behavior in many aspects of life, and the taking of medicine is often just one of them.

Additionally, these medicines often have a calming influence on teens. Many of them, especially boys, are not that thrilled to be calm. Teens on stimulants or mood stabilizers usually feel more focused and serious, and they will tend to think before they act. This sounds like heaven to parents, but for teenagers it is often seen as hell. A normally rambunctious teen is replaced with a bit of a fuddy-duddy. Or so they say. I had one young person tell me that when she was on her medicine for ADHD she didn’t feel like cheering for her team any more. Not a good deal for a cheerleader. But without it, she struggled constantly to keep grades up to be on the squad — even worse.

One angle may be to introduce your son to kids or young adults who are on meds and functioning well. We actually see a lot of these kids, who we refer to as “the masters.” They have been through horrible down times, rebellion about meds and everything else, legal problems and hospitalization — a result of either or both of these disorders. After much pain and natural consequence, they have come to see themselves as better off with good team-based treatment than without it. This MIGHT help your son learn from others without having to experience all those problems himself.

Jenny: Your teenage son is more than likely thinking that the medications will make him feel not like himself anymore. It is tough to realize that you need medication to help you through the day, instead of relying on yourself to take care of the problem. As Wes notes, many teens describe the feeling of being on medication as numbing.

My advice is for you to help him realize the doctor who prescribed the medication has his best interests in mind, and that taking the drugs is not meant to numb him but to allow him to feel in control. Drugs are meant to help, not harm.

I encourage you to look at the statistics and sit down with him in a mature manner and actually discuss why he should take the medication. Ask him why he is so resistant to taking medication. If you understand his hesitation and fear, it will be easier for you to help him. Just remember not to get emotional, even if he does. Stay at a mature level and treat him like an adult, not a teenager, when you talk to him. Good luck.