Wes: About once a month someone catches me on the street and asks us to do a story on some interesting topic. Usually I ask them to write a letter so we have a good basis from which to write. Even without a letter, I thought a recent topic was worth revisiting. Someone asked whether physicians (or nurse practitioners) are too quick to prescribe medications for kids or adults. I'm not a prescriber, and I won't second-guess anyone's practice of medicine. But this comes up frequently in therapy from a more existential and psychological standpoint.

When you look at the big picture, the most glaring problem with psychopharmaceuticals is not whether they're simply good or bad - much-needed lifelines or marketing tricks foisted off by big corporations. Instead, what families need to consider before putting kids on medication is much more basic: Exactly what are we treating here?

There are teenagers and even children who have a genetic predisposition to depression, bipolar disorder, attention deficit hyperactivity disorder and even psychosis. We really don't know the rates of each of these illnesses in the general population because the science is still evolving and mental health services are only now becoming more available to the general public. Without a treatment regimen of therapy and medication, these young people will suffer needlessly. This is not an opinion; it's borne out in countless studies.

Other kids who are depressed, emotionally distraught or behaviorally disordered are responding to problems in their environment. Sometimes medication is requested or suggested as a way to resolve symptoms which are actually behavioral representations of these problems. Some families, desperate for some level of social control, seek medication. In other cases, a teen is depressed because of significant life changes - a divorce, problems with friends, family conflict, abuse or personal losses. While medication can be helpful for symptom relief, in many cases it may actually prevent the teen from dealing with the problem - and more importantly, learning HOW to deal with problems. I recall a case many years ago where a woman was in a battering marriage and came to a session telling me that she had gone off her maximum dosage of Prozac. I told her this was not a very good idea. "No," she said. "I'm doing it because I don't think I should feel this good when my life is this terrible." Only after she let herself feel how bad things had gotten could she make the tough decision to get out of an abusive marriage. Often stressed teens and young adults really need to spend some time reflecting on whether their lives are going in a productive or destructive direction. Instead, they may reach for a quicker, more comfortable solution.

The National Institutes of Mental Health used to recommend that families undertake 12 sessions of psychotherapy before starting teens on antidepressants. Now they recommend combining medication and therapy right off the bat. I still lean to the old standard in less complicated cases. Either way, the point is clear - meds alone are not enough because symptom reduction isn't the same as problem resolution. The goal is always to help young people learn to deal with their problems effectively. For some that will mean a careful use of medication. For others it means core changes. For many it means BOTH. Every intervention has an impact. We want it to be the best impact possible.

Julia: I'm torn on this issue. On one hand, I silently curse those people who seem to flaunt how many medicines they take and therefore how many problems they have. On the other, it seems like a poor choice not to take a medicine knowing that it will make something better. The best case is finding a middle road between knowing when to cut back on hypochondriac tendencies or when to accept the evidence that medicine is a pretty decent amenity nowadays.

It gets interesting when you realize that the person who really influences the use of medicine is the person who needs it. It's largely in the patient's control, based on how they voice their symptoms how much and what kind of medicine they receive. Sometimes medicine can be a way of getting attention or showing bravado: "Oh, I took so many ibuprofen for my headache." It can be an expression of excessive worry that only medicine and lots of it can fix the problem. There's the exaggerated diagnosis leading a small and easily fixable problem to escalate into a pharmaceutical nightmare. And then, of course, there are the people who like to abuse medicines for the effect it has on them. Other people seem to want to overtreat problems so that they feel they are getting somewhere faster. It's the elevator button effect - the more you push it, the faster you think the elevator will come. As Wes points out, some people would rather have an immediate cure to any ailment than take the steps to properly help themselves. This makes it easy to take something without knowing the risks or understanding the original problem.

I also wonder if doctors are too quick to prescribe medicines to people of all ages, but I suspect its because patients push so hard for them. Just as serious are those people who avoid medicine altogether out of a fear of some complication. People aren't necessarily in control of their illnesses or problems, but they can certainly control how they handle them. Overdosing or refusing to dose isn't the wisest way to handle problems; being educated about what causes and what fixes the problems is.

Next week: A reader asks which if any teens have self-esteem.

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