Therapy vs Meds: Managing Treatment in Youth Mental Health

When it comes to youth mental health, one of the biggest questions families and healthcare providers face is whether therapy or medication is the right treatment path. But even the framing of “either/or” does a disservice to the child’s health. The answer, as with most things in medicine, depends on several factors—including age, severity of symptoms, and access to care. Medicine alone can of course work miracles, but larger picture lifestyle interventions (such as coaching and therapy) set children up for success in the long-term. The goal of this piece is to provide a clear framework for pediatricians and other healthcare professionals when making these decisions and to acknowledge the challenges that come with treatment recommendations.

Understanding Severity: The Key to Treatment Decisions

The most significant factor in determining the best course of treatment is the severity of the child’s symptoms. Severity isn’t just about how a child feels internally—it’s about how their symptoms impact their ability to function in daily life.

• Mild Symptoms: A child who feels sad but still engages in friendships, school, and activities may not need medication. Therapy alone is often sufficient in these cases, as it provides a space to process emotions and develop coping strategies.
• Moderate Symptoms: If sadness is leading to social withdrawal, declining grades, or difficulty managing responsibilities, therapy remains the first-line recommendation. If there’s no improvement after 4–6 weeks, adding medication may be considered.
• Severe Symptoms: In cases where a child is failing school, refusing to attend, showing aggression, self-harming, or expressing suicidal thoughts, a combination of therapy and medication is usually necessary. At this stage, biological changes—such as disrupted sleep, lack of appetite, and low energy—make it difficult for a child to improve quickly without medication.

The Role of Medication: When and Why It’s Used

Medication can be a powerful tool in youth mental health, but it’s not a standalone solution. It works best when paired with therapy and skill-building interventions. In certain cases, such as ADHD, medication is often considered early in treatment due to its well-documented benefits in improving attention and impulse control. However, even in ADHD, medication doesn’t teach organizational skills, social skills, or emotional regulation—these must be learned through therapy or structured interventions.

A major concern is the over-reliance on medication without therapy. This is particularly common in pediatric settings, where a lack of available therapists and pressure from families can lead to prescriptions without additional support. While medications can “wake up the brakes” in a child’s brain, they don’t teach a child how to complete homework, manage friendships, or regulate emotions. Without these skills, children risk becoming behaviorally dependent on medication, meaning they rely on it for functioning rather than developing the necessary coping mechanisms for long-term success.

It’s similar to GLP-1s: patients can lose weight with these medications, but if they are not simultaneously learning and implementing healthy eating practices, they become dependent on the medication to keep the weight off.  

The Importance of Looking at the Whole Picture

Before prescribing medication, it’s important to take a step back and assess the full picture of a child’s health. There are several physical and environmental factors that can contribute to mental health symptoms:

• Iron Levels & Nutrition: Low iron can mimic symptoms of ADHD, leading to fatigue, trouble focusing, and irritability. A child with iron deficiency may appear inattentive when, in reality, they need dietary intervention.
• Sleep Quality: Poor sleep can exacerbate mood disorders and attention problems, making it crucial to address any underlying sleep disturbances before assuming a psychiatric condition.
• Exercise & Physical Health: Regular movement and time outdoors have a profound impact on mood and attention, yet they’re often overlooked in mental health treatment.
• Family Dynamics & School Environment: Stress at home or school can contribute significantly to a child’s mental health. Before jumping to medication, it’s important to explore these external factors and consider supportive interventions.

Pediatricians and Prescriptions: The Challenge of Limited Resources

Pediatricians often find themselves in a difficult position when managing youth mental health. Many children first present with mental health concerns in a pediatrician’s office, and with long waitlists for therapy and limited insurance coverage for mental health services, pediatricians may feel their only option is to prescribe medication.

For pediatricians facing this challenge, a few key steps can help ensure a more comprehensive approach:

• Take a Pause: Before prescribing, consider recommending books, online ADHD skill-building programs, or therapy apps. Slowing down the process can prevent unnecessary prescriptions.
• Use Screening Tools: Vanderbilt assessments for ADHD or PHQ-9 for depression help ensure a proper diagnosis.
• Explore Non-Medication Interventions: School accommodations, such as 504 plans, can be an important first step in helping children with attention or anxiety issues before turning to medication.
• Encourage Collaborative Care: Connecting with mental health professionals—even if only for consultation—can improve treatment plans and support pediatricians in making informed decisions.

The Holistic Approach to Youth Mental Health Treatment

Medications play a crucial role in youth mental health treatment, but they should never exist in a silo. The best outcomes occur when medication is paired with therapy and skill-building interventions that help children develop long-term coping mechanisms. For healthcare professionals, especially pediatricians, the key is to approach treatment holistically—considering severity, exploring non-medication options first when appropriate, and advocating for therapy and lifestyle interventions alongside prescriptions.

Ultimately, the goal is to equip children with the tools they need to thrive—not just to get through the day, but to build skills that will serve them for life.