For many parents, one of the most difficult questions in their child’s mental health journey is whether medication should be part of the treatment plan. It’s a decision that often brings up important questions: Is medication truly necessary? Will my child need it for a long time? Will it change who they are?
In this episode of You Only Know What You Know, hosts Beth Hope, LCSW, and Britt Teasdale are joined by Dr. Alex Timchak, Child, Adolescent, and Adult Psychiatrist, and Regional Medical Director, to discuss how medication decisions are made, when psychiatric care may be appropriate, and how medication can work alongside therapy and other mental health supports. They also explore common concerns about side effects, dependency, and long-term use, while explaining how progress is monitored throughout treatment.
If you’ve been wondering how medication fits into your child’s treatment, this episode offers an honest look at how psychiatrists approach these decisions and what families can expect along the way.
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Meet the Guest
Alex Timchak, MD is a Child, Adolescent, and Adult Psychiatrist and the Regional Medical Director at Compass Health Center.
Episode Highlights
The conversation below comes from an episode of You Only Know What You Know featuring Dr. Alex Timchak, MD, Child and Adolescent Psychiatrist and Regional Medical Director at Compass Health Center. The transcript has been lightly edited for length and readability.
What’s the difference between a psychiatrist and a psychologist?
Alex Timchak, MD: A psychiatrist needs a minimum of four years of medical school and a minimum of four years of residency training. The first year of that residency is in general internal medicine, and then three years of adult psychiatry training. In child psychiatry, you can do a five-year total program—I did three years of adult training and then two years of fellowship. It takes a long time, but the nice part is that you get a lot of experience, not just from the psychopharmacology perspective, but also with medical comorbidities, and in learning to provide therapy.
Who typically prescribes psychiatric medication first: a psychiatrist, or someone else?
Alex Timchak, MD: Psychiatrists are not the only ones who treat child, adolescent, young adult, and adult patients. Nurse practitioners and physician assistants can also prescribe medications; they require a collaborating physician in most states. A psychiatrist is often not the first person a parent might see, unless they have a family friend or a neighbor who’s worked with one. Oftentimes pediatricians are the first port of call, because they know your child and you know them.
What’s the difference between outpatient psychiatric care, PHP (partial hospitalization), IOP (intensive outpatient), and inpatient care?
Alex Timchak, MD: In an outpatient setting, usually after that first visit, if a medication is prescribed, you’ll need to follow up with a psychiatrist anywhere from two to four weeks after that initial visit. In PHP and IOP, patients are seen by a psychiatrist or nurse practitioner multiple times a week. PHP is kind of like a school day, a partial hospitalization program. IOP is at least one to two times a week, for a child who’s functioning well enough to be in school but still needs closer monitoring and support.
Inpatient psychiatry is really the highest level of care, with some exceptions, but it’s usually reserved for clinical situations where patients need 24-hour monitoring. For example, a patient who is so depressed and suicidal that even staying at home with close monitoring from their parents isn’t enough.
How do I know if it’s time to consider a medication evaluation for my child?
Alex Timchak, MD: There’s no cut-and-dry answer. Most of the time, parents will have known something is different with their child over the course of days or weeks—baseline patterns of behavior start to shift. That might look like spending less time with friends, spending more time in their room, more time on screens, or being more irritable. Irritability is a huge hallmark of both depression and anxiety in children, in a way that may not present the same way for adults.
The rule of thumb in psychiatry, for almost every diagnosis, is impairment: you get the sense that your kiddo is really struggling, and you don’t necessarily know why. If you’re trying to talk to them and you’re not getting a satisfactory answer, that’s when to bring it to the pediatrician.
How is this different for younger kids who can’t explain what’s wrong?
Alex Timchak, MD: Behavior is communication. Oftentimes when kids are having a major shift in behavior, they may not be able to identify what’s wrong. Acting out covers a very broad spectrum—dysregulated, disruptive behavior in the classroom, or not going to school—but it’s a behavior signaling a need that isn’t being met.
If you get that parent gut-check that something is definitely wrong, treat it like a 104-degree fever: you’re probably not going to keep your child home all weekend and wait it out. That’s a big red flag, and it’s a situation where we need to get them evaluated.
Where does the stigma around psychiatric medication come from?
Alex Timchak, MD: I think the field of psychiatry has a lot of historical, painful baggage that’s been baked into social consciousness, and with good reason. People were getting lobotomies in the early part of the 20th century because we didn’t have data. So, I don’t think distrust of the medical field is a bad thing. That said, most people go into this field not to experiment on anybody, but to provide support based on the best data we have.
The word “zombie” is intimately connected with psychiatry, because many people have had an aunt, an uncle, or a parent who was over-medicated or improperly medicated, and they’re understandably skeptical.
What actually pushes a family toward medication as an option?
Alex Timchak, MD: Usually the inflection point is that things are bad enough or hard enough that we’ve tried other interventions first—therapy, working with a pediatrician—and we’re concerned enough about the child’s ability to function on a normal developmental path. I’ll be the first to say that medications aren’t going to cure diseases in psychiatry. What we have to do is treat symptoms. It’s not a right-or-wrong answer about prescribing medications. It’s about risk versus benefit.
How do I find a psychiatrist or nurse practitioner I can trust?
Alex Timchak, MD: Start with your community and people you trust, because it may not be a direct referral. It could be a friend’s uncle who’s a pediatrician in the area and loves the psychiatrist he’s worked with for 10 years. Only 71% of counties in the US have a child psychiatrist. There’s a massive crisis and shortage of child psychiatrists. One of the few positive changes to come out of COVID is that many providers are now available virtually.
How do doctors decide what to treat when there are overlapping symptoms, like ADHD and anxiety?
Alex Timchak, MD: A child diagnosed with something at age seven may not have it at 13. Diagnoses are labels that don’t always—and shouldn’t always—stick. We still don’t fully understand the genetic basis for most psychiatric disorders.
With ADHD specifically, we have to triage what the most pressing symptom is, just like excellent nurses do. I want information not just from parents, but from teachers, too. There are many rating scales, but symptoms have to show up in more than one setting; it can’t just be that a child is struggling at home. It has to show up at school, at grandparents’ houses, at temple or church, as well, to make the diagnosis.
Stimulant medication is the mainstay for ADHD, and those work quickly—you’d know within a week if it’s working. Anxiety medication typically takes multiple weeks before we know if it’s working. That factors into the decision, too.
How do I know if my child’s medication is working?
Alex Timchak, MD: Beyond the macro-level behavior and functioning parents describe, rating scales can be really helpful—things like the GAD-7 or PHQ-9, which are free and available, and we use at Compass. Having the patient fill those out gives an objective way to quantify their symptoms and track them over time.
Is it common to try several medications before finding the right one?
Alex Timchak, MD: For most medications, tolerance is the first goal, before efficacy. It takes four to six weeks for what’s considered an adequate trial at an adequate dose. If we haven’t seen any signal of improvement by then, and side effects are still a burden, we have three choices: stay the same, go up on the dose, or go down and consider switching.
The three hardest letters in psychiatry are N, O, and W, because we want our kids to feel better now.
Will my child have to be on medication forever?
Alex Timchak, MD: It depends on the diagnosis. For ADHD, chances are a child will need it through college. A lot of people discontinue in young adulthood once they find a career path that fits their pattern of focus and attention without medication. For other diagnoses, like OCD or bipolar disorder, it’s probably going to be a longer time frame.
I gain nothing from keeping kids on medication. I really don’t care if you’re on medication; I care that you’re doing well.
What if my child refuses to take medication?
Alex Timchak, MD: The goal isn’t to win a battle. It’s about partnering with the child or teenager and saying: “This isn’t about making you do something you don’t want to do. We’ve tried everything else, and what you’re telling me is that you still feel really bad and you’re really struggling. I can’t promise medication will work, but we have to try something different from what we’re doing now.”
When should I tell teachers or coaches about my child’s diagnosis or treatment?
Alex Timchak, MD: For ADHD, teachers are going to know. They’ll absolutely notice, and they’ll actually be very grateful to know a child is being treated. I think disclosure makes sense once you feel like accommodations are needed. At that point, having that conversation with the school can be really helpful.
Are psychiatrists influenced by drug companies to prescribe medication as a first option?
Alex Timchak, MD: The generic maker of Zoloft has never paid for a lunch or a flight for me. I do my own independent research and talk with my colleagues. The responsibility of being a good doctor or nurse practitioner is to stay as informed as possible.
What about supplements or holistic approaches—do they work?
Alex Timchak, MD: There are some things out there that are low risk, right? Taking a daily vitamin is low risk. When it comes to treating psychiatric disorders with cannabinoids more broadly, we’re not there yet. There’s promise, but study after study shows it can exacerbate symptoms instead.
What lifestyle habits actually help support a child’s mental health?
Alex Timchak, MD: A cell phone and screen plan should be mandatory. Adequate sleep matters—doomscrolling at two in the morning is not going to lead to a good day. Regular movement matters too, whether that’s dance, soccer, or something else.
Should parents trust AI chatbots for questions about their child’s medication?
Alex Timchak, MD: I understand why a parent would go to an AI chatbot and ask, “My child is taking Cymbalta and Adderall. Is this a bad combination?” I’d just say be very careful, especially with medications that aren’t approved for kids, because these tools will often say very dire things that don’t match up with clinical experience. Bring those questions to your provider instead. In my own testing, many of these searches have erroneously escalated the risk for certain medications.
What’s the one piece of advice for a scared parent trying to decide what to do next?
Alex Timchak, MD: I talk about a safety plan with every family, even if a child has never mentioned suicidal thoughts. If you truly don’t know whether you can keep your child safe, that’s a situation where you can go to an emergency room to be assessed. There’s also 911 and 988; 988 is especially helpful for teens.
This article is based on a conversation from the You Only Know What You Know podcast, hosted by Beth Hope and Britt Teasdale, featuring Dr. Alex Timchak, MD, Child and Adolescent Psychiatrist and Regional Medical Director at Compass Health Center.
The information shared here is intended for general education and shouldn’t replace medical advice from your child’s healthcare provider. If you have questions about your child’s mental health or treatment, talk with your pediatrician or a psychiatric provider.
