Her new psychiatrist told her that medications could only do so much. “They help with irrational stress and irrational depression,” Ms. Smith recalled the new doctor telling her, and that “taking antidepressants isn’t going to make you less sad if someone you care about dies.”

In

Last summer, Jean, 22, who is being identified by her middle name to protect her privacy, grew increasingly agitated and depressed before her senior year in college.By April of this year she was taking seven psychiatric medicines.

A.D.H.D.

Nonetheless, many experts emphasized that the proper use of the right medications can be essential in helping to stabilize an adolescent who is clinically anxious, depressed, self-harming, suicidal or inattentive.AdvertisementSKIP ADVERTISEMENT“Medication is important,” said Dr. Stephanie Kennebeck, a pediatric emergency room doctor at Cincinnati Children’s Hospital who has studied therapeutic approaches to suicidal impulses. Also vital, she said, was “knowing that medication has its limitations. Therapy is the cornerstone of what we try to get kids into.”

Moreover, “the meds don’t work all that well,” said Dr. Robert Hilt, a psychiatrist at the University of Washington. He noted that studies have shown only a modest upside for some of the major classes of medications, including antidepressants, prescribed to adolescents.Dr. Joshua Gordon, director of the National Institute of Mental Health, said that doctors often “scramble to help a kid who is in their office,” but that the lack of clear evidence about what drugs work can lead to educated guesswork and prescription of multiple medications. “Why kids end up on multiple medications is because we don’t have the medications that are really working for them,” he said. “All of it suggests we need more research.”Image

A.D.H.D. medications are prescribed widely and considered to be a relatively risk-free way to improve focus. But Dr. Lohr explained that when one medication doesn’t resolve all the issues — or when new ones crop up — parents and doctors can be quick to add additional medications instead of relying on nonpharmacological solutions such as therapy. And A.D.H.D. drugs can have side effects, including sleeplessness, that doctors sometimes treat with additional prescriptions.

But, he added, the practice of overprescribing was common among doctors: “When they’re searching for something that makes the patient symptom-free, they create problems that can result in what is politely called pharmaceutical misadventure.”

“I can’t think of any disorder that would result in her being on all these classes of medications,” said Dr. Mark Olfson, clinical psychiatrist at Columbia University and one of several experts whom The Times consulted about Ms. Smith’s drug regimen. They all expressed similar concerns. “It’s not a coherent regimen,” Dr. Olfson said.

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Lamictal is primarily intended for adults with bipolar disorder and seizures, neither of which Ms. Smith had been diagnosed with, although some studies have shown its effectiveness in treating other mood disorders. But the drug comes with a black box warning about dangerous skin rashes that in rare cases are life-threatening, noting: “The rate of serious rash is greater in pediatric patients than in adults.”

In 10th grade, the same psychiatrist added a prescription for Effexor, an antidepressant that is not approved by the F.D.A. for use in adolescents and that puts teens at increased risk for suicidal behavior and hindered growth.

Her search to feel better led her and her family to various treatments and, eventually, to use of multiple drug prescriptions.

He vowed not to let his own children suffer any mental health issue unaddressed. “I try vigorously to give Renae all the tools she needs to combat it,” he said.

Ms. Smith’s diagnoses began with inattention.

0.7 percent of people ages 2 to 24 who were prescribed a drug for attention deficit hyperactivity disorder were also prescribed at least one other medication for depression, anxiety, or another mood or behavioral disorder. The study found more than 50 different psychotropic medicines prescribed in such combinations, and a review by The New York Times found that roughly half of the drugs were not approved for use in adolescents, although doctors have discretion to prescribe as they see fit.

You can very cogently argue that we don’t have evidence about what it means to be on multiple psychotropic medications,” said Lisa Cosgrove, a clinical psychologist at the University of Massachusetts, Boston. “This is a generation of guinea pigs.”

Moreover, many psychiatric drugs commonly prescribed to adolescents are not approved for people under 18. And they are being prescribed in combinations that have not been studied for safety or for their long-term impact on the developing brain.

These drugs, generally intended for short-term use, are sometimes prescribed for years, even though they can have severe side effects — including psychotic episodes, suicidal behavior, weight gain and interference with reproductive development, according to a recent study published in Frontiers in Psychiatry.

But, these experts caution, such medications are too readily doled out, often as an easy alternative to therapy that families cannot afford or find, or aren’t interested in.

Psychiatrists and other clinicians emphasize that psychiatric drugs, properly prescribed, can be vital in stabilizing adolescents and saving the lives of suicidal teens

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One morning in the fall of 2017, Renae Smith, a high school freshman on Long Island, N.Y., could not get out of bed, overwhelmed at the prospect of going to school. In the following days, her anxiety mounted into despair.“I should have been happy,” she later wrote. “But I cried, screamed and begged the universe or whatever godly power to take away the pain of a thousand men that was trapped inside my head.”Intervention for her depression and anxiety came not from the divine but from the pharmaceutical industry. The following spring, a psychiatrist prescribed Prozac. The medication offered a reprieve from her suffering, but the effect dissipated, so she was prescribed an additional antidepressant, Effexor.A medication cascade had begun. During 2021, the year she graduated, she was prescribed seven drugs. These included one for seizures and migraines — she experienced neither, but the drug can be also used to stabilize mood — and another to dull the side effects of the other medications, although it is used mainly for schizophrenia. She felt better some days but deeply sad on others.