This is not a trivial question, nor an attempt to start an esoteric philosophical debate. The question is being raised out of urgent need, with profound consequences for the well-being of our children.
Often when a child presents with severe psychiatric symptoms, the focus is on quickly alleviating those symptoms with psychotropic medications. Those medications often get added to, changed, more added to... and more symptoms crop up, sometimes as side-effects masquerading as "progression of the illness".
At some point, someone realizes that extensive endocrinological testing needs to be done. Truth be told, even if not to diagnose other ailments, the tests should have been done to at least get baseline values before the psychotropics were ever started.
So who orders the tests? The psychiatrist often does NOT order the tests. After all, they are not endocrinologists. But they ARE M.D.s and since the endocrine system is so often intertwined with psychiatric symptoms, AND the medications affect the endocrine system, should they not order the proper TESTS? Are psychiatrists in the United States not being adequately trained to address these issues as a MEDICAL doctor should? In the United States (not every country is this way), the psychiatrists are not even supposed to touch the patient -- give an exam, to feel if their thyroid has goiter, check reflexes, look at their skin and fingernails for signs of ill-health, and look for other possible neurological and endocrinologic complications.
Perhaps they have spent too many years focused on just the psychiatric symptoms themselves, immersed in treating with the psychotropics and paying no attention to the rest of the body and the endocrine impact. They CAN order tests, at least, but they defer that to other specialists. The psychiatrist assumes that since the endocrine system is involved, an endocrinologist should monitor what is going on in the endocrine system. An endocrinologist is presumed to be the appropriate specialist to run the appropriate tests.
Let's say the child IS sent to an endocrinologist. The endocrinologist is likely to say that since the child is on psychiatric medication, and the psychiatric medications affect the balance of neurotransmitters such as serotonin, dopamine and norepinephrine as well as hormones such as testosterone, prolactin, ACTH, cortisol, thyroid stimulating hormone, thyroxine (T4), and triiodothyronin (T3) among others including hormones affecting hunger, satiety, and even glucose regulation (even "just" antidepressants have some of these effects), it is therefore the responsibility of the psychiatrist to order endocrine testing as part of monitoring for the side-effects of the given medications.
So the net result, unless the parent is lucky enough to encounter an actual practicing Psychoendocronologist or, better yet, a neuropschoendocrinologist, the child gets left in limbo with insufficient endocrinological testing.
The lucky person gets the thorough endocrine testing prior to the introduction of psychotropics, but here is the catch. Many endocrine problems develop slowly over time and fluctuate. Even getting a partial snapshot of the system at a given time, (like only TSH) -- which is what tends to happen -- can miss what is really going on.
And then once the person is on the psychiatric medications - all bets are off.
IF the parents have enough money to doctor search, travel, or order their own tests, the child may get adequate testing, monitoring, and care. If not... the child, family, and all of society suffers in the long-run economically as tax-payers, as well as emotionally and socially.
So whose responsibility is it?
Ask a psychiatrist and the answer is likely to be "the endocrinologist."
Ask the endocrinologist. The answer is likely to be "the psychiatrist."
That's a problem.
And that was our experience.
But being fore-warned is being fore-armed. KNOWING at least that routine testing is NEEDED while on psychotropic medications such as antidepressant and neuroleptics (antipsychotics) can give us the confidence to INSIST that someone run the tests. If all else fails, find a pediatrician, General Practitioner, Family Doctor, or even an M.D. specializing in Integrative Medicine, to order the tests.
Who knows, it may be the side-effects of the medications themselves contributing to the continuation of symptoms.
Update: It's Not Mental - finding innovative support and medical treatment for a child diagnosed with a severe mental illness
includes information (and an entire appendix) about endocrine testing gathered from Dr. Thomas Geracioti M.D., Dr. Robert Fredericks M.D., Dr. David Marwil M.D. and a few others.
- Brain Health: The Thyroid Connection
- Childhood-onset Schizoaffective - A Medical Doctor's Perspective of the Case
- Asking the Right Doctor the Right Question
- Managing Symptoms Vs Treating Illness
- Some Known Medical Causes of “Mental” Symptoms
- Important Links, Books, & Resources to Help Our Children
- Plastics & The Brain
- Sleep: A Critical Yet Under-addressed Component of Health
 Side effects blunt antidepressants gains Oklahoma EnidNews.com Feb 2, 2009
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Last Updated: 29 June 2011