Psychiatric medications are often prescribed at an alarming rate. What people don’t know is that while these medications may provide short-term relief, they don’t always address the root cause—especially in complex conditions like PANS and PANDAS. In many cases, these medications come with significant side effects. If we truly want lasting healing, we need to look beyond symptom management and focus on addressing the underlying factors that drive these conditions. By shifting our focus from masking symptoms to true healing, we can help children and families break free from the cycle of these conditions. In this episode, we'll talk more about why psychiatric medications are often a short-term solution rather than a true fix, the risks and side effects that parents need to be aware of, and why addressing the root cause is key to long-term recovery.
Psychiatric Medications and Their Limitations
Psychiatric medications, in the case of PANS and PANDAS, are typically used for severe symptoms like unrelenting OCD, debilitating anxiety, extreme aggression, or even psychosis. But before jumping to medication, it’s critical to dig deeper. If aggression or psychosis is part of the picture, I always urge parents to explore tick-borne illnesses like Bartonella and Babesia. It is clear from research studies that these infections are closely linked to severe anxiety and other neuropsychiatric symptoms. The tricky part, however, is that testing isn’t always reliable because these pathogens can hide inside cells, making detection difficult. That’s why clinical assessment by an experienced practitioner is so important. One of the most common psychiatric medications is antidepressants, specifically SSRIs, which impact serotonin levels in the brain. Then there are antipsychotics, sometimes used for more extreme symptoms. And, surprisingly, some kids are even prescribed ADHD medications like stimulants which is something I consider as a big mistake. The key thing to understand about these medications is that they treat symptoms but not the root causes. That’s especially true for PANS and PANDAS, where we know that infections and toxins trigger a misdirected immune response, leading to neuroinflammation. That inflammation is what’s driving the psychiatric and cognitive symptoms.
Side Effects and Risks of Psychiatric Medications
Before medicating, it’s essential to consider potential side effects and what research actually tells us about using psychiatric meds in PANS and PANDAS. Unfortunately, research is limited, and much of what we know is anecdotal. However, a 2021 study looked at why children with PANS were prescribed psychiatric medication and what side effects they experienced. The most common reasons for medication were OCD, anxiety, and aggression. But here’s something important: You can’t medicate OCD away. With PANS and PANDAS, the underlying infections and toxins must be addressed first. Once OCD develops, it becomes a behavioral habit in the brain. This happens because of a process called negative reinforcement. The child experiences distress or anxiety, they perform a ritual which might be a visible behavior or an internal thought pattern, and they feel a temporary sense of relief. That relief makes it more likely they’ll repeat the ritual over and over. The problem is that each time they do, their baseline level of anxiety doesn’t return to normal but rather, it actually gets worse over time. Moreover, families often accommodate OCD behaviors without even realizing it. When this happens, it reinforces the cycle even further. That’s why even when medical treatment is necessary, psychiatric medication alone isn’t a complete solution. Behavioral strategies, therapy, and addressing the underlying immune and inflammatory triggers are crucial. 54% of people had significant side effects even at a low dose of these medications. I’ve seen that ADD medications can sometimes trigger more severe behaviors before someone even realizes they have PANS or PANDAS. The literature does support that this can happen, but with PANS and PANDAS, these medications can overstimulate the nervous system and push someone into an agitated state, leading to a range of negative behaviors. Psycho-stimulants are commonly prescribed, but there’s a misconception that they’re harmless. In reality, they always have some side effects. SSRIs, on the other hand, have side effects like anxiety, agitation, aggression, and movement issues, including uncontrollable movements. With antipsychotics, you can see dystonia, which causes involuntary muscle contractions. Other potential side effects include aggression, self-injurious behaviors, and general behavioral agitation. The FDA even has a black box warning on SSRIs, stating that they can worsen psychiatric symptoms, including triggering rage and suicidal ideation. In the UK, their warning is even more severe, and they take a more cautious approach with psychiatric medications for youth. So before deciding on medication, take a step back. Consider the full picture—what’s triggering the symptoms, what alternatives exist, and what the long-term implications are. Remember that every child is different, and every case of PANS and PANDAS requires a personalized approach.
Alternatives to Medication for PANS and PANDAS
I want to be clear—I’m not opposed to medication, but it’s a big decision, and it’s critical to weigh the risks and benefits carefully. In some cases, it can provide short-term relief when everything feels out of control. But we also need to recognize that infections and toxins can unlock genetic vulnerabilities, triggering symptoms that might not have otherwise surfaced. That’s why it’s so important to address the root cause. When people receive proper treatment for underlying infections and inflammation, I’ve seen them recover time and time again. This is why I want you to stay hopeful. Medication may help manage a symptom, but it won’t resolve PANS or PANDAS. Indeed, the biggest con of psychiatric medication is the high risk of side effects, including potential destabilization. And it’s not just about the worsening of symptoms—it’s how terrifying that experience can be for both you and your child. Psychiatric medication is not a magic wand for complex issues and it does not target the root causes. We need to focus on treating infections, reducing inflammation, and detoxifying the body. This means supporting drainage pathways and removing toxins that fuel neuroinflammation, which is what keeps PANS/PANDAS in a cycle of flares. Incomplete or improper treatment, along with not maintaining the right lifestyle, can keep someone stuck in this cycle. Improving diet is also key. We have to think about which foods trigger inflammation and which ones help calm it. Anti-inflammatory foods like those in a Mediterranean diet are essential because nutrient density matters so much in recovery. Beyond diet, I use neurofeedback, PEMF, and brain-based tools to regulate the nervous system. When the nervous system is dysregulated, it can be impossible to move forward, but these tools offer quick relief when used consistently. There’s a misconception that lifestyle changes take a long time to work, but in reality, neurofeedback and dietary shifts can bring rapid results if they’re done properly and consistently. For OCD, the best therapy is Exposure and Response Prevention (ERP). It’s the gold standard, and anything else is likely a waste of time. If you’re not working with my team, you need an OCD specialist, not just an anxiety therapist. A great resource I can recommend is International OCD Foundation (https://iocdf.org/) or the Anxiety and Depression Association of America (ADAA). It’s important, however, to focus on co-regulation when it comes to getting better. This journey is definitely overwhelming but I hope you all take care of yourselves. Religion and belief also play a powerful role in providing hope and a sense of higher power that makes a real difference in healing. Most importantly, nervous system regulation is a game-changer. Regulate before you medicate because a dysregulated nervous system can block healing. And there are so many ways to do this. When you focus on regulation first, everything else falls into place more easily.
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