When a Patient’s Mom Is Slipping Her Daughter Prozac

#3 Change the policy! Allow volunteers to tag things they would like to buy so they get right of first refusal. A small perk for a job well done. Nobody loses.

Just repeating what many have said -- this mother is violating the law, which of course the doctor must realize, and she is arguably engaging in child abuse by giving her drugs without medical supervision, not just unknowingly. The doctor should stop indulging this mother's "feel good solution" instead of, essentially, conspiring with her. More fundamentally, as a person with family members who have significant mental illness, I have never forgotten what one doctor told me when I was considering whether to involuntarily commit my sister, and that is, when you have someone's trust they are much more likely to really believe that you are trying to act in their best interest. It's really hard to persuade a mentally person hat a given course of treatment is in their best interest, but if this girl finds out that her mother has been secretly medicating her, how will she ever trust her in the future? It only seems like a good idea.

Doctor should be reported to Board of Registration. Thrift shop volunteers - have at it.

Get an AOT order.

There was a famous psychologist (one anathema to NY Times' attitudes) whose statement on maternal thinking was that it should begin and end with "I am my child's mother", with all other consideration - social, legal, even moral - being subservient to that one basis consideration. Here, we find that the mother's actions (which MAY be illegal or just plain dishonest) are benefiting her daughter's health and current outlook (the pediatrician seems to think so), and our only real concern (meaning the Ethicist's and those people making comments) seems now to be whether it is legal for her to do so, honest for her to do so, and relationship-inhibiting for her to do so. The doctor involved obviously thinks she needs the Prozac, the results of it being given to her seem to indicate that she does - how about if the mother stopped giving it to her surreptitiously, the daughter refused to take it on her own, and then she committed suicide? - would that be okay with everyone. If this was some kind of vitamin or supplemental tablet one was introducing into their recalcitrant parent's daily dietary regimen, would we be seeing all this hoopla about it? If I am taking my motherly role seriously, seeing that my actions are the correct ones to insure my daughter's health, I would quite happily stand before my doorway with a rifle, ready to use it, if outside and disinterested parties tried to interfere with my course of action. That USED TO BE valid thinking. before kid NEEDED Prozac!

Other than the fact that what the mother has been doing is likely illegal. You are not permitted to give mediation to someone for which it has not been prescribed. And a doctor is not allowed to prescribe medication for one person knowing that it is actually going to be given to someone else, especially when it will be given other person's knowledge. Aside from the ethical considerations, the legal ones are clear.

Ethically, unless the daughter is incompetent to participate in her own healthcare decisions, no matter what age, it is wrong for a parent to unilaterally decide to drug their child especially with a powerful drug like Prozac. The daughter has s right to know whether her mental health issues have resolved or whether they are being drugged into submission. That knowledge has a tremendous impact on many decisions she will make in her life.

For the physician, it shouldn't be an ethical dilemma. Her training should have made it clear that this is not appropriate.

Before making any decision, the pediatrician should first contact the psychiatrist and psychologist that treated the girl to better understand the patient's past behavior. I would also question whether the standard of "being a threat to oneself or others" which is normally made in these cases as it relates to mental health issues of adults is applied in the same manner for minors.

As the parent of a child with similar issues, you sir missed the point. I have one word for you....minor. This dr should honor the mother's desire to protect her child. In fact, I think the mother should seek another provider.

The advice to LW # 3 is wishy washy at best. The volunteers who pocket donated items are thieves, no matter how you look at it. The LW should report it to the store manager who in turn should, in no uncertain terms, communicate to the staff that anyone caught stealing donated items will be asked to go volunteer somewhere else.

Re: mama/Prozac letter. To the mom who will never read this, you are damaging your relationship with your child, and it will take years to repair. In all likelihood, the young woman in question will have a hard time ever trusting her mother again.

On a separate note (correct me if I'm wrong), I was under the assumption that citric acid should not be consumed alongside antidepressants. If the medication is unable to perform due to the citric acid, then perhaps there are other factors contributing to the daughter's improvement.

The first question from the paediatrician seems to be more appropriate for a medical ethics board, rather than the NYTimes. The paediatrician states that the girl in question engaged in self-injurious behaviour that resulted in being committed to a psychiatric institution. This contradicts the reply from the ethicist that she is clearly not at risk of harming herself or others. (Unless the ethicist doesn't consider cutting oneself to be harmful).

There is no clear indication of the girls age here, other than a statement that she is under 18. I suspect the pediatrician has legal considerations that go far beyond the advice that the ethicist can provide in this case.

I wonder if as a pediatrician the doctor is less accustomed than a psychiatrist would be to the scenario in which the patient refuses to take the treatment that might help them. It's the only reason I can think of why he might think for a moment that the mother should be allowed to continue with what in the UK at least would qualify as criminal assault. There are laws that dictate at what point people can be forcibly medicated, laws which require full disclose to the patient and come with safeguards and rights of appeal. They cannot be sidestepped because it's easier to treat someone that way. I fully agree with the ethicist-this had to stop and the daughter has to be told what has been done to her, what side effects might have been caused and what withdrawal symptoms might be expected.

Having worked as a child abuse investigator and a licensed therapist for almost 30 years the doctor's response is outrageous! Depending on location, the doctor is a mandated reporter . The doctor didn't say if anything was done to find out what the responsibility is for her/him. If the daughter is over 14 she has the right to refuse treatment (the age in many states). Doing this without her knowledge or consent is something to report. Whoever wrote the original prescription the mother has filled probably doesn't know what the mother is doing. Most doctors who prescribe Prozac have the patient come in for regular visits. Prozac can have many side effects and needs to be managed by a medical professional. Everything the mother is doing is wrong and possibly considered child endangerment.

The doctor sounds as if afraid the family will "hate" after this is disclosed. Yes, the parent child relationship will be harmed. How could it not? But the doctor has an ethical duty now that he/she knows. In other word Doc, don't be a wimp!!

Bring the 2 of them into your office, tell them what you know but give the mother a chance to tell her daughter first in your presence. Tell the mother this is what you're doing. Have the practice manager or nurse be in there too. Make sure there is documentation in the chart of what happened.

The mother needs help to figure out why she does this. They will both need much help to process this.

Come on Doc do your job!!!!

I can't figure Dr. Appiah out lately. He's issuing hard apologia for racist behaviors and actual child molestors but our first nuanced answer in weeks is a long meditation on the fine points of why you shouldn't enable someone to drug her child in a field in which you aren't even a specialist? Curiouser and curiouser.

What self-respecting and responsible physician uses this mechanism to make, or help make, decisions regarding medical ethics? This column has been rife with bogus information regarding medical matters and medical ethics. There are plenty of resources available for DISCREET consultation with EXPERTS. Does either the LW or Prof. Appiah understand that it is possible that the patient and family in question might read this newspaper?, and readily determine that the matter in question refers to them?
Calling (again) for the suspension of this irresponsible column.
Love the comment section censors, though.

That first letter is appalling. That poor girl is being abused over and over again, this time by her doctor and her mother.
#1. The doctor says her patient "reported" being molested, yet the patient's behavior shows a severely traumatized reaction. "Reported" implies that the patient isn't being truly believed or heard, which is shattering to the victim.
#2. The mother is assaulting her again, deceiving her, by drugging her without her knowledge or permission. That child will learn never to trust anyone if she can't trust her own mother.
#3. Doctor says: "it seems wrong to medicate her without her permission". It doesn't seem wrong, it IS wrong, and possibly illegal. Definitely immoral and unethical.

If the patient thinks she's getting better and doesn't know it's because she's being secretly drugged, how is she ever going to get better? Her mother can't keep her on Prozac for life. Execrable behavior on both the doctor and mother's part. And I suspect Mom is dosing up her daughter just because it's more convenient than taking the long, hard road of recognizing that something did happen to her daughter to drive her toward insanity, and doing something more than just turning to drugs to keep her quiet.

LW #1 should be monitored very closely--and reported to authorities if she does not cease and desist such behavior. This is child abuse, imo. Any parent (mom or dad) or caregiver who would add medications to their child's food without that child's knowledge is asking for trouble--for themselves as well as their child. Does she not realize how much serious harm could occur if the child were to a) ingest another medication and/or drug and suffer severe drug interactions b) receive emergency treatment which compromises her life if the doctors are unaware (even if the adolescent is conscious) that she is taking a drug which could interfere with possible life-saving treatment.
I'm not buying the excuse that this mother is acting on behalf of the daughter's best interest. This could very possibly result in a relapse for the daughter (actually not a child anymore). At the very least, the daughter will probably be very angry and not want to trust the mother on anything else (and frankly I wouldn't blame the daughter in the least).This mother is dishonest and subversive. I wouldn't trust her judgement in the future
The mother is playing with fire and the doctor should not write another prescription. Because the mother may try to pull this same stunt with another doctor, I would report her. At the very least, she might be adding other substances to the mix.What happens if she continues with the Prozac but it stops working and/or the daughter relapses. This mother disgusts me.

1. Pediatrician - no matter how sympathetic to the girl and her well-meaning mother, this seems to be the same problem as when families cannot force their kids into therapy. Until some adjustments are made to the policies of how we allow mentally-ill people to avoid treatment because of their rights, we will have young people killing themselves and others because they are too mentally ill to make sound judgments. Short of getting the girl committed again to a facility, I can't see how the pediatrician can authorize medications that the girl doesn't know about.

2. The sexist boss. If the HR department is as clueless as this writer says, she needs to see an employment lawyer. The rules about harassment and sexist behavior are there, and HR can't get away with saying 'boys will be boys.' If she has documented the past encounters, she should show it to a lawyer to insure that her concerns meet the legal tests, and then go to the highest level in the company. Her immediate supervisor AND the HR people need to be replaced, not promoted.

The doctor should NOT be telling the girl what her mother did. Depressive relapses are not uncommon. If she relapses coming off the Prozac, it could be attributed to her body cycling and she could be encouraged to reconsider her previous opposition given that she benefited from it before when she knowingly took it. It's always possible she no longer needs Prozac to stay level though.

Adolescents like this often look for and create chaos. Don't give her more explosives to be tossing about. There are sins of omission and sins of commission. Have you really thought about the consequences of this type of confession? DON"T do it.

I am not sure about the Prozac question. I think for a young enough patient, it is reasonable for the parents to have the final say regarding prescribed medication for the child, regardless of the child's wishes and even regardless of whether the child knows they are taking medication.

For an old enough child, this seems wrong. But where is the cutoff? It's impossible to say (and in this case we know only that the child is an "adolescent" but not her age).

An adolescent - who RECENTLY left a psychiatric hospital - and who has struggled over the last couple of YEARS with depression and harming herself - is finally doing well. This is a good thing. The Mom isnt harming the daughter. Truth be said - parents are expected to medicate their children - even when the children are not willing. If they don't, they face charges of abuse and neglect.

Considering that the daughter is still very young, AND doing well, AND only out of a psychiatric hospital for a few months, the pediatrician absolutely should write a prescription for prozac. I wonder, if a minor refused to take their epilepsy meds and the parent slipped it into their OJ, would the pediatrician still be so willing to throw up his hands?

If the daughter was doing badly on the drug, it would be different. If the daughter was 16 or 18 and ready to begin managing her own life, it would be different. If the daughter was YEARS away from her mental health crisis, it would be different. But none of those are currently true.

The responsible thing would be for the pediatrician to support the current situation - because its actually stable and working well for the adolescent. The pediatrician shouldn't be allowed to just throw up his hands because mental health care is hard. Its not as if psychiatric drugs and phychiatric treatment are readily available. Right now, the pediatrician needs to discuss a care plan with the Mom.

The mother is participating in and perpetuating the earlier sexual abuse by infringing upon her body without her permission. I have complete empathy for the mother'a helplessness but she needs to work harder to find supports for her daughter. By keeping the secret the doctor would be perpetuating the abuse reenactment too. The daughter is having normal reactions to the abuse. Perhaps one support for the mother would be to get herself in trauma focused treatment. a stable mother can only be a support to the doctor. Supporting her in lying and secrecy only continues the abuse dynamic.

There are at least 4 ethical problems to be addressed re letter 1.
1. The mother. The behavior is unethical for a number of reasons, addressed by Prof. Appiah and some commenters. Is there really any question?
2. The physician. Confidentiality is a key element of ethical medical practice, so much so that it recognized by our system of justice. No responsible physician writes to a newspaper re a matter such as this where there is risk of patient, family, others of identifying the patient. Hospitals, medical researchers, others who have access to medical information have protocols to de-identify that information. This physician should put himself or herself before her state medical board for review and appropriate censure or penalty. If the patient and/or family do identify herself/themselves as subjects of this letter, I wish them the best in pursuit of justice, although this wrongdoing cannot be corrected.
3. Prof. Appiah. If he selected this letter for publication, he shares culpability with the physician. Further, he has repeatedly demonstrated lack of famiarity with medical matters and medical ethics. This is a serious ethical problem - to publish advice on matters well outside one's expertise.
4. The NY Times. The sponsor of Prof. Appiah here, and therefore culpable as well. This column is not worthy of this paper.

The pediatrician's letter is horrifying. The long-term consequences of the young woman's broken trust--of family and the medical establishment--are far more damaging than the dubious benefits of the drug. For heaven's sake, she has already had her autonomy severely violated from being molested. The daughter must know what her mother has done to her, the pediatrician should apologize, and the mother herself needs counseling.

The statistics on SSRI effectiveness suggest there will be minimal risks from the tapering because the drugs do very little to begin with. The pediatrician should know this.

"You might also tell her that managing her situation isn’t best left to a nonspecialist like yourself."

That is not true. Depression in teens (and adults) is bread-and-butter primary care. Most patients are effectively cared for by pediatricians and family doctors. And primary care doctors have the advantage of knowing the patient really well because we are probably the doctors of the other kids in the family and possibly the doctors of the parents, too.

Only wealthy over-doctored people in big cities could imagine that there's a specialist child psychiatrist waiting to take care of this young woman. In those big cities, normal and disadvantaged kids, can't get to a child psychiatrist, nor can anyone anywhere else.

Good of you to be sensitive to the doctor's position in all this.
--Upstate primary care doc

To the LW with the supervisor who thinks harassing behavior is OK:Been there, done that, and survived. But not ideally.
1. Document, document. Start now, with notes of past behavior as much as possible, complied evenings , and never on a work computer.
2. From your statements, this is illegal. But, that doesn't make HR your protector; they are hired by the company to keep it out of trouble.This is more risky because the entire HR person and concept is brand new and untested.
3. Start a job search for a nontoxic company. Get references lined up confidentially.
4. Get an hour's worth of consultation with an employment attorney: what is the job market like; is it better to approach the interim director, what documentation do you have.
5. Most of all: yes, retaliation is so wrong and so forth - but realistically it happens all.the.time: silicon valley, universities, churches, etc. Assume that it will happen to you. My advice: make it an informal discussion with the interim director, but an attorney can advise you better.
Have a game plan first, information about the job market and some experienced
advice.
6. Make truthful statements and (the best advice I got) never, ever retract your
statements, once you are committed to a path.

SJW is correct. The pediatrician has committed a serious ethical lapse. As a pediatrician for over 45 years, I would offer the following comments. it is understandable that the mother would request that the pediatrician continue the medication. Patients and families often make inappropriate requests. It is the physician's responsibility to guide them. Your writer who observed that the mother is responsible for her daughter's care is correct only in the narrowest sense, one which does not excuse the physician's action. The physician's​ first responsibility is always to the child, his patient. Young children lack capacity to give consent, and the parent acts for them, but as they grow older that presumption changes. As evidence take the statutory rights accorded in New York to minors, among them in reproductive health and privacy of medical records. Even where parental consent is required, that is assent, not dictation.
Lastly, the physician's most powerful tool is the patient's trust. Once lost it is nearly impossible to regain. I feel deeply for the difficulty the pediatrician and the mother face in righting this immense transgression against trust, and for their fear for the child's well-being as they do so. The parent and pediatrician, if possible together, should seek wise and compassionate advice for themselves from a psychologist or other qualified counselor in the knowledge that resolution of this difficult situation can either lead to great good or great harm.

Prozac- There are 1072 drugs known to interact with Prozac, according to something called Drugs.com. That's kind of a lot. Most of the reactions are not life-threatening, but some of that may be due to the dosage. I'll assume our mom is absolutely, serenely sure her teenage daughter is not getting any of those drugs (including a different dose of Prozac from a friend) because where would a kid get drugs or alcohol? Why would the girl reject mom's Prozac medication and take Prozac meds from a friend? Maybe because she's a depressed adolescent...
The girl may have a friend who had a relative who took a medication and felt better, so the friend might offering the girl some of the leftover pills, or in her search for comfort, she may be taking any number of drugs. Every day in the news (including 2 long articles in yesterday's Times) we see astonished relatives who didn't realize someone was taking drugs until that person died.

Mom means well, but the road to hell is paved with good intentions. Time for the pediatrician to call a conference and find a way to gently include the patient. Probably won't be easy, but sometimes you find yourself in a position where all the choices are painful...

Is assessing the mental health and capacity of an adolescent female patient within the authority of a pediatrician?

Might an evaluation by the patient's psychologist and/or psychiatrist be warranted to assess the patient's capacity and the risks of any action?

Would it be helpful for the psychologist and/or psychiatrist to assist with a mother & daughter discussion.

You say that the adolescent patient is being denied autonomy. Let me ask you a question: if it was an adolescent with diabetes who refused to take her insulin or one with cancer who refused chemotherapy because she didn't feel she needed them, would you be so cavalier about the need for autonomy?
Mental illness can be just as deadly as diabetes or cancer.

Meds: Your patient has been molested, meaning she has been lied to and physically assaulted, and made to feel as if her body, soul and emotions have no worth. She is your first concern and you must speak with her, regardless of her mother's mixed intentions. Giving someone medication without consent is a battery. I don't understand why you didn't tell the mother to immediately stop giving her medication without her consent. I also suspect it is unlawful and highly unethical for you to give this mother any prescription, at all, given her expressed intentions.

The thrift store volunteers shouldn't steal, but it is also true that the thrift store is making it harder than it must for them to do the right thing. Not only should managers remind people not to pocket donations, they should establish a system where volunteers can designate newly donated items for themselves on a first-come, first-served basis and then purchase them at the thrift store's usual price (as determined by written guidelines or another volunteer) after the usual processing. Having first crack at the goods is a reasonable perk of volunteering, and doing this would help rather than harm the organization.

This doctor has committed a serious ethical lapse by prescribing a psychoactive medication requested by a patient's family member without assessing and consulting with the patient herself. The mother's giving the medication to the daughter secretly makes it even worse, but the burden of guilt is on the doctor. Anti-depressants can have side effects that patients should be aware of when they start taking them. For instance, increased suicidality in teenagers, and loss of libido. This doctor should immediately consult with the teenager's psychiatrist and confess to having screwed up, and find a way to have any psychoactive medications discreetly changed over to management by the psychiatrist in consultation with the mother so that this perhaps fragile teenager never discovers the violation of trust. The kid should also get a new primary care doctor; perhaps it's a good time to move on from a pediatrician. The letter writer seems primarily concerned with getting out of this without getting herself in trouble.

How old is this child? If she's under 18, the mother still has responsibility for her care and should have a say in what medical care she receives. She's also the one paying the bills. It won't work in the long run, once the girl turns 18 and finds out what has been going on, but I think the mother has a right to do what is in her minor daughter's best interest.

Does a licensed physician really have no recourse but to write to a newspaper advice column when making such a decision? Where is the AMA?

To follow on Cheryl's point: Is the mother's behavior illegal in any way?

Aren't some of the warnings of side-effects: may cause suicidal thoughts or depression? So, wouldn't this secret behavior be negligent and cause possible harm? Medication's progress need to be monitored for this reason and others.

I am a child psychiatrist, and this issue has come up in my practice more than once. This mother certainly put herself in a bind here. It's not clear here if the pediatrician has already been prescribing the Prozac, or if the mother was using refills from when her daughter was seeing the psychiatrist.

If the mother has been using refills, then the original prescribing physician should also be contacted to let them know that the medication has been given without the patient's knowledge. And this girl needs to be seen in the office, either by the pediatrician or a psychiatrist, before any further psychiatric medications are prescribed. Taking this mother's word over the phone on her daughter's state of mind is inadvisable.

It is counter-productive for the long-term health of the daughter to dose her without her knowledge. She will think this is her baseline health without medication and perhaps not realize as an adult why she seems worse. Plus, having someone you trust is very important for people with mental health issues, and this is a big betrayal of trust. The mother will need to be able to say "trust me" when her daughter is an adult and needs help but cannot be forced to take it. A strong trust bond is difficult to forge, but invaluable.

If she doesn't realize how much better she is with the medication, she, her mother and her therapist should work together to help her become more self-aware. It can be hard. When my daughter was younger she also didn't see the behavior changes her medication made, while they were very obvious to everyone else. We had to help her see how people reacted to her with and without her medication as part of her symptoms, since she felt the same either way. A similar outside verification or daily checklist of behavior might help the daughter see how the medication does help. It's so hard to be objective when you are depressed.

Wow, I am appalled at the mother who is slipping her daughter Prozac. I do get it -- I have a teen daughter with mental health issues who takes meds, and I just found a cache of pills in her room when I was helping her clean it up once finals were over. But it led to our having a discussion about it (well, after I scolded her first) -- I would never think to slip her drugs into food! She is an autonomous person. I am informing her prescribing physician and therapist just so they can also tell her it is better to stay the course and not skip doses. In talking with her, she thinks she did it because she was so sleep-deprived during her finals that she wasn't thinking straight.

Ethically, the pediatrician should respect the daughter's (i.e., his or her patient's) autonomy and encourage her to continue her meds and not self-taper without medical advice. Kids do grow up, and she deserves to be treated with respect.

I understand well the fear that parents have -- my daughter also went through some traumatic events and was harming herself a few years ago. But this isn't the way to go. Build those bridges with your daughter and try to develop better trust, and that will be a step forward for her to make more informed choices.

If this person is a real doctor they ought to know they have no business talking about an adolescent's health issues with her mother without also talking to the adolescent. There is no conceivable justification short of a court order for providing medication to the mother knowing she is going to drug the daughter without the daughter's consent. The doctor is obligated to speak to the daughter directly and immediately as the she would seem to be justified in not trusting her mother. (And yes, I am the mother of a daughter.)

It seems to me that medical ethics should not be addressed in an advice column and the author of the colum should not accept them.

For the first question.

It's not a bad answer, but why answer at all? There are specific medical protocols that doctors follow. These are established by the relevant boards and medical societies.

These decisions have already been made. Except for extraordinary circumstances the clinician should follow the ethical protocols.

I was very surprised to see a pediatrician writing in to ask whether she should disclose the truth about information about her patient's possible medication, to the patient. It seems that as long as long as the patient is doing well, she has a right to know this and therefore it should be a no-brainer. However, one thing that the pediatrician did not mention is that if something were to happen to her patient (e.g., suicide attempt), what would be her responsibility (professional) in not letting the patient know that she had been secretly been administered Prozac? Parents should not slip medications into anyone's orange juice when the patient is capable of taking it themselves - especially Prozac. The doctor should immediately rectify this situation by calling in patient and parent and explaining what has been going on. A very important part of patients accepting treatment for mental illness is honesty and integrity of those treating them, as such patients may have in the past been betrayed or abused.

While I support having children make their own decisions from the earliest age possible, medical neglect is considered a form of child abuse. The girl in question is not an adult. It seems to me that if her psychiatric issues were severe enough to warrant hospitalization, her own ability to decide what's best for her may be limited in this area. As a minor, it is her parent's responsibility to make sure, as best they can, that she is being cared for and safe. At this point, exposing the mother would only create a negative situation, one that would be difficult for a teenager to handle under any circumstances, and one that would clearly not be in the clinical interests of the child. While the doctor feels strongly about the girl being able to make her own decisions about this medication, stopping a drug like that suddenly can have severe ramifications. While I don't see that the mother did anything wrong, (what if the girl refused to take an antibiotic for a severe infection?), at this point it would be best if the doctor agreed to help the mother slowly taper the daughter off the medication. Then they could see how the girl was doing going forward. If nothing changed: great! If depression returned, mother and doctor could together encourage the daughter to try Prozac.

1) No one has the right to medicate another. I know it will be argued that a child does not "know better," but the issue is not an aspirin; it is a drug that has a lot of negative baggage associated with it, and I am putting that nicely, viz., it can be a dangerous drug.

2) Document, document, document. But, having allowed this to go on for years, your newfound complaints will likely be seen as retaliatory and thus, negative. So, document, document, document so that even if you are told you should not surreptitiously record/film another, you likely could not be fired for it because you could sue. But continue to document, document, document.

3) Forgiveness is not the issue, Dr. Appiah; theft is the issue, and theft is theft. Yet, while I find the idea of asking store managers to remind everyone about how pocketing donations is wrong to be smart, likely the question asked will be "what have you seen?" The worker will then be put into the position of telling a white lie ("well, I'm not sure, but I thought I may have seen someone take something") or "telling on someone". Perhaps an anonymous note to the managers asking them to remind all workers would work better.

Mom, why do you insist that I, a nearly 18 year old, drink a glass of orange juice (prepared by you) every single morning?
Oh, no reason...

Really?

This pediatrician evidently does not know that Prozac is not an upper. It does not make you feel better suddenly but it is much more subtle and one might not even realize if it is working until some time after starting to take the medication. The mother is not a doctor and should not be playing with any kid of medication for her depressed daughter. Wow what a mess.

The pediatrician's lament grabbed me: s/he, as a caring doctor, has inadvertently taken on ownership of the mother's inappropriate behavior. STOP.

The Dr has to do HER job. No more Rxs; refer the daughter and mother to a psychiatrist, being clear that you want confirmation that they have followed through. You also want a release to share your notes as background for the referral.

Bluntly, this mother could be accused of child maltreatment by administering a psych med w/o authorization. And - is it possible she may add anything else? A little tranquilizer if "needed"? Can anyone not in the home be sure? She may well be a good mom, and coping with children's mental health issues is challenging, but doctors often accept 100% of what they hear from the parent. Pediatricians are especially trusting - because they must rely on parents for young children. Add skepticism.

A conference with the daughter and mother can be a good step, but not every one is really good at running this sort of intervention. The Dr. should definitely inform the mother that the Dr. will not keep the mothers' secret: a 17 year old is entitled to know what medications are being administered. In fact, minors of this age in general have to consent to treatment.

Inform the girl directly - and maybe privately - of the referral and your concerns. She IS going to be furious with her mother, so the Dr has to maintain professional distance to have credibility and induce the girl to listen.