Psychotropics and Youth, Part 1 – The Five Myths




“The dramatic rise in prescriptions [of psychotropics for children and young adults] has alarmed several commentators,” according to Lakhan and Hagger-Johnson. In their article, they trace this problem to five erroneous myths that influence prescribing:

1) Children are little adults. During adolescence, the brain changes rapidly. As a result, therapeutic benefits, potential adverse occurrences, and drug interactions can vary with age. Adolescents, in particular, have unique characteristics meaning inconsistent results and effects. For example, SSRIs are being prescribed less for adolescents because studies have identified increased suicide risk among adolescents taking them.

2) Children have no reason to develop depression or anxiety. Researchers estimate “2-6% of children and adolescents in the community suffer from depression.” In addition, a report prepared by Hankin, Abramson, and Siler indicate between the ages of 15 to 18, depression rises from 8% to 18%. There are significant risk factors for youth depression, including genetic predisposition, stress, negative thought processes, and overall environmental factors such as bad parenting.

3) Psychiatric disorders are the same across adults and children. Depression is depression, but the symptoms are not the same for adults and children. For example, clinicians categorize irritability in children and adolescents as a core symptom of depression, but the same is not true for adults. What’s more, adult measures are more static, and treatment follows suit. However, disorders can change with age for younger populations making the child’s disorder a moving target for physicians.

4) Children can be prescribed lower does of the same drug. There is currently not enough evidence to substantiate this claim. Body weight is a factor, age is not.

5) Drugs are successful at treating psychiatric disorders. Pharmacological treatments are not the only or necessary the best option for all conditions. For example, cognitive behavioral therapy (CBT) and parental training can help treat and prevent conduct disorders.

In today’s highly evolved world of psychiatry, research has proven mental illnesses can begin in childhood or early adulthood. There is no question treatment is necessary to combat this grave problem. However, debate is continuing to grow about the over-reliance of psychotropics. In my next post, I will identify three areas of research that can provide answers to this alarming issue.

References

Lakhan, S., & Hagger-Johnson, G. (2007). The impact of prescribed psychotropics on youth Clinical Practice and Epidemiology in Mental Health, 3 (1) DOI: 10.1186/1745-0179-3-21

Hankin, B., Abramson, L., & Siler, M. (2001). A prospective test of the hopelessness theory of depression in adolescence Cognitive Therapy and Research, 25 (5), 607-632 DOI: 10.1023/A:1005561616506

  • I’m looking forward to reading the series. All to often I see children and teens present with major bx issues that can be directly attributed to lousy parenting. And it’s the kids that get smacked with the meds.

  • David Stein

    Thoughtful piece. I’m deeply troubled by this issue as I have children whose friend’s have been pushed by school Administration officials to take anti-depressants and ADHD medication. This article opens up another much needed discussion on ethics, public education policy and legal issues pertaining to youth and psychotropics. Good read.

  • Here! Here!

  • Joseph Rawlings

    I was very glad to see this post. Pharmacological intervention can be a valuable treatment, but it should be a last-line treatment. The rush to prescribe is troublesome, and these are good points about why that rush should slow dramatically, especially in the case of children.

  • Dana

    I think this really needs to be brought forward. I have known so many parents that agreed to “medicate” their children in order to keep them in school. They were getting pressured from school teachers and administrators that, in my opinion, either lacked the experience, creativity, or determination to coach kids who … See Moresupposedly had ADHD. I have also known parents who moved their kids to other schools and refused to be bullied by administrators. Once in the right environment and with the support of loving parents, these kids didn’t just do well, they did great. I hate how often and how easily meds are given to kids and teens, whether it be ADHA, depression, etc. It really should be a last resort. Looking forwarad to your next one!

  • David Stein

    I hear you Bill. Loud and clear. May I ask your background–education, medicine? It seems most of the children and teens I know are on some type of psychotropic whether it be for ADHD, ADD or depression. And the high stats on prescriptions written in the US alone speak for themselves. My friends across the pond in England tell me it’s more of the same over there too. Clearly, it’s a global epidemic.

  • Hi David. After decades of panic, GAD, depression, and alcoholism; I made it out. Because of my life circumstances I’d always been interested in affairs of the mind. Due to a number of situations, it became apparent six years ago I’d found my life’s passion and work. So I went back to school and earned my master’s in counseling. But, as with any passion, it’s gone beyond just “work.” Psychotropics and neurophysiology are of great interest so I do all I can to keep current. And what helps the most is my work as an E.R. (E.D. these days) psychiatric counselor. I really can’t think of too many psychiatric situations I haven’t seen, and to be involved on the scene with a patient’s family and friends broadens my horizons all the more. As does phone consultations with psychiatrists.

  • David Stein

    Very cool Bill. So your initial comment you posted is based on experience I take it. Must be some pretty heavy scenes you witness. Bravo to you! And glad you keep current. That speaks volumes in and of itself.

  • Thanks David. Never a dull moment!

  • Courtney Sherman

    I agree wholeheartedly with David and Bill. The topic of Psychotropics & Youth has really just begun. I foresee a discussion on ethics, public education policy and legal issues pertaining to youth making its way into the public mainstream soon. Really catching fire. Clearly, it certainly has in this forum. Thanks everyone for the insightful comments.

  • You know, as a side note, and I was going to mention this a few days ago. How ’bout it? Five-year-olds on Abilify. I’ve seen it several times. Now, I’m 55 years old…and I can’t help but wonder what happened to kids back when I was a boy who had issues that now warrant atypicals (in fact, I was probably one of them). Hmmm. I’m telling you, our society has become way too reliant upon the quick-fixes. And, of course, these “fixes” more often than not lead to the “necessity” of more quick fixes (you think pharma knows that???). In so many ways we’ve lost our connection with our children…we simply don’t take care of them. Instead, we’re all too often about mobility, convenience,and the material.

  • Thank you so much for this post. As a mental health care provider for both adults and children, it is so important to know the differences. Although I do not prescribe medications, it is still so important for me and the readers of my blog about children’s mental health to be very aware of these differences.

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  • Courtney Sherman

    My pleasure Emily.

    Bill: Regarding Abilify, in your professional contact with patients in the ER and elsewhere, do you see any trends so far in terms of the demographics of the kids prescribed this medication; i.e., socioeconomic status, ethnicity, etc.? There are stories behind numbers that can often illuminate larger issues at play here. Very interesting and possibly troubling.

  • Well, I deal primarily with unfunded and Medicaid patients. And I’ve seen it in that arena. But I’ve also seen it with the PPO/HMO set. I can’t make a firm statement re socioeconomic factors, but I can say that all in all the quickest fix seems to be too readily accepted.

  • Bravo, bravo!
    I’m out of words trying to describe how I feel reading you!
    Brilliant, courageous, “about time someone steps up for our youth”, comforting, and a whole bunch of other things come to mind I can barely describe.

    The good side of this tragedy is that maybe our children will save us in the end. Our future is at stake.

    By bringing into question all of these issues, I think we can really make giant steps in the way we consider, and more importantly, how we treat all who suffer mental, emotional and behavioral problems.

    Eagerly looking forward to read the rest.

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  • Anthony K

    Hi, commented on another post on this blog and saw this one. I used to work with very difficult and disturbed boys un a special school. I did that for 17 years, and saw the gradual introduction of the likes of Ritalin (though even then, the percentage who took them was quite low (I think British doctors are reluctant to prescribe). My observation was that, well, it seemed to make little difference! Most boys were unmedicated and some of them were aggressive and “hypoeractive”, so were the ones on Ritalin. Sometimes you could tell from their behaviour that they hadn’t had their pills that day, and maybe they were worse without, but I ended up being unconvinced either way. Whatever their behaviour, we had to deal with it gently and sympathetically: the pills didn’t seem like a magic bullet to me.
    I would say, though, that I think that the children should have the chance to try them: if they do feel better for it, and their family are better able to cope, then good. (As for me, I didn’t care too much: I always felt I had to deal with the child, not the behaviours.)

    One boy, I remember, who was very witty and clever and who really did seem much worse when he hadn’t had his meds, was walking down the street of his little rural village when he saw the drapess of one of the houses twitch. He became angrier and angrier. “The woman who lives there,” he thought to himself, “just saw me walking past and she thought I was about to go in and vandalise her garden! How dare she make that assumption about me! I’ll show her!”
    So he opened the gate, walked up the path, and vandalised her garden.

    Hey, let’s give kids the chance to take pills if it helps them – and if it helps us too, so much the better!

  • Andrei Rotariu

    Children should not be prescibed drugs for ‘depression’ FULL STOP! No one should be prescribed drugs for ‘depression’, people need to get counselled and helped not pilled up and addicted, im so sick of mecical capitalism!

  • steffen

    Really good and informative article, because I am young too, and this can be like a warning for me,,

Courtney Sherman, BA

Courtney Sherman, BA, is a graduate of the University of California, Los Angeles (History). She is a writer living in Los Angeles.
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