Psychotropics and Youth, Part 2 – The Solutions




“Prescribed psychotropic medications are now high on the research agenda,” assert Lakhan and Hagger-Johnson. Their study advocates new approaches to research to address the rising concern over dramatic increases in psychotropic prescriptions for both children and young.

Our first post delineated the five erroneous myths often adhered to when prescribing youth’s psychotropic medication. Here are the three areas of recommended research to address this “alarming” problem.

1) Clarify child/adult differences for psychotropics. The future promises to see questionnaires and interviews tailored specifically to children and adolescents. Prominent will be the initiation of normative data for youth mental disorders. Studies will need to focus on specific age groups, disorders and treatments.

2) Attend to the growth of “cosmetic” use of psychotropics in children and adolescents. Researchers’ alarm over the marked increase in psychotropic prescriptions for youth has spilled over into the public arena. Recent media attention, in conjunction with changes in clinical practice standards and drug product labeling, has juggernauted psychotropic investigation to the forefront of the research agenda.

3) Address concerns about the diagnostic validity of mental illness in the current DSM classification system. Due to lack of psychotropic research on youth, the current DSM system is flawed, Lakhan and Hagger-Johnson noted. Ethical challenges such as reluctance to enroll children in psychotropic clinical trials and the lack of “well-designed”, placebo-controlled trials have traditionally been barriers to effective research. Increasingly, the idea of hands-on research with children is more palatable.

Lakhan and Haggar-Johnson remind us that “for the first time, we can begin to record and measure, rather than assume, the impact of prescribed psychotropics on children and adolescents.” The final verdict — children and adolescents need accurate, age-appropriate data that does not exist today.

Reference

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

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  • Bill

    Interesting piece. The third point really struck me. So the medical establishment believes its unethical to test these drugs on children — yet it’s all right to prescribe them willy-nilly without testing? Hello, people! — don’t we see a problem here?

    • Dear Bill,

      I wrote on this issue for The Lancet Student last year:

      It is true that research done on children is ethically questionable but the medical community and critics should be aware that innovative non-invasive measures are being used worldwide to help make medications safer for children. The great myths in pediatrics — children are little adults and children can be prescribed a lower dose of the same drug — have been widely dispelled [Ref]. But, we must now measure pharmacokinetic, pharmacodynamic, and response effects across different age ranges and establish the true differences of drug effects on adult and pediatric populations. Perhaps virtual models can place us one step closer to this goal.

      You can read the full article here. I would like to know the public’s opinion on traditional clinical trials or using virtual models for testing medications on pediatric patients. Thank you.

      Sincerely,
      Shaheen

  • David Stein

    I agree Bill. They’d like to test children if society allowed it, but it’s not “in vogue” in the public sphere right now. You make a good point.

  • Courtney Sherman

    Thank you for your comments, Shaheen. Your article was quite interesting and your point astute. We should be well past the point where people recognize that children are not little adults, and be on a path to matching treatment to the specific ages and characteristics of the children involved. One-size-fits-all should never be a recipe for medical treatment of our children.

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  • Richard Kensinger, MSW

    Psychotropics are clerly overprescribed for persons under the age of 10, even 5. Foster kids w/ “behavioral dyscontrol”, are 5 X more likely to be placed on “drug cocktails”, often 5 at a time!

    I have very serious concerns about the schedule 2 controlled agents: the psychostimulants. The US prescribes 85% of the world market!

    Likewise, the neuroleptics are very often inappropriately used in young kids. For example, for “irritability” in those w/ autism. They are only clinically indicated for those who are psychotic. In the clinical literature on autism, I see no concordance between autism & psychosis!

    The neuroleptics at high doses & for long durations, show a range of serious side-effects, & adverse events, such as TD & NMS. Some of these conditions are irreversable & lethal.

    Rich

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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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