Let them eat Prozac...
Kids all have one thing in common: every generation that comes along is–at least according to their adult keepers–worse than the one that came before: more rebellious, less attached, more depressed, less capable, more disturbed and so on.  Nowadays, kids are said to suffer from frightening rates of ADHD, depression, anxiety, and autism.  Recently, the FDA approved the use of the drug Prozac for the treatment of children diagnosed with depression and obsessive-compulsive disorder.  In reality, of couse, this drug (and a host of others) had been used with kids since 1987 without formal approval.   Indeed, the use of psychotropics among children and adolescents has more than doubled in the last decade–nearly equaling use in adults in spite of the fact that less than a handful of these chemicals has actually been granted approval as "safe and effective."  Now, scientists are finding that the antidepressant may affect growth in kids–in particular, making them shorter and weigh less.  More importantly, virtually nothing is known about the effect of the drug on brain development.

Williams, J. (April 2003).  Prozac before puberty.  Psychology Today, 36, 2, 14.

The Middle Class Addiction to Attention Deficit Disorder . . .
Are you wonder if America's children are over medicated? Well, consider the following information which appeared recent in the American Journal of Public Health:

	Ritalin use among children is up from 900,000 in 1990 to 5,000,000 in 2000.
	While researchers estimate that as many as 3 to 5% of America's kids may have the so-called disorder, the same research shows that in some schools 6 times as many kids are taking the drug.
	The problem seems to be particularly pronounced in wealthy US communities where parents may be giving the medication to their children in a misguided attempt to give them a competitive edge in school.

Carle, E. (2000). ADHD for Sale. Psychology Today, 32(3), 17.

Here are some other little factoids about Ritalin:

	350 million doses of Ritalin are taken in the US every day! That's one and a half for every man, women, and child in the country.
	Surveys indicate that 3-8% of high school seniors have used the drug without a prescription.
	Data from school surveys, poison control centers, and emergency rooms indicates a dramatic increase in the drug's abuse since 1990.

Mertl, M. (2000). Running on Ritalin. Psychology Today, 33(5), 11.

Drugging our Children: The Lack of Data is Fatal
If anyone would know about the effectiveness of psychotropic drugs in the treatment of children it would be John S. Lyons, Ph.D. For the last several years he's traveled the country and participated in several thousand case reviews at more than 200 program sites. He reports finding that 80-90 percent of children in these treatment programs are on at least one medication and nearly half are on two or more! At the same time, however, he notes, "There is no evidence of efficacy of the other (meaning with the exception of Ritalin) commonly used medications for the treatment of any disorders of childhood." He notes in particular the widespread use of neuroleptic drugs–the most powerful psychotropic agent on the market. Federal agencies and the medical profession appear to conspire in this unethical practice given that current law does not restrict physicians from prescribing drugs to children that have not been proved safe or effective for kids and medical professionals seem willing to prescribe in spite of the lack of evidence. With two such powerful forces working in concert, one has to wonder who will stand for the children?

Lyons, J. (1999). A call for outcomes data: psychopharmacology with children. Outcomes and Accountability Alert, 12.

So you the doctor says your kid needs to take a neuroleptic, eh?
As reviewed on this website, psychotropic drugs of all sorts are being prescribed with increasing frequency to children and adolescents in spite of a dearth of evidence regarding safety and efficacy. No where is this practice more troubling than in the use of neuroleptic drugs. Of course, a primary concern for using such powerful drugs is the unknown effects they may have on a developing nervous system. In this study, researchers Wudarsky et al. investigated the effect of neuroleptic drugs–including an "atypical" neuroleptic–on the endocrine system and found that they resulted in significantly elevated prolactin levels–the hormone that regulates breast milk secretion during pregnancy. Indeed, other research finds that prolactin is linked to sperm and breast milk production and that high levels of the hormone lead to decreased sexual desire.

Wudarsky, M. et al. (1999). Elevated prolactin in pediatric patients on typical and atypical antipsychotics. Journal of Child and Adolescent Psychopharmacology, 9, 239-45.

Pirisi, A. (2000). Once is enough. Psychology Today, 33(5), 16.

So you want to put your kid on an SSRI, eh?
As reviews cited on this website demonstrate, there has been a marked increase in the prescription of SRI's to children. Nowadays, this class of drugs is used in children diagnosed as autistic, OCD, MDD, and social phobia. Other reviews have found little or no evidence for the safety or efficacy of these drugs in use with children. In short, the effects are unknown. Now researchers have found that exposure to these chemicals in young rats changed their brains in ways that persisted into adulthood long after the drug was discontinued! The researchers point out that the drugs may affect synaptogenesis (the formation of critical connections between cells in the brain) and other neurodevelopmental processes when they are administered at critical periods in early life. The question is, "Why are these drugs being used at all given the lack of knowledge presently available to practitioners and the public?"

Wegerer, V. et al. (1999). Persistently increased density of serotonin transporters in the frontal cortex of rats treated with fluoxetine during early juvenile life. Journal of Child and Adolescent Psychopharmacology, 9, 13-24.

More Info on drugging kids . . .
Biological psychiatrists have implicated the thalamus in obsessive-compulsive disorder (OCD). While OCD frequently has its onset during childhood, no study prior to this one has measured neuroanatomical changes in the thalamus of patients with OCD near the onset of illness, and before and after treatment. The researchers found that thalamic volumes were significantly greater in treatment-naive patients with OCD than in controls but declined significantly after paroxetine monotherapy to levels similar to controls. Decrease in thalamic volume in patients with OCD was associated with reduction in OCD symptom severity. The researchers claim that the findings provide evidence of thalamic abnormalities in pediatric OCD and further suggest that paroxetine treatment may be paralleled by a reduction in thalamic volume. HOWEVER, these reductions may not be specific to paroxetine treatment and could be due to a more general treatment response, and/or spontaneous improvement in symptoms. Moreover, while portrayed as a good thing, since the study claims that the thalamus of OCD patients is too large and 12 weeks of treatment shrunk the brain region to normal size, one has to wonder what happens to the brain after 12 weeks, say in lengths of treatment more typical for this class of drugs (e.g., 50, 100, 200 or more weeks of brain atrophy).

Gilbert AR, Moore GJ, Keshavan MS, Paulson LA, Narula V, Mac Master FP, Stewart CM, Rosenberg DR. (2000). Decrease in thalamic volumes of pediatric patients with obsessive-compulsive disorder who are taking paroxetine. Arch Gen Psychiatry, 57(5):449-56.

Rx's for Kids, "On the Rise" Study Shows
Even though anti-depressant medications have never been licensed for use with children, a study which appeared in the Journal of the American Medical Association found that their use is on the rise among preschoolers (ages 2 to 4). Analyzing the records of 200,000 children, the researchers noted a 2 to 3 fold increase in the use of stimulants, anti-depressants, and clonidine. In an accompanying editorial, Dr. Coyle from Harvard Medical School wrote, "Given that there is no empirical evidence to support psychotropic drug treatment in very young children and that there are valid concerns that such treatment could have deleterious effects on the developing brain, the reasons for these troubling changes in practice need to be identified." Really? Is the cause so difficult to ascertain given the targeting of primary care doctors and pediatricians by pharmaceutical company representatives?

JAMA, 283, 1025-1030, 1059-1060.

Rx's for Kids, "On the Rise": Primary Care Docs Rush to Defend Themselves
In an article in the latest issue of Pediatrics, researchers surveyed primary care doctors regarding their prescription of psychotropic drugs to children and reported, "Most Primary Care Physicians Do Not Medicate Depressed Children." However, on closer examination, the data reveal that a significant percentage (23-52%) of doctors routinely prescribe anti-depressants to children in spite of no drug being tested, found safe or efficacious, or licensed for kids! Family physicians were twice as likely to prescribe as pediatricians! The bottom line: consumer beware: you may inadvertently be exposing your children to a legal drug pusher.

Ruston, J.L. et al. (2000). Journal of the Ambulatory Pediatric Association, 105, 957-62.

Ritalin Redux: More Money = More Drugs
The industry says that attention deficit disorder is not overdiagnosed and that Ritalin and other stimulant medication is not overprescribed. You be the judge:

	Since 1990, the number of children and adults diagnosed ADD has risen from 900,000 to about 5 million.
	Since 1990, there has been a 700 percent increase in the amount of Ritalin produced in the US.
	Males are much more likely to be diagnosed and given medication relative to females.
	White, middle-to-upper-class kids are more likely to be diagnosed and given the drug that minorities.

Diller, L. (1999). Running on Ritalin. Family Therapy Networker, 23(3), 30-31.

Colorado Reigns in Kiddy Drug Pushers (called teachers) Operating in the Schools
In a move criticized by mental health experts, the state Board of Education in Colorado is discouraging teachers from recommending the use of prescription drugs for students. The board this month voted 6-1 in favor of a proposal that encourages "school personnel to use proven academic and/or classroom management solutions to resolve behavior, attention and learning difficulties." "We cannot ban Ritalin or any other drugs," said board member Patti Johnson, who proposed the resolution, "our intent is to give parents the authority with their medical doctor to make decisions and not be pressured by any school official to put their child on this drug." Parental concerns about such drugs were heightened because of the discovery that Columbine High School gunman Eric Harris was taking Luvox, an antidepressant, prior to the April 20 massacre in which 15 people died. Boulder Valley School District Deputy Superintendent Mack Clark said, "We’re educators here; we’re not medical personnel. We can only describe behaviors that impact the child’s learning. It’s a shame we’ve put ourselves in a policy conversation that tries to simplify a very complex set of issues." (AP)

For taking a stand that most talk therapists are no longer willing to take–that is, recommend that their clients take advantage of proven psychotherapies to resolve their problems rather than opt for psychotropic drugs–the Colorado State Board of Education receives the I.S.T.C. "Seal of Approval Award."

The Treatment of Supposedly "Bipolar" Kids
It's a popular and growing practice: giving drugs that have no proven efficacy or safety record to children. Now, research shows that the practice of giving valproate to kids supposedly suffering from bipolar affective disorder can have serious consequences. To begin girls and young women given the drug had an 80% prevalence of obesity and polycystic ovary disease. Lovely isn't it? That's not all though, 48% of the girls given the drug as an alternative to more "established" treatments for supposed bipolar disorder developed testosterone levels that we 2 or 3 standard deviations above the control group. Isn't nice that the medical profession is experimenting on kids?

Vainionpaa, L.K. et al. (1999). Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Annals of Neurology, 45, 444-50.

Why the Use of Psychotropic Medications in the Treatment of Children and Adolescents is in Most Cases UNETHICAL!

At an alarming rate, adolescents and children are being placed on various psychotropic medications for the treatment of various supposed psychiatric disorders. A recent review of the research strongly suggests that the practice is unethical, ineffective, and potentially dangerous. Researchers Fisher and Fisher (1997), recently reviewed the literature on the use of psychotropic medications in the treatment of depression, anxiety, and bipolar disorders and concluded that, "There is no scientific evidence that the major drugs widely prescribed for depressive, manic-depressive, and depressive symptoms are superior to placebos" (p. 317). In addition, they noted that antidepressants may cause sudden death in children and troubling side effects." They recommend that mental health professionals stop referring children and adolescents to psychiatrists and pediatricians for the pharmacological treatment of depression, anxiety, and bipolar disorders. For clinicians who argue that such treatment is justified because of the lack of other effective treatments, the authors site ethicist Roy, "When there is uncertainty or definite doubt about the safety or efficacy of an innovative or established treatment, there is, not simply may be a higher moral obligation to test it critically than to prescribe it year-in, year out with the support of custom or of wishful thinking" (p. 311).

Fisher, R., and Fisher, S. (1997). Are we justified in treating children with psychotropic drugs? In Fisher, S., and Greenberg, R. Eds.). From Placebo to Panacea: Putting Psychotropic Drugs to the Test. New York: Wiley.

Fisher and Fisher (1997). APA Monitor, 28(7), 6.

Medication in the Inpatient Treatment of Children with "Conduct Disorder": NOT!
Children who make it into the hospital as a result of their negative social behavior are frequently placed on medication. In this study of boys and girls, ages 9-17, who were hospitalized because of chronic and severe aggression, researchers examined the efficacy of lithium as compared to a placebo medication. Nearly half of those studied (48%) had a therapeutic response to the placebo medication and simply being in the hospital! Indeed, researchers Malone, Luebbert, Delaney, Biesecker, Blaney, Rowan, and Cambell (1997) found that lithium was no more effective than placebo in the treatment of chronically and severely aggressive children and that "behavioral improvement may be attained by environmental change alone." The authors of the monograph note that the findings argue against the fairly standard practice of immediately medicating children upon hospitalization. Interestingly, the design of the study suggests that a "halo" effect may be responsible the observed changes in the children as hospital staff were asked to observe and rate the children's behavior during the course of the study. Perhaps the children began acting differently in part because those around them began expecting something different to happen.

Malone, R.P., Luebbert, J.F., Delaney, M.A., Biesecker, K.A., Blaney, B.L., Rowan, A.B., and Campbell, M. (1997). Nonpharmacological response in hospitalized children with conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 242-247.

Clonidine for Children diagnosed as ADHD: NOT!
There is a growing trend of using clonidine either alone or in combination with stimulant medication in the treatment of children diagnosed with ADHD. Even though there is no controlled, scientific research support for the practice over 100,000 children have been placed on this medication. In 1995, there were 20 cases of adverse reactions including four deaths of children taking the drug. This research report documents four more cases who were taking a combination of stimulant medication and clonidine. Missed doses may lead to severe withdrawal symptoms. Children with a history of cardiac, vascular, or renal disease are at particularly high risk for complications.

Cantwell, et al. (1997). Case study: Adverse response to clonidine. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 539-544.