Independent Perspective News - Medicating Young Minds

Drugs have become increasingly popular for treating kids with mood and behavior problems. But how will that affect them in the long run?

Getting by is hard enough in middle school. it's harder still when you've got other things on your mind—and Andrea Okeson, 13, had plenty to distract her. There were the constant stomach pains to consider; there was the nervousness, the distractibility, the overwhelming need to be alone. And, of course, there was the business of repeatedly checking the locks on the doors. All these things grew, inexplicably, to consume Andrea, until by the time she was through with the eighth grade, she seemed pretty much through with everything else too. "Andrea," said a teacher to her one day, "you look like death."

The problem, though neither Andrea nor her teacher knew it, was that her adolescent brain was being tossed by the neurochemical storms of generalized anxiety, obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD)—a decidedly lousy trifecta. If that was what eighth grade was, ninth was unimaginable.

But that was then. Andrea, now 18, is a freshman at the College of St. Catherine in St. Paul, Minn., enjoying her friends and her studies and looking forward to a career in fashion merchandising, all thanks to a bit of chemical stabilizing provided by a pair of pills: Lexapro, an antidepressant, and Adderall, a relatively new anti-ADHD drug. "I feel excited about things," Andrea says. "I feel like I got me back."

So a little medicine fixed what ailed a child. Good news all around, right? Well, yes—and no. Lexapro is the perfect answer for anxiety all right, provided you're willing to overlook the fact that it does its work by artificially manipulating the very chemicals responsible for feeling and thought. Adderall is the perfect answer for ADHD, provided you overlook the fact that it's a stimulant like Dexedrine. Oh, yes, you also have to overlook the fact that the Adderall has left Andrea with such side effects as weight loss and sleeplessness, and both drugs are being poured into a young brain that has years to go before it's finally fully formed. Still, says Andrea, "I'm just glad there were things that could be done."

Those things—whether Lexapro or Ritalin or Prozac or something else—are being done for more and more American children. In fact, they are being done with such frequency that some people have justifiably begun to ask, Are we raising Generation Rx? Just a few years ago, psychologists couldn't say with certainty that kids were even capable of suffering from depression the same way adults do. Now, according to PhRMA, a pharmaceutical trade group, up to 10% of all American kids may suffer from some mental illness. Perhaps twice that many have exhibited some symptoms of depression.

Up to a million others may suffer from the alternately depressive and manic mood swings of bipolar disorder (BPD), one more condition that was thought until recently to be an affliction of adults alone. ADHD rates are exploding too. According to a Mayo Clinic study, children between 5 and 19 have at least a 7.5% chance of being found to have ADHD, which amounts to nearly 5 million kids. Other children are receiving diagnoses and medication for obsessive-compulsive disorder, social-anxiety disorder, post-traumatic stress disorder (PTSD), pathological impulsiveness, sleeplessness, phobias and more.

Has the world—and American society in particular—simply become a more destabilizing place in which to raise children? Probably so. But other factors are at work, including sharp-eyed parents and doctors with a rising awareness of childhood mental illness and what can be done for it. "While we don't know exactly why the incidence of psychopathology is increasing in children and adolescents, it probably has to do with better diagnosis and detection," says Dr. Ronald Brown, professor of pediatrics at the Medical University of South Carolina.

Also feeding the trend for more diagnoses is the arrival of whole new classes of psychotropic drugs with fewer side effects and greater efficacy than earlier medications, particularly the selective serotonin reuptake inhibitors (SSRIS), or antidepressants. These have been rolled out with highly visible, to-the-consumer ad campaigns.

While an earlier generation of antidepressants—tricyclics like Tofranil—didn't work in kids, SSRIS do. According to a study by Professor Julie Zito of the University of Maryland School of Pharmacy, use of antidepressants among children and teens increased threefold between 1987 and 1996. And that use continues to climb. Nobody, not even the drug companies, argues that pills alone are the ideal answer to mental illness. Most experts believe that drugs are most effective when combined with talk therapy or other counseling.

Nonetheless, the American Academy of Child and Adolescent Psychiatry now lists dozens of medications available for troubled kids, from the comparatively familiar Ritalin (for ADHD) to Zoloft and Celexa (for depression) to less familiar ones like Seroquel, Tegretol, Depakote (for bipolar disorder), and more are coming along all the time. There are stimulants, mood stabilizers, sleep medications, antidepressants, anticonvulsants, antipsychotics, antianxieties and narrowcast drugs to deal with impulsiveness and post-traumatic flashbacks. A few of the newest meds were developed or approved specifically for kids. The majority have been okayed for adults only, but are being used "off label" for younger and younger patients at children's menu doses. The practice is common and perfectly legal but potentially risky. "We know that kids are not just little adults," says Dr. David Fassler, professor of psychiatry at the University of Vermont. "They metabolize medications differently."

Within the medical community—to say nothing of the families of the troubled kids—concern is growing about just what psychotropic drugs can do to still developing brains. Few people deny that mind pills help—ask the untold numbers who have climbed out of depressive pits or shaken off bipolar fits thanks to modern pharmacology. But few deny either that we're a quick-fix culture, and if you give us a feel-good answer to a complicated problem, we'll use it with little thought of long-term consequences.

"The problem," warns Dr. Glen Elliott, director of the Langley Porter Psychiatric Institute's children's center at the University of California, San Francisco, "is that our usage has outstripped our knowledge base. Let's face it, we're experimenting on these kids without tracking the results."

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