There are more children and adolescents using prescription medication than ever before
By DANIELA BAYER
In the last 20 years, the use of antidepressants in children increased 4 to 10 fold, depending on the child's age group, country of residence, and laws related to consumer-direct advertising of antidepressants. In the United States, one in five children on antidepressants are not meeting diagnostic criteria for depression. Most antidepressants are prescribed by general practitioners. Managed care promotes this behavior by rewarding time spent prescribing medication over time spent providing psychological assessment, observation, and therapy. Children who have dysfunctional relationships with parents are at the highest risk for overmedication with multiple prescriptions of stimulants, mood stabilizers and antipsychotics.
Medications are often used for purposes other than those for which they were designed and clinically tested. In the last 10 years, medications for ADHD, antipsychotics, antidepressants, and anti-epileptics registered the largest increase in prescriptions. In the United States, female students are more likely than male students to receive ADHD medications and antidepressants, and 90 percent of children with ADHD take medication. In half of cases, it is the school that recommends to the parents that their child be on medication for hyperactivity or lack of attention. The most frequently prescribed medications to children for mental and behavioral disorders are stimulants like Ritalin, antidepressants like Prozac, and antipsychotics like Abilify. Boys are 10 times more likely than girls to be diagnosed with ADHD and twice as likely to be diagnosed with learning disabilities. In the U.S., there are 1 million children on Ritalin, and 75 percent of them are boys.
The medications alter the child's behavior, learning and social interactions, and there is always the possibility of developing serious health problems in adulthood in response to taking age-inappropriate psychotropic drugs. Many new types of medications, like selective serotonin re-uptake inhibitors (SSRI) have not been in use long enough to provide evidence and support for a safe long-term use in children. In 2004, the U.S. Food and Drug Administration issued a Public Health Advisory about the use of antidepressants and heightened risk of inducing suicide. Doctors must use the lowest effective dose of medication and closely monitor safety and effectiveness. Psychotic drugs cause severe side effects in children, including metabolic complications and neurological problems. The primary safety issue for antidepressant medications in youth pertains to mood-related adverse effects. Valproate used for bipolar disorder in young children has been linked to polycystic ovary syndrome in adolescent girls. Antipsychotics prescribed to treat aggression, agitation, mood dysregulation, psychosis and self-injury in preschoolers carry the risk of inducing Tardive Dyskinesia, which is a difficult health condition.
Certainly, there are situations when the use of psychotropic drugs in children and young adults is warranted because the psychological disorder is severe and affects the individual's quality of life. However, in most cases, nonpharmacological options like therapy, counseling, nutrition and physical activity are safer and should be explored first. Children are vulnerable. They are not yet fully developed psychologically, neurologically and mentally, and depend on their parents and guardians for love and maturity. They need to be protected from abusive and harmful practice.
We adults are responsible for creating conditions for children in which they can succeed. This means also stopping overreliance on psychotropic medications and providing better alternatives with compassion and discipline. Children have a right to be nurtured and treated with respect.
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