Sunday, November 26, 2006

Medicating the Mind of a Child

From loading iPods to popping uppers, all in a day's work for a ten year old these days. The New York Times has an interesting article on the "scant" evidence for psych medication for youngsters. Well, that's not stopping the Psychiatrists I know. Who ever let evidence interfere with treatment--especially when parents want the easy out?

Many psychiatrists and parents believe that such drug combinations, often referred to as drug cocktails, help. But there is virtually no scientific evidence to justify this multiplication of pills, researchers say. A few studies have shown that a combination of two drugs can be helpful in adult patients, but the evidence in children is scant. And there is no evidence at all — “zero,” “zip,” “nil,” experts said — that combining three or more drugs is appropriate or even effective in children or adults.

“There are not any good scientific data to support the widespread use of these medicines in children, particularly in young children where the scientific data are even more scarce,” said Dr. Thomas R. Insel, director of the National Institute of Mental Health.

I'm going to write something very unpopular: ADHD and many other pseudo-diagnoses, are largely the results of poor parenting. Rather than continue, I'll refer you to the work of Dr. John K. Rosemond and Dr. Rogers H. Wright, specifically the chapters "The Diseasing of America's Children: The Politics of Diagnosis" and "Attention Deficit Hyperactivity Disorder: What it Is and What It Is Not" in the book Destructive Trends in Mental Health. It is a worthwhile read. It is no longer politically correct to look to the parents when children misbehave. It is now the standard to heavily drug children and there is absolutely no evidence whatsoever that indicates any benefits. None. Zero. And yet, look what is happening:

Ms. Kehoe, who receives government financial and child-care assistance because her children are considered mentally ill, said she knew that there were risks to the drug cocktails. Both her sons are short and underweight for their age — a common side effect of stimulants — and she fears that the drugs have affected their health and behavior in other ways.

“But I don’t think the insurance would pay for it if the F.D.A. didn’t decide that children should use it,” said Ms. Kehoe, who herself takes psychiatric medication.

In fact, the drug agency has specifically warned against the use of Lamictal, one of the drugs Stephen takes, in children who, like him, do not suffer from seizures because in 8 out of 1,000 children the drug causes life-threatening rashes.

Stephen and Jacob’s psychiatrist did not reply to telephone messages left with an office secretary on three different days. Ms. Kehoe said that she asked him to speak to this reporter but that he refused. The boys have had 11 psychiatrists over the last three years, according to prescription records, and many more before that, Ms. Kehoe said.

Ms. Kehoe herself is medicated. Is it possible that Ms. Kehoe hasn't learned coping mechanisms and has taught her children the same maladaptive behaviors? Worse than this, though, are the physicians so willing to drug children when all evidence points to the fact that they simply don't work:

The use of two-medicine combinations in children is on much shakier ground. Even for single drugs, the effectiveness of some psychiatric medications in younger patients is questionable: most trials of antidepressants in depressed children, for instance, fail to show any beneficial effect. But hardly any studies have examined the safety or the effectiveness of medicine combinations in children. A 2003 review in The American Journal of Psychiatry found only six controlled trials of two-drug combinations. Four of the six failed to show any benefit; in a fifth, the improvement was offset by greater side effects.

“No one has been able to show that the benefits of these combinations outweigh the risks in children,” said Dr. Daniel J. Safer, an associate professor of psychiatry at Johns Hopkins University and an author of the 2003 review.

If the evidence for two-drug combinations is minimal, for three-drug combinations it is nonexistent, several top experts said.

“The data is zip,” Dr. Hyman said.

No matter the med, no doctor can tell you how a two or three-drug interaction will affect an adult's body--that includes statins, beta-blockers and anti-cholesterol meds to name three commonly prescribed medications. Now, imagine a child's developing mind being subjected to powerful brain-chemical altering medications.

One of my first patients in clinic was a guy who had been on Depakote and Lithium almost his entire adult life. He was a drooling mess. Now children are routinely given tranquilizers, stimulants, anti-convulsants, anti-depressants, etc. to moderate behavior.

This is a dangerous game being played on the minds of our children. No research exists supporting this invasive behavior by doctors. Children are walking experiments all to save parents and schools the difficulty of dealing with sensitive, challenging children.


Antoinette said...

Oh Dr. M you have hit such a sore spot with me I could write a comment the length of War and Peace. I have a lot to say on this subject, having seen so many young boys drugged to fit into the tiny mold we think everyone must fit. My nephew is the opposite of hyperactive, I have wondered if he might not be hypoglocemic because he is so lethargic. But he has been labeld ADD and put on Stretera. His mother just spouts the commercial that states "non-stimulating" and never read the list of side effects that go with the drug. Now this mild mannered, nice little boy has developed mood swings that make PMS look like a day in the park. He was labeled ADD by his school, and he takes the drugs only to help him get along in school. He never had behavioral problems at home or with family. In order to keep up in his classroom he has to be drugged. And no one considers that if a child must be drugged to get along in school there might be something seriously wrong with the school maybe? As I said I have a lot more to say but my keyboard is starting to melt from the steam shooting out of my fingers.

Dr. Melissa said...

It is outrageous, no question. The problem is philosophical at heart. So many people believe that solutions to problems are external--so a drug, person, thing will solve the problem. Rather than look inward and tap built-in resources and flexibility, people look outward.

These children will grow up very, very angry. Once they hit adulthood, if they haven't internalized the message that they are the problem and aren't actually brain-damaged by the medications, there will be hell to pay.