Psych meds and children—what parents need to know

Giving medicine to a childWe’ve all heard the stories in the news about Rebecca Riley, the 4-year-old who died in 2006 of an overdose of psychiatric medication. She made her first trip to a psychiatrist when she was two, because she was active and had trouble sleeping. She was diagnosed with bipolar disorder when she was only three–her ten-year-old brother and four-year-old sister had already been diagnosed with the same—and put on three different medications. By the time she died, she was taking more than ten pills a day. She got sick, and her mother, who was recently convicted in her death, gave her extra pills to make her sleep. Rebecca never woke up.

It’s easy to dismiss Rebecca’s case as an extreme, an outlier. But a paper published in the September 2007 edition of the Archives of General Psychiatry noted that there has been a 40-fold increase in the diagnosis of bipolar disorder in youth over the past decade, with widespread prescribing of medications for bipolar disorder that are not FDA-approved for children. The National Institute for Mental Health (NIMH) is studying children and adolescents diagnosed with bipolar disorder, and has found that in many cases, the diagnosis is overused or misused (in response, the American Psychiatric Association has developed a new diagnosis, temper dysregulation disorder, that it hopes will be used instead). This is very troubling.

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Data from the National Center for Health Statistics shows that in 2005-2006 (the most recent data available), 5 percent of American children ages 4-17 were prescribed psychiatric medication. That’s an awful lot of kids. The vast majority—89 percent–were treated for Attention Deficit Hyperactivity Disorder, or ADHD; over the past decade, the prescribing of ADHD medication to children under 18 has more than doubled. Here’s another startling statistic: in that same decade, the prescribing of antidepressants to children under 18 has quadrupled.

As scary as all this sounds, it’s important to remember that for many children, psychiatric medications can make a tremendous difference. I have seen it in my practice. For children with ADHD, medication can be the difference between doing well in school and failing, the difference between making friends and having no friends at all. For children with depression or anxiety, medication can change how they see the world. And for children who truly do have bipolar disorder and other serious psychiatric illnesses, medication can be a lifeline for them and their families.

sad little girlThe key is to be sure that psychiatric medications are used sparingly, carefully and responsibly in children. Here are some suggestions to make sure that happens:

• All children should have a thorough, careful evaluation before prescribing medications. Not all active or aggressive children have ADHD, let alone bipolar disorder, for example, and one quick visit with a doctor or the results of a questionnaire filled out by a teacher isn’t enough to sort things out. I get asked frequently by elementary school teachers to medicate children with behavioral problems; people seem to look to medication as a quick fix. But to really help kids, we need to really understand them. The choice of who should do the evaluation (pediatrician, psychiatrist, other mental health provider, neurologist) depends on the diagnosis that is being considered—but whoever does it should be licensed, reputable and have experience working with children. If you are considering medication for your child, talk to your doctor about the best way to proceed.

• Parents need to be aware of all the possible side effects. As with any medication, psychiatric medications can have side effects—and some can be serious. For example, in some children, selective serotonin reuptake inhibitors, or SSRI’s, may make them feel like killing themselves. While this is rare, and these medications are generally safe and effective, it’s important for parents to be monitoring their children closely. Parents should be fully educated on all the possible risks of medications, and told exactly what to do if they occur.

• Medication combined with therapy gives the best chance at success. Studies show that for most children, cognitive and/or behavioral therapy along with medication works better than either one alone. Therapy also allows for closer, more detailed monitoring—and can give support to family members coping with the fallout of mental illness.

• Children on medication should see their prescriber regularly. How often will depend on the medication and how long the child has been taking it. These visits are crucial, to monitor for side effects and for effectiveness. Parents should be wary of a practitioner who routinely gives refills without seeing their child.

• If a child isn’t getting better, or multiple medications are being prescribed, a second opinion may be a good idea. Sometimes it helps to have someone take a fresh look.

Psychiatric medications can be safe, and can improve a child’s life—but only when used wisely. For more information on medications used to treat mental health problems, visit the website of the National Institute of Mental Health.