Rising use of psychiatric drugs on young stirs concern

`Good thing or bad thing? It may be a bit of both'

January 14, 2003|By Erika Niedowski | Erika Niedowski,SUN STAFF

The use of medications to treat emotional and behavioral problems in children and teen-agers more than doubled in the decade ending in 1996, new research shows, raising concerns about the long-term effects of some drugs that have not been studied in young people.

The research, appearing today in The Archives of Pediatric and Adolescent Medicine, found that the use of psychiatric drugs - which include antidepressants such as Prozac and stimulants such as Ritalin - doubled in one study group and tripled in two others.

The findings provide further confirmation of a trend toward more medication in the treatment of a range of mental illnesses in youths, such as depression and attention deficit hyperactivity disorder, the most common child psychiatric problem.

"There's no doubt in my mind there are more children receiving psychotropic drugs today than ever before in the United States," said Julie Magno Zito, associate professor of pharmacy and medicine at the University of Maryland School of Pharmacy and the study's lead author. "Until the 1980s, we hardly ever gave children psychotropic medications, with the exception of a very small proportion of children with very specialized medical needs. It's really a '90s phenomenon that this reflects."

The surge in psychiatric drug use can be viewed in two ways: as an encouraging sign that more children are getting help for treatable mental disorders or as a disturbing sign that they are being overmedicated, in some cases with drugs whose long-term safety has not been shown. Ritalin in particular has generated a backlash among some parents.

"The question becomes: Is it a good thing or a bad thing? It may be a bit of both," said Dr. Graham J. Emslie, chief of the division of child and adolescent psychiatry at the University of Texas Southwestern Medical Center.

900,000 youths studied

The study examined records of nearly 900,000 youths enrolled in a Medicaid program in a Midwestern state, a Medicaid program in a Mid-Atlantic state and a health maintenance organization in the Northwest.

The use of psychiatric drugs tripled from 1987 to 1996 in the HMO and the Mid-Atlantic Medicaid program, from 18.6 to 59.1 children per 1,000 and from 18.4 to 61.6 children per 1,000, respectively. In the Midwest Medicaid program, use doubled in the same period.

Overall, by 1996, about 6 percent of children studied had been prescribed at least one psychiatric medication.

The researchers found a substantial increase in the use of alpha-agonists, including Clonidine, which is sometimes given as a sleep aid to children who are taking stimulants.

"These are really adult anti-hypertension drugs that have in recent years been introduced to use in children," said Zito. "That's relatively new and not tested in children."

The effect of psychiatric drugs on children's developing brains is not fully known. The two most commonly prescribed classes - stimulants and antidepressants - have been studied the most.

"Across the different classes of medicine, there's a considerable range from almost no research to a fairly convincing body of research to support their use," said Dr. Mark A. Riddle, director of the division of child and adolescent psychiatry at the Johns Hopkins School of Medicine and one of the study's researchers.

Causes of increase

Riddle attributes the increase in part to a growing acceptance among clinicians that mental illness is, in fact, a disease that can respond to medical treatment - in the form of prescription drugs.

"There has been a sea change, I believe, in the way that physicians view mental problems or mental illness in the last 15 years," he said.

The introduction of new "easier-to-prescribe" medicines with fewer potential side effects, beginning with Prozac in the late 1980s, has also contributed to the increase, he said. Another factor is the drugs' manufacturers, who have vigorously marketed their products.

"Prior to 10 or 15 years ago, the pharmaceutical industry wasn't very interested," explained Riddle. "I think now they are."

More research urged

Emslie, of the University of Texas, said more research needs to be done to determine whether psychiatric drugs are being prescribed properly and what their long-term effects are.

"I think we probably need to take a step back and be a little more careful in diagnosing before prescribing medication," he said.

At the same time, Emslie said, psychiatric drugs have proved life-saving for many children with severe depression.

Said Riddle: "I think the important thing to remember is there are a lot of children out there with real psychiatric disorders. And although we would like to minimize the use of medicine to treat them, we want to be very careful that we don't deprive them of legitimate and effective treatments because we have some philosophy or belief or whatever that medicine's bad. Because these diseases, left untreated, are really bad."

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