Anti-depressants and stimulants such as Prozac and Ritalin have provided badly needed relief for millions of patients suffering from depression and attention-deficit and hyperactivity disorders. These are powerful, mind-altering drugs that can deliver powerful cures. Yet there is something deeply unsettling about a series of recent studies that suggest that doctors may be recklessly overusing these medicines in children. It's time to put on the brakes--and to ask companies to do the research needed to prove that the drugs are safe for kids.
On Mar. 20, the White House announced an initiative to slow the steep increase in psychiatric drug use in children. The initiative was prompted by a February study in the Journal of the American Medical Association (JAMA) that examined three medical programs. It found that stimulants, antidepressants, and antipsychotics were being prescribed to as many as 1 1/2% of children only two to four years old. The study also found that use of stimulants, such as Ritalin, tripled from 1991 to 1995, and the use of antidepressants doubled.
For the pharmaceutical industry, this ought to mark the end of a long free ride on the use of psychiatric drugs in children. One reason for the concern about increasing use of psychiatric drugs is that few have been tested in children. Researchers don't know if the drugs have adverse effects in kids or if long-term use could be dangerous. But companies have no incentive to test their products in children. Once drugs are shown to be effective in adults and are approved by the Food & Drug Administration, doctors are free to prescribe them to anyone--including kids.
Eli Lilly & Co., the maker of Prozac, said in a Mar. 20 statement that it "has always stood for appropriate utilization of its medications, and this is especially crucial where children are involved." But the company added that "far too little is known about the emerging field of pediatric behavioral health." Novaartis Pharmaceuticals says it supports the use of "behavior modification and counseling" along with its drug Ritalin.
The JAMA study is only the latest cause for alarm. Last year, a survey of doctors by the University of North Carolina at Chapel Hill found that 72% had prescribed Prozac or a similar drug to children under 18 years old. Yet only 8% of the doctors said they had received adequate training in the treatment of childhood depression. In an analysis of Michigan Medicaid claims, researchers identified 223 children who were diagnosed with attention-deficit/hyperactivity disorder. While 60% of the children were receiving psychiatric drugs, only a quarter were receiving psychological treatment. The children were three years old or younger.
These findings raise two fears: One is that children who might be better served by therapy are being sent away from their doctors' offices with a prescription for a bottle of pills. Another is that drugs may be given to unruly kids who aren't sick at all but who need more help from their parents. Drugs are a quicker and cheaper fix than therapy or parental counseling. But they may be doing long-term damage to thousands or even millions of American children.
VULNERABLE. Experts in children's drugs are especially concerned. When Joseph T. Coyle, chairman of the psychiatry department at Harvard Medical School, polled a group of 35 such experts, 28 of them reported that they never use these drugs or save them for rare occasions. "Early childhood is a time of tremendous change for the human brain," Coyle warns. Studies in rats have shown that altering brain chemistry in the young leads to significant brain changes and memory deficits in adults. That's why Coyle urges extensive new studies.
The White House initiative includes plans for a nationwide, taxpayer-funded study of the use of Ritalin in children under the age of six. But the government can't solve--or fund--this problem alone. The FDA has asked seven drugmakers to study antidepressants in children 7-18 years old. The pharmaceutical industry needs to go ahead with this research as soon as possible. America's children are now unwitting guinea pigs in a vast, unplanned experiment. We need to end this experiment before it's too late.