Even babies getting treated as mentally ill

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Even babies getting treated as mentally ill

Prescriptions on the rise even though they haven’t been tested on children

Monday, April 25, 2005

Encarnacion Pyle

THE COLUMBUS DISPATCH

Doctors prescribed sedatives and powerful, mood-altering medications for nearly

700 Ohio babies and toddlers on Medicaid last summer, according to a Dispatch

review of records.

There’s no doubt that mentalhealth drugs can help troubled youngsters, whether

they’re on the government insurance program for the poor or not. But dozens of

advocates, child-welfare workers and psychiatrists interviewed by The Dispatch

question the wisdom of prescribing potent medications, most of which have never

been tested on kids, for so many young, vulnerable children.

‘‘It’s shocking, " said Dr. Ellen Bassuk, associate professor of psychiatry at

Harvard Medical School. ‘‘Who’s really being helped by these children being

drugged? The babies? Or their caregivers?

‘‘These medications are not benign; they can have dangerous side effects and

have to be closely monitored. "

Federal officials have long required that drugs be screened for safety in

adults. But less than one-fourth have been tested on children.

‘‘Kids are not little adults, " said Dr. Goetz, assistant medical

director for the state Department of Mental Health. ‘‘Children’s brains are

different. They don’t fully develop until after adolescence. "

That often leaves doctors with more questions than answers about the long-term

effects of many drugs on children.

Physical side effects can range from headaches, nausea and weight gain to heart

attacks, liver damage and sudden death.

Psychological effects remain a mystery. But several antidepressants carry

FDA-required warnings that they can increase the risk of suicide. Some

antipsychotics have caused learning problems in 3- to 6-year-olds.

‘‘It seems a growing number of yesterday’s wonder drugs, such as Adderall, have

turned into today’s suicide pills, " said Wissler, a parent advocate for

the Mental Health Association of Summit County.

In February, Canada pulled the attention-deficit hyperactivity drug from the

market, saying it was related to 20 sudden deaths. The U.S. Food and Drug

Administration reviewed those deaths last year and determined Adderall should

carry a warning that it not be prescribed to people with heart trouble.

A Westerville woman watched her daughter’s high spirits disappear under the

influence of Paxil, which she was taking for anxiety.

‘‘The stuff did not work for her, and it was in weaning her after only two

apparently ineffective weeks that we saw the horrifying effects we now know are

typical, " said Lucy, who asked that her full name not be used, to protect her

child’s identity.

Lucy noticed the drug’s effect 2½ years ago, the night of her daughter’s 11 th

birthday.

‘‘My wonderfully precocious child told me, ‘I don’t think it would be so awful

to die, except I couldn’t bear what it would do to you,’ " she said. ‘‘I’ve

never seen her so miserable and hopeless. "

Those scary days are long gone, but Lucy and her daughter can’t forget the

memory.

Drugs become first option

Many advocates worry that mental-health disorders are overdiagnosed and youths

aren’t given options such as counseling.

‘‘Medications only help control symptoms, " said Yvette McGee Brown, president of

the Center for Child and Family Advocacy at Children’s Hospital. ‘‘Counseling

helps children control their behaviors, feelings and thoughts. You can’t put

kids on a bunch of drugs, then take them off thinking they’ll know how to cope. "

Advocates are especially concerned about the very young.

‘‘Research shows that 0 to 3 are the most critical years for the development of

children and their success in the future, " said Amos, a member of the

Family Alliance to Stop Abuse and Neglect in New Jersey.

‘‘How do we know we’re not messing that up by starting children on one

medication, then adding on another and another, until their brains are

hyperaroused, overstimulated and permanently altered? "

But others say the more early intervention, the better.

‘‘The biggest public-health crisis facing the state and nation is the number of

children with mental illness who fail to receive any care or treatment, " said

Hogan, director of the Ohio Department of Mental Health.

‘‘It’s true children are more likely to get medication than counseling or other

behavioral therapy if they go to their pediatrician or family doctor. But at the

end of the day, meds are quite safe and effective. "

There is such a shortage of child psychiatrists that the wait often is three

months or more for an appointment. Many parents simply can’t wait that long, so

they take their kids to a family doctor.

One survey said as much as 70 percent of psychiatric drugs are prescribed by

family doctors.

Struggling youngsters lucky enough to get into the mentalhealth system are three

times as likely to receive therapy as to receive drugs, Hogan said. Research

suggests that children who receive both are more likely to be successful than

those who receive one or the other, he said.

Still, 80 percent of troubled youths nationwide fail to receive any help, said

Terry , executive director of the Ohio chapter of the National Alliance

for the Mentally Ill.

‘‘Psychotropic medications for young children should be used only when

anticipated benefits outweigh the risks, " said. ‘‘But we’d hate to see

doctors’ hands tied, because research shows that reaching children with mental

illness early significantly improves their long-term prognosis. "

Big profits in medications

Psychiatric medications are big business.

In 2002, drug companies made $12 billion in profits from antidepressants alone.

Those numbers continue to grow, largely because of increasing use on children.

Nationwide, the number of children using psychiatric medications tripled between

1987 and ’99.

But researchers say they don’t have the data to know whether kids are being

given risky combinations or dosages, practices experts say occur frequently.

Concerned by these issues, the Ohio departments of Mental Health and Job and

Family Services are reviewing two years of Medicaid claims for red flags,

including children who are on three or more mental-health drugs.

A consultant hired by the state will begin sending letters next month to

physicians whose practices raise concerns, said Margaret , a state

pharmacologist.

The consultant, Comprehensive Neuroscience, of White Plains, N.Y., has helped

several states, including Florida, where 442 doctors have received such letters.

Private insurance plans don’t report how psychiatric drugs are used by their

clients, but because Medicaid is government-run, more information is available.

Nearly 40,000 Ohio children on Medicaid were taking drugs for anxiety,

depression, delusions, hyperactivity and violent behavior as of July. For the

entire year, the Ohio Department of Job and Family Services paid out about $65.5

million for kids’ mentalhealth drugs.

Concerns also have been raised nationally about the high number of children

being medicated in foster care, residential treatment and youth prisons.

In Ohio, 31 percent of children ages 6 to 18 in foster and group homes took

mental-health medications in July. And 22 percent of children in detention were

on a psychiatric drug as of January. Many were on five or more.

Those who defend the use of medications on these youths note that they often

have been victimized.

‘‘A lot of these kids have been beaten, sexually assaulted and emotionally wrung

through the wringer, " said Moskow Sigal, executive director of the Mental

Health Association of lin County. ‘‘They have poor self-esteem, feel

unloved and suffer from severe psychiatric problems. "

Still, parent concerns have prompted other states to respond.

In Texas, Controller Carole Keeton Strayhorn criticized her state’s

child-welfare agency for spending as much as $4 million a year on mental-health

drugs without enough oversight. She also blasted the agency for giving children

drugs to make them docile and so ‘‘doctors and drug companies can make a buck. "

Some people think drugs are the cheapest, easiest way to subdue kids for

overburdened foster parents and understaffed residential centers. Most pills

cost from 2 cents to 17 cents, while child psychiatrists can earn more than $500

per day.

Others think some foster parents want children on drugs so they can get more

government money for being classified as a ‘‘treatment " or ‘‘therapeutic " home.

A few say the only way to solve the overmedication problem is to keep children

with their parents.

‘‘Only a parent, or another close relative, is likely to put up with difficult

behavior from a child, because only family loves that child enough to put up

with it, " said Wexler, executive director of the National Coalition for

Child Protection Reform in andria, Va.

Doctors may know the disease best, but parents generally know their children

best, Wexler said.

Even infants put on pills

Advocates are equally distressed by the high numbers of drugged-up infants. In

1994, 3,000 prescriptions for Prozac were written nationwide for children

younger than 1 year old, according to the Journal of the American Medical

Association.

Almost all psychiatric prescriptions for toddlers and preschool children are

‘‘off label " — without dosage recommendations and for conditions other than

those for which the drugs were created.

Physicians frequently ‘‘dose down " adult medications by adjusting for a child’s

weight.

At least 696 Ohio children who were newborn to 3 years old received

mental-health drugs through Medicaid in July. Hydroxyzine was prescribed most

often, with about three-quarters taking it.

The drug, a long-acting antihistamine, has many uses. It relieves itching caused

by allergies, controls vomiting and reduces anxiety. It’s given most often to

young children for its sedative effects.

‘‘It’s generally calming, has low side effects and is pretty inexpensive, " said

Bob Reid, pharmacy program director for Job and Family Services. ‘‘It’s a real

bargain. "

But Bassuk, the Harvard psychiatrist, says doctors should avoid giving babies,

especially those still in diapers, unnecessary medications.

‘‘Sure, there are drugs that make kids sleepy, but what’s the point if they

don’t have any medical purposes? " she said.

More than 90 of the children were on another antihistamine, 48 were taking

anti-anxiety medication and 28 were prescribed antidepressants, including Paxil,

Prozac and Zoloft, which have been found to increase suicidal thoughts and

behaviors in some children. Twenty-seven received Valium, and 18 were on

antipsychotics.

‘‘It’s troubling, " said Saros, executive director of lin County

Children Services. ‘‘How do doctors even determine that a 2-year-old is anxious?

There’s a reason they call it the terrible twos. "

But Martha Hellander, of the Child and Adolescent Bipolar Foundation in

Illinois, says she has seen babies who cry for hours, 2-year-olds who fly into

unprovoked rages and 3-yearolds who try to jump out of moving cars.

‘‘The medication is essential for these kids, " said Hellander, the group’s

research policy director.

Girl’s death haunts parents

Mike and Janet Hall, of Canton, can’t help wondering whether their daughter

would still be alive if they hadn’t agreed to medicate her.

died of a heart attack in January 1996, the morning after a doctor doubled her

daily dose of Ritalin.

The Halls say ’s firstgrade teacher pressured them to drug their

daughter when she was 6. She remained on medication for attention-deficit

hyperactivity disorder for years and died in her sleep six days before her 12 th

birthday.

‘‘I almost wish she had died 12 hours later at school, on their doorstep, " said

Mrs. Hall, 40. ‘‘They started this thing by telling us she had to be on

medication because she had a problem getting up out of her chair. What do they

expect from a 6-year-old? "

The day before she died, was ‘‘out of it " in the morning but seemed

fine later, Mrs. Hall said.

When her father tried to wake her the next morning, she didn’t move.

‘‘At first, we thought she had the flu, " Mrs. Hall said. ‘‘But then I noticed

she was cold and blue. "

They sued the company that makes Ritalin in January 2000, but the case was

thrown out because the statute of limitations had expired.

Today, the Halls warn other parents to research the pros and cons before placing

their child on psychiatric medications.

‘‘ used to tell me, ‘Mom, I’m going to be a firefighter or paramedic

because I’m going to save people,’ " Mrs. Hall said. ‘‘But who could save her?

No one. She was just a human guinea pig in a failed medical experiment. "

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