Too many young children are medicated with powerful drugs

Recently while cleaning out my office in anticipation of my new job, I discovered that I had unknowingly been witness to to an historic moment in child psychiatry. I found a binder from a course I had taken in June of 2001 sponsored by Harvard Medical School on Major Psychiatric Illnesses in Children and Adolescents.

Though I did not remember until I looked at my scrawled notes in the margins, on Saturday June 9th I attended a lecture given by Janet Wosniak entitled “Juvenile Bipolar Disorder: An Overlooked Condition in Treatment Resistant Depressed Children.”

Little did any of us at the lecture know at the time that, largely as a result of Dr Wosniak her close colleague Joseph Biederman’s ideas, we would over the next nine years see a 4,000 percent increase in diagnosis of this “overlooked condition.” These children were described as irritable with prolonged, aggressive temper outbursts that she called “affect storms.” Some children were as young as 3 and over 60% were under age 12.

As this was in a sense a new disease, there were no controlled treatment trials. Wozniak described how she and Biederman reviewed charts of children seen with this constellation of symptoms in a psychopharmacology unit from 1991-1995. Patients received tricylics, stimulants, SSRI’s, and mood stabilizers. Neuroleptics were used in 10% of visits. Mood stabilizers seemed to be the most effective, SSRI’s seemed to be associated with risk of inducing mania. Wozniak did not mention atypical antipsychotics.

So here we have a perfect storm. A new disease with no clearly identified treatment. A new drug. Between 2000 and 2010 six atypical antipsychotics, Clozaril, Seroquel, Zyprexa, Risperdol, Abilify and Geodon were approved for treatment of pediatric bipolar disorder. The number of prescriptions for atypical antipsychotics for children and adolescents doubled to 4.4 million between 2003 and 2006. Prescribing of antipsychotics for two to five year olds has doubled in the past several years. Atypical antipsychotics are among the most profitable class of drugs in the United States.

It is not surprising that these powerful drugs are effective at controlling the explosive behavior associated with what Drs Wozniak and Biederman labeled as bipolar disorder(and is currently being redefined as Temper Dysregulation Disorder in an attempt to undo some of the damage of the storm). But this perfect storm may have prevented us from understanding these children in a way that leads to meaningful interventions.

While this storm was brewing, across the ocean in London, Peter Fonagy, Miriam Steele and colleagues were discovering, in the London Parent Child Project, that a parents capacity to reflect upon and understand her child’s experience helps that child learn to regulate strong emotions. Subsequent research has shown that child may be born with a genetic vulnerability for emotional dysregulation, but interventions that address family conflict and support relationships protect against this vulnerability and facilitate emotional regulation at the level of gene expression and biochemistry of the brain.

My hope is that this storm is clearing. Our culture, realizing the potential harm of medicating so many young children with powerful drugs that have serious side effects, may now be open to new ways of thinking about these “irritable” children Dr. Wosniak described that June day 9 years ago.

Claudia M. Gold is a pediatrician who blogs at 
Child in Mind and is the author of Keeping Your Child in Mind.

Comments are moderated before they are published. Please read the comment policy.

  • http://www.facebook.com/halfemptywallet DianaW.

    I feel so many doctors just throw prescriptions around like nothing now, well not like nothing. But by giving the strongest prescriptions, they think it’ll kill off whatever and save both their time of coming back for a free followup? #assuming

    GenY-er, definitely took a lot lot of medication and antibiotics as a kid. Mom realized later that I keep getting sicker cause these antibiotics actually killing off healthy cell? And I kept growing weaker in a way, but I’m better now….using antibiotics only if its extremely situations now haha

    example of sensitivity….when I get papercuts, random hurts, or bug bites they always go the extreme now with infections. And I’m so much more sensitive to air, and random environments…..or are these all situations of getting older? ;)

  • Doc99

    “…We don’t need no education
    We dont need no thought control
    No dark sarcasm in the classroom
    Teachers leave them kids alone
    Hey! Teachers! Leave them kids alone!
    All in all it’s just another brick in the wall.
    All in all you’re just another brick in the wall.

    I don’t need no arms around me
    And I dont need no drugs to calm me.
    I have seen the writing on the wall.
    Don’t think I need anything at all.
    No! Don’t think I’ll need anything at all.
    All in all it was all just bricks in the wall.
    All in all you were all just bricks in the wall.”

    R. Waters, “The Wall”

  • http://www.pacificpsych.com/ pacificpsych

    “My hope is that this storm is clearing. Our culture, realizing the potential harm of medicating so many young children with powerful drugs that have serious side effects, may now be open to new ways”

    My friendly advice: don’t hold your breath. Prolonged anoxia is incompatible with life.

    The madness that has overtaken psychiatry–can it be cured? When I see the terms “medcheck” and “med management” disappear from the vocabulary, I’ll know something has changed.

    Got to keep trying. But I don’t think we’ll reach the promised land in our lifetime.

  • http://hematopoiesis.info/ Alexey

    I recommend to watch a documentary: Psychiatry – the industry of death –
    http://video.google.com/videoplay?docid=-30073771927921128#

    and video embedded in this post -
    http://www.cchrint.org/2010/08/17/people-power%E2%80%94drug-money/

  • http://hematopoiesis.info/ Alexey

    Also, watch statistics here -
    http://www.cchrint.org/videos/

  • sharon.a.wander

    As a Pediatrician: Yes, children from young ages suffer from depression, schizophrenia, can’t sleep ,up all night, hear voices, different voices, have school phobia, around other children, because of this many mothers find home schooling is best and do not subject their children to chaos in the public school system and do not put their children in the hands of psychologist/psychiatrists for the psycho meds.

    • http://www.facebook.com/halfemptywallet Diana W.

      Interesting…..but does home schooling help those kids?

      I’m not as bad, but I definitely have seasonal depressions and ADHD,

Most Popular