Among the most emailed articles at the NY Times today is this one: “Use of Antipsychotics by the Young Rose Fivefold.” It begins, “The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday.” I can hear the clucking now. What is this nation doing to its children? But the closest depiction of truth cannot lie at the top of an inverted pyramid article, in the lead. One comes nearer to it only by drilling down.
In the new study, about a third of the children who received antipsychotics had behavior disorders, which included attention deficit problems; a third had psychotic symptoms or developmental problems; and another third were suffering from mood disorders. Over all, more than 40 percent of the children were also taking at least one other psychiatric medication.
“We feel the medications are effective in children with bipolar and have some data to show that,” said Dr. Melissa DelBello, an associate professor of psychiatry at the University of Cincinnati, who has done several studies of the drugs.
Dr. DelBello said that the field “desperately needs more research” to clarify the effects of the antipsychotic drugs but that many children struggling with bipolar disorder got more symptom relief on these drugs than on others, allowing psychiatrists to cut down on the overall number of medications a child is taking.
Lisa Pedersen of Dallas, the mother of a 17-year-old boy being treated for bipolar disorder, said he was unpredictable, hostile and suicidal before psychiatrists found an effective cocktail of drugs, which includes a daily dose of antipsychotic medication.
“Believe me, I would never choose having him on these meds,” Ms. Pedersen said in a telephone interview. “It’s not fun watching a child deal with the side effects. But finding the right combination of medicine has made his life worth living.”
Yet this process is one of trial and error for many children. Ms. Pedersen said her son had responded badly to the first two antipsychotic drugs he received. And some experts think the way that psychiatric drugs are prescribed is obscuring any understanding of underlying disorders and the optimal treatments.
“If you’re going to put children on three or four different drugs, now you’ve got a potpourri of target symptoms and side effects,” said Dr. Julie Magno Zito, an associate professor of pharmacy and medicine at the University of Maryland.
Dr. Zito added, “How do you even know who the kid is anymore?”
When do you put your kid on a drug like Ritalin or Adderall?
When you know his ADD or ADHD will otherwise hopelessly undermine his education.
When do you put your kid on an antidepressant that means you’ll be watching her closely for a couple of weeks for suicidal thinking?
When you are pretty damned sure that her life is at greater risk should you do nothing.
When do you put your kid on an antipsychotic with potentially nasty side effects?
When he’ll never have a normal life unless you can get his symptoms under control.
When do you put your kid on a cocktail of drugs that make her very personality seem like a chemical experiment?
When you recognize that your child’s real personality has already been missing in action, maybe for years, replaced by the manifestations of a disorder that is already brain chemistry gone wrong, when talk therapy can’t even start to help until brain chemistry is at least partly righted, and most of all when your child’s life borders on the unlivable otherwise.
It is easy to lament the five-fold increase in the use of antipsychotic medications in young people. But it is impossible to judge, from the outside, the decisions of individual parents and physicians who struggle to find solutions so that troubled young people can aspire to livable lives imbued with a measure of hope.
The search for what works for an individual child is often a matter of trial and error, of weighing the costs and benefits of any course of treatment, of hoping that someday we’ll be able to ascertain just what is out of kilter and how to right it. Solutions are hardly ever found solely in pill bottles, but some solutions in difficult cases, if there are solutions to be had, have as an essential component powerful medications we would otherwise not think of giving to our children.
To those who say, “I can’t imagine giving my children drugs like these,” I can only say, and this from the heart, “I hope you never have to.”