Are antidepressants endangering our children?
Q.Antidepressants for school phobias, anti-psychotics for children who refuse to obey the rules. A generation ago, parents worried about giving their children too much Baby Aspirin. Today, psychiatric drugs rank among the top five medicines prescribed to Canadian children and teens.
A.Prozac-like drugs are being prescribed to children in emergency rooms and even walk-in clinics, with virtually no follow-up, and children are increasingly being put on not just one mind-altering pill, but two or three, including potent anti-psychotics that may have contributed to nearly 75 reported deaths in Canada in people taking the pills. Doctors once doubted children could even get depressed. Earlier ideas about depression centred on complex psychological states that doctors felt children couldn't experience - feelings such as guilt and worthlessness. In other words, says Toronto child psychiatrist Dr. Mark Sanford, little children had little problems. "It's hard to know how it was missed for so long." Today, it's widely accepted that children not only get depressed, they can suffer a wide range of mood disorders. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the "bible" doctors use to diagnose mental illness, contains an entire chapter devoted to disorders that typically first surface in childhood. They include conduct disorders ("often bullies, threatens or intimidates others"), oppositional defiant disorder ("often loses temper") learning disorders such as mathematics disorder and "disorder of written expression" (writing skills that fall below those expected given the child's age), and separation anxiety disorder. Preschoolers are being diagnosed with bipolar disorder, or manic-depressive illness - a diagnosis once reserved for adults. Some experts say the criteria have become so soft and slippery every normal childhood behaviour now runs the risk of being labelled a disorder that needs to be "cured" with a pill. But others say the growing list of sicknesses and symptoms is a positive sign doctors are finally paying attention to mental health problems in children. "In the past, a lot of those kids would have been in the gastro-intestinal clinic getting worked up for stomach aches," says one doctor. Panic disorders in kids were frequently misdiagnosed as epilepsy or heart problems. Today, the use of SSRI antidepressants in children is soaring. But just how many children truly need the drugs is murky. "The fact that 20 per cent of young people are being diagnosed with a major psychiatric illness (depression) that does not respond to conventional treatment (antidepressants) and the placebo response is so great begs the question, are we misdiagnosing this group of patients?" one doctor wrote in a recent electronic letter to the Canadian Medical Association Journal. Meanwhile, some parents of mentally ill children see a bitter irony. While healthy children may be getting drugs, parents of children so sick they think Walt Disney cartoon characters are real struggle for years to get doctors to take their concerns seriously so they can get the appropriate treatment.
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