Children are overprescribed medications for psychiatric conditions, psychologists and psychiatrics say.
In the United States, prescriptions for childhood antipsychotic drugs — prescribed to treat conditions such as bipolar disorder and schizophrenia — increased sixfold between 1993 and 2002, according to a study published the Archives of General Psychiatry in June 2006.
“Antipsychotic medications have substantially increased in the last 10 years, and caused a great deal of medical concerns for kids who are on them,” said Dr. Paul Ballas, a child psychiatrist in Philadelphia.
“Often I wonder, kids who are on antipsychotics, whether they are being prescribed for an appropriate diagnosis,” Ballas said.
Others are concerned about the use of stimulant medications, prescribed for conditions such as attention deficit hyperactivity disorder (ADHD).
Prescriptions for amphetamines for children increased 120-fold between 1994 and 2009, according to statistics from the United Kingdom's National Health Service, said Dave Traxson, an educational psychologist in the U.K.
The experts all said that putting kids on medications unnecessarily is worrisome because the drugs, particularly antipsychotics, can have undesirable side effects. For instance, antipsychotics can cause weight gain and diabetes and stimulants can cause decreases in appetite and sleep problems, according to the National Institute of Mental Health. Further, too little is known about the long-term effects of taking these drugs.
However, they disagree over what exactly is causing the overmedication predicament.
The researchers said medications should be given only when a diagnosis calls for them and when evidence has shown that they work. Sometimes, the problem arises in making that diagnosis.
Traxson said doctors rely too heavily on information from parents to make diagnoses, and are wrongly labeling children with conditions like ADHD. He also said descriptions of some of these disorders, such as bipolar disorder, as written in the Diagnostic and Statistical Manual of Mental Disorders (DSM), are too broad, and encompass too many children.
But Ballas said the problem lies not with the DSM, but how doctors use it. Some symptoms described in the DSM are normal behaviors of children. “It’s the aggregation of symptoms, and what sets them off, that often lead to the diagnoses,” he said.
For instance, a child with chronic sleep deprivation may be misdiagnosed as having ADHD, and be prescribed stimulants, Ballas said.
Misdiagnosis due to doctors inappropriately using the DSM is especially a danger when doctors do not have specialized training, Ballas told MyHealthNewsDaily.
“I'm concerned when primary care physicians or pediatricians make a diagnosis of bipolar disorder without additional training in psychiatry,” Ballas said.
“I feel that the medical system in general is just becoming so taxed that there is increasing pressure for people with less experience to make these diagnoses,” he said.
Beyond diagnoses, others say the overprescription problem stems from doctors being too quick to prescribe medications for conditions that could be treated another way, such as with psychotherapy. This may happen because psychotherapy is a more labor-intensive process and requires more time, said child psychologist Ronald Brown, vice president of academic affairs at Wayne State University in Detroit.
“Very frequently, medication is the first thing that providers turn to,” Brown said. “This is an issue because there are often times some therapies that are as effective, or maybe even more effective, than medications,” he said.
The effects of continually medicating kids remain to be seen.
“We worry about what we don’t know…we don’t know the long-term effects,” Brown said.
Some studies have suggested that the long-term use of stimulants may lead to changes in the brain. For example, children placed on stimulants for long periods have a buildup of the neurotransmitter dopamine in their brain, Traxson said. This buildup can damage the connections between nerve cells, he said.
But whether such changes translate to physiological problems has yet to be determined, Ballas said. He noted that stimulants have been used for 80 years to treat ADHD, and that much research suggests they are safe.
And while there has been some concern over cardiovascular risks, a recent study found that ADHD medications do not appear to pose a significant danger for children's hearts when taken over the long term.
However, more researchers need to investigate the consequences of these drugs, Brown said.
Traxson is calling for a national and international review of the use of psychiatric medications in children. He recently spoke about the issue at the annual conference of the Division of Educational and Child Psychology in Newcastle, U.K.
Pass it on: Children are overmedicated with psychiatric drugs, but experts disagree about the exact reason for this overprescription and what the consequences will be.
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