Overprescribing Medication for Children

I’ve written on this subject before, and others are catching on.  John Grohol of PsychCentral writes:

Eight medications for a single child? Heck, I wouldn’t want to see an adult taking that many medications for a psychiatric disorder, much less a child of 10.⁽¹⁾

Yes, he talked about a report of a child being on 2 antipsychotics, 2 mood stabilizers, 2 stimulants, 1 antidepressant, and another med just for ADHD.  You’ve got to be kidding me.

I wish this surprised me.  It doesn’t.  Dr. Grohol thinks things might be better if the diagnoses were rendered by psychiatrists….maybe…maybe…

…general practitioners and physicians should never be diagnosing a child’s psychiatric condition unless they are a psychiatrist, plain and simple. They might offer a preliminary diagnosis, but then the rule should be that they refer on to a qualified mental health professional (a psychiatrist is fine, but psychologists and other mental health professionals are also well-qualified to properly diagnose and recommend a comprehensive treatment plan).

I’ve evaluated numerous children diagnosed by psychiatrists who were on 4 different classes of medication for ADHD (antipsychotic, mood stablizer, antidepressant, and another med to combat side effects).  As Dr. Grohol notes:

Compared to adults, few studies have been done to ensure the safety and efficacy of many of these psychiatric medications (except for childhood concerns like ADHD). Medications for children are sometimes necessary, absolutely. But it should be done only under the oversight of a specialist in mental health concerns (a psychiatrist) and treatment should, ideally, be conducted through a treatment of team of mixed mental health professionals.

I would urge even more caution that Dr. Grohol.  A psychiatrist will typically spend 15-30 minutes evaluating the issue.  Usually (not always), their only tool is medication.  In my practice, if it is at all feasible, I work with the patient in every way I can think of to avoid medication.  Occasionally, it’s not possible.  But very often it is.  If a psychiatrist wants to put your child on meds, ask if it has been approved for use in children.  There are not many meds that have been, but they are used all the time.

(1). http://psychcentral.com/blog/archives/2008/12/15/overprescribing-medications-in-children/

Children with “ADHD” and medication

I’ve seen yet another one.  A child labeled as ADHD and put on 5 different medications (an antipsychotic, a stimulant, an antidepressant, a mood stabilizer, and clonidine–an antihypertensive).  If I saw this every once in awhile, I could dismiss it more readily.  But this practice seems to be becoming common based on the number of children I’ve seen with this type of polypharmacy. 

Polypharmacy has multiple definitions.   “Mixing many drugs in on prescription.”  “The practice of prescribing multiple drugs to patients suffering from more than one malady.” “The prescription or dispensation of unnecessarily numerous or complex medicines.”  This according to the freedictionary.com. 

 

http://glennsacks.com/blog/?p=940

I’m not a psychiatrist.  I’m a psychologist.  For those of you who don’t know, psychologists can’t prescribe medication in most states.  Psychiatrists can in all states.  So, my viewpoint may be a bit biased.  You see, I try to help people overcome problems without medication whenever possible.  I’ve been able to keep several children off of medication for “ADHD.”  So far, the only children on medication for ADHD that I see, are the ones who were already on medication when they came in.  I’ve had to convince teachers and principals to be patient.  I’ve had to give suggestions of how to deal with different children in the classroom.  I’m sure there are some teachers who don’t like me very much because I don’t advocate medication in most cases.  That’s tough luck as far as I am concerned.  There are difficult adults and difficult children in the world.  You deal with them the best that you can.  Worst case scenario, you try some medication.  But to me, that is the worst case scenario.  Try everything else first. 

Try nutritional changes, try exercise, try everything you can think of.  If the child is failing then consider medication.  Otherwise, use your brain, use the Internet, talk to others, and do anything you can to keep kids off of medication.  Medication is warranted when there are severe consequences that may occur without it.  The case I described at the beginning on this post, was given all of those medications because, “he gets a little irritable somethimes.”  I feel sorry for this poor kid’s brain and mind.  But he is not alone.

Some day, this whole approach of polypharmacy, the idea that you might as well throw every class of drug at a kid and maybe one will work, will be seen as in the perspective of psychosurgery (read labotomy) and electroconvulsive therapy for all kinds of problems.

St. John’s Wort and ADHD

A  most recent research trial, conducted by a pharmaceutical hack, found that St. John’s Wort was no more effective than placebo in alleviating symptoms of ADHD in children.  You could read this as no more effective than antidepressant medication if you’ve read my previous posts.  John Grohol notes that this study was conducted by Joseph Biederman who has been outed by CLPsych as having taken 1.6 million dollars from the pharaceutical industry which he didn’t report between 2000 and 2007.  So, you can take this for what it’s worth.  Maybe there’s no bias here, but I don’t believe in non-biased research.  If you do, then you can feel comforted by the fact that a cheap/safe alternative to stimulant medications does not exists.