Which Represents the Greatest Violators of the Public Trust, Pharmaceutical Companies or Prescribing Physicians?

"It's not just a bad news story in the sense that maybe more [children] are getting drugs -- there might actually be people getting better access and doctors catching [mental health problems] earlier."
"The easiest thing to do is give medications. Medications alone are not the only treatment."
Dr. Mina Tadrous, research associate, Ontario Drug Policy Research Network, St.Michael's Hospital, Toronto

"It [study of prescription count] doesn't tell us how many tablets were dispensed at each time, how long the prescription was for or if each went to a different child."
"It could be that people are being very cautious in giving only one week's worth of medicine at a time, so, for a month of treatment there could be four prescriptions instead of one."
"A four-year-old with anxiety, we're not going to go first to an SRRI, we're going to be working with the parent to address the anxiety issue that child is having."
Dr. Corine Carlisle, child and adolescent psychiatrist, Centre for Addiction and Mental Health, Toronto

"Having saturated the adult market, Pharma has turned its attention to aggressively marketing pills for children who are, in some ways, their perfect customers -- because once pill solutions become the norm, the kid may become a customer for life."
"[Pills are often prescribed in response to requests for] behavioral control [even while very few children present with clear indications they require anti-psychotics]."
"There aren't that many kids with bipolar disorder or schizophrenia or psychosis. It's not that the kids are sicker and it's not that all those kids needed the medication."
Dr. Allen Frances, professor emeritus, Duke University, Durham, North Carolina

Most children have been exposed to bullying in their school lives in some form. (ThinkStock.com)

It is rare that medical-drug producing companies focus on research to design medications meant specifically for children. Most such medications are formulated for use on adults, and more specifically, male adults. Taking those drugs and prescribing them for use with children is a risky move. For one thing young brains are far different than older brains, just as any other physical attribute in a child gradually matures as they age into adulthood. It is unknown what the long-range effect of such drugs may be on a child.

Yet Canadian doctors are increasingly choosing to prescribe antidepressants and antipsychotics when faced with a child whose behaviour may require modification through other means. Where parents throw up their hands at the very thought that they may themselves be required to spend time, energy and patience to help their child overcome unwelcome behaviours that the parents see as burdening them with responsibilities they prefer not to face. So they apply pressure for their family doctor to come up with an instant solution.

What could be more 'instant' that drugging a child? Dispensing of antipsychotics seems to go hand in hand with a societal reality that sees greater numbers of prescriptions for such drugs being dispensed to adults, in an increasingly drug-dependent society, where the issue of prescription painkillers has arisen as a controversial news item, resulting from overdose deaths and the proliferation of more lethal laboratory drugs being cut with conventional illegal drugs making their way into mainstream society. The use of medicalized drugs has become so common, few give it a second thought.

Little wonder that parents, accustomed to the availability and proliferation of drugs used as a solution for irritating, persistent medical problems that other, drug-free treatments might address adequately or in combination with milder drugs, see little amiss in starting their vulnerable but troublesome children on a drug regimen, making pill taking a 'natural' part of their lives, as well. There is nothing new about doctors prescribing drugs for children, fifty years ago it was also done, but not as ubiquitously.

Now, two researchers have published a study in the Canadian Journal of Psychiatry that reflects their research on the proliferation of medications prescribed for children. Drs. Tadrous and Carlisle worked together to focus on the new and growing social phenomena which they feel results from parents desperate to solve a problem with their children, but finding themselves locked out of access to non-drug treatments, turning to antidepressants and antipsychotics.

Most prescriptions, they found, were for selective serotonin reuptake inhibitors, (SSRIs), thought of as "first line" treatment with drugs in cases of depression, anxiety and obsessive-compulsive disorders exhibited by children. These drugs are also known to cause an uptick in suicidal impulses in young people, besides which in mild to moderate cases they are recognized as having more of a placebo effectiveness.

Children diagnosed with attention deficit hyperactivity disorder, behavioral disorders, aggression along with additional symptoms are being prescribed antipsychotics along with a stimulant, "off label". Troubling for many reasons, not the least of which is that antipsychotics can cause swift weight gain, an increase in blood pressure, and blood fats as well as additional metabolic abnormalities.

The national dispensing rate between 2010 and 2013 in Canada increased from 34 per one thousand children to 55 per one thousand. Over the study period, 4.6 million antipsychotic prescriptions were dispensed, with some provinces notably seeing the use of such drugs much more frequently for children than other provinces. Some studies conclude that antidepressants and antipsychotics are prescribed for use with children as young as six years of age.

As far as Dr. Frances is concerned, this has all resulted by drug companies actively "pill pushing".
Lest anyone think this is a Canadian problem only, studies in the United States point to very similar results:

Modern antipsychotic drugs are increasingly prescribed to children and adolescents diagnosed with a broad variety of ailments. The drugs help to alleviate symptoms in some disorders, such as schizophrenia and bipolar disorder, but in others their effectiveness is questionable. Yet off-label prescribing is on the rise, especially in children receiving public assistance and Medicaid. Psychotic disorders typically arise in adulthood and affect only a small proportion of children and adolescents. Off-label prescriptions, however, most often target aggressive and disruptive behaviors associated with attention-deficit hyperactivity disorder (ADHD). “What's really concerning now is that a lot of this prescription is occurring in the face of emerging evidence that there are significant adverse effects that may be worse in youth than in adults,” says David Rubin, a general pediatrician and co-director of PolicyLab at Children's Hospital of Philadelphia.  

Other side effects of antipsychotic medicines include:

• Weight gain.
• Restlessness.
• Sleepiness.
• High cholesterol or high blood sugar.
• Movement disorders, such as tardive dyskinesia.