Debate Grows over Antidepressant Use among Preschoolers

By Elizabeth Armstrong writer of The Christian Science Monitor | The Christian Science Monitor, April 8, 2004 | Go to article overview
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Debate Grows over Antidepressant Use among Preschoolers

Elizabeth Armstrong writer of The Christian Science Monitor, The Christian Science Monitor

Like many mothers across the country, Chris Battaglini has been closely watching her son's high energy since he was a toddler. "He was excitable," the stay-at-home mom in Lakeville, Mass., says of those anxious, early days. "He wasn't bouncing off the walls, but he wasn't able to focus."

By the time he started school, her son's restlessness became more problematic, and Mrs. Battaglini took him to a doctor. The 6-year- old was put on medication, something his mother is still adjusting to. "I'm not thrilled," she says. "But if it's something that's going to help him be able to focus ... then I'm willing to do it."

Battaglini's experience is part of a growing trend in America: preschoolers being medicated to control behavior.

While antidepressants and other mood-altering drugs have long been prescribed to adolescents, the fastest-growing group using such medication is children under age 5.

Indeed, by one estimate, twice as many preschoolers are being prescribed antidepressants today than just five years ago. The development is touching off a new controversy over whether doctors should be prescribing mood-altering drugs to toddlers at all, let alone much more frequently.

Critics, including many in the medical community, question whether youngsters really are more depressed today or simply more medicated. Many would like to see greater federal oversight of the process - particularly at a time when there is little consensus on the impact of Ritilin and other drugs on children. "Depression in a 3- or 4-year-old?" says Lawrence Diller, a pediatrician and the author of "Running on Ritalin." "What is that? I can't see any reason for it. Every doctor who's ever prescribed a psychiatric drug to any kid is doing a balancing act between the needs of the kid and the needs of the system."

The latest evidence of the growing use of antidepressants among the very young comes from a report by Express Scripts, a healthcare management firm in St. Louis. It studied 2 million children in the US between 1998 and 2002. It found that the number of children younger than five prescribed antidepressants doubled during that time.

In 2002, 0.16 percent of girls and 0.23 percent of boys in this age group were on antidepressants, representing some 40,000 kids. For children of all ages, use was highest among girls age 15 to 18, at 6.8 percent. Overall, antidepressant use among patients 18 and younger increased from 1.6 percent in '98 to 2.4 percent in 2002. "It was surprising it doubled," says Thomas Delate, director of research at Express Scripts, of the growth among preschoolers. But he's not sure the prescription-drug culture shouldn't filter down to that age group. "One of the biggest reasons [for the jump] is the growing awareness of depression in this age group," he says.

That, in fact, is a key point of debate. Doctors such as Diller doubt the very notion of depression among toddlers - let alone something that's detectable. He calls it a "pseudo-science."

But others believe it definitely exists and needs to be dealt with. Graham Emslie, a psychiatry professor in Dallas, Texas, and author of several studies on antidepressants, estimates that as many five percent of all adolescents, which includes toddlers, suffer from severe depression.

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