Prozac, the best-selling antidepressant, is increasingly being
prescribed for the under-18 set - occasionally to children as young
as 5 or 6.
"Just as it was OK 20 years ago to take your kid to an analyst,
now it's OK to put them on Prozac," says Dr. Massan Hassibi,
director of child and adolescent psychiatry at Metropolitan
Hospital in New York City.
Though the majority of psychoactive drugs are given to adults,
prescriptions of Prozac and similar new antidepressants to children
have more than doubled since 1990, according to government
statistics. The use of Ritalin has also doubled since then, making
it the most widely prescribed psychoactive medication for children.
Should the rise in the use of these medications in children and
adolescents be a cause for concern?
Mental health professionals say the answer depends on how these
drugs are dispensed and whether they are part of a considered
treatment plan or just an attempt at a quick fix that does not
address a child's underlying problems.
To many specialists, the rate at which antidepressants are
penetrating the children's market is not in itself cause for alarm.
Between 2 and 3 percent of adolescents become profoundly depressed
and even suicidal each year; if medications can help them recover
and function better in school and at home, why not use them? Such
arguments have become more persuasive since the advent of Prozac
and the similar drugs Zoloft and Paxil, which appear to have few of
the side effects of older medications like lithium or desipramine.
The problem, some specialists say, is that these medications
are sometimes dispensed too quickly and casually, without
considering the long-term effects on a child's development.
"There is a lot of looseness in the way these medications are
being prescribed," said Dr. Alexandra Rolde, a child and adolescent
psychiatrist who works in two mental health clinics and has a
private practice in Watertown, Mass. Many of the teen-agers she
sees in the clinics say antidepressants don't help. "They really
need someone to talk to, and there just isn't anyone."
Psychiatrists say what is most worrisome is that the
medications may not give children the chance to learn how to
control their feelings or impulses on their own. "Taking a pill
gives everyone a false sense of security that everything is all
right, when, in fact, a child's development can occasionally be
impaired in some way," Rolde says.
Some psychiatrists say these drugs are increasingly prescribed
not because they are the best treatment for a child's problem, but
because they are quick and inexpensive.
Pressure to medicate, mental health professionals say, can come
from both managed-care insurance companies trying to save money and
families reluctant to delve into their emotional lives.
"There is economic pressure from insurance companies to do
something quick: Throw a pill at them, and then you don't have to
pay for psychotherapy," said Dr. Elizabeth Beane, a child and
adolescent psychiatrist in Braintree, Mass., who believes in both
medication and psychotherapy. "And there is human nature: Parents
want something to happen quickly, and they don't always want to
look at what's really going on. A lot of times, there are family
secrets that people don't want to face up to."
When school-age children have problems - misbehaving in school
or refusing to go, destroying property, threatening to hurt
themselves or others - there could be a myriad of causes. Such
children could be reacting to learning difficulties or biological
illnesses. Or they could be dealing with family problems, from
severe neglect and abuse to parents who are too busy to give their
children the attention they need. Most specialists say digging out
the underlying causes of the behavior is a time-consuming task that
takes two to seven sessions with a professional who specializes in
child development. …