Prescribing Prozac for Children Is Increasing in U.S. Some Fear Drug's Use as a Quick Fix, Cheaper Than Psychotherapy
1994, Boston Globe, St Louis Post-Dispatch (MO)
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. …