headline: even babies getting treated as mentally ill

Columbus Dispatch (Ohio)

April 25, 2005 Monday, Home Final Edition

SERIES: DRUGGED INTO SUBMISSION
HEADLINE: EVEN BABIES GETTING TREATED AS MENTALLY ILL;
Prescriptions on the rise even though they haven't
been tested on children

BYLINE: Encarnacion Pyle, THE COLUMBUS DISPATCH

Doctors prescribed sedatives and powerful,
mood-altering medications for
nearly 700 Ohio babies and toddlers on Medi-caid
last summer, according to a
Dispatch review of records.

There's no doubt that mental-health drugs can help
troubled youngsters,
whether they're on the government insurance program
for the poor or not. But
dozens of advocates, child-welfare workers and
psychiatrists interviewed by
The Dispatch question the wisdom of prescribing
potent medications, most of
which have never been tested on kids, for so many
young, vulnerable children.

"It's shocking," said Dr. Ellen Bassuk, associate
rofessor of psychiatry at
Harvard Medical School. "Who's really being helped
by these children being
drugged? The babies? Or their caregivers?

"These medications are not benign; they can have
dangerous side effects and
have to be closely monitored."

Federal officials have long required that drugs be
screened for safety in
adults. But less than one-fourth have been tested on
children.

"Kids are not little adults," said Dr. Patricia
Goetz, assistant medical
director for the state Department of Mental Health.
"Children's brains are
different. They don't fully develop until after
adolescence."

That often leaves doctors with more questions than
answers about the
long-term effects of many drugs on children.

Physical side effects can range from headaches,
nausea and weight gain to
heart attacks, liver damage and sudden death.

Psychological effects remain a mystery. But several
antidepressants carry
FDA-required warnings that they can increase the
risk of suicide. Some
antipsychotics have caused learning problems in 3-
to 6-year-olds.

"It seems a growing number of yesterday's wonder
drugs, such as Adderall,
have turned into today's suicide pills," said Laura
Wissler, a parent
advocate for the Mental Health Association of Summit
County.

In February, Canada pulled the attention-deficit
hyperactivity drug from the
market, saying it was related to 20 sudden deaths.
The U.S. Food and Drug
Administration reviewed those deaths last year and
determined Adderall
should carry a warning that it not be prescribed to
people with heart
trouble.

A Westerville woman watched her daughter's high
spirits disappear under the
influence of Paxil, which she was taking for
anxiety.

"The stuff did not work for her, and it was in
weaning her after only two
apparently ineffective weeks that we saw the
horrifying effects we now know
are typical," said Lucy, who asked that her full
name not be used, to
protect her child's identity.

Lucy noticed the drug's effect 2 1/2 years ago, the
night of her daughter's
11th birthday.

"My wonderfully precocious child told me, 'I don't
think it would be so
awful to die, except I couldn't bear what it would
do to you,' " she said.
"I've never seen her so miserable and hopeless."

Those scary days are long gone, but Lucy and her
daughter can't forget the
memory.

Drugs become first option

Many advocates worry that mental-health disorders
are overdiagnosed and
youths aren't given options such as counseling.

"Medications only help control symptoms," said
Yvette McGee Brown, president
of the Center for Child and Family Advocacy at
Children's Hospital.
"Counseling helps children control their behaviors,
feelings and thoughts.
You can't put kids on a bunch of drugs, then take
them off thinking they'll
know how to cope."

Advocates are especially concerned about the very
young.

"Research shows that 0 to 3 are the most critical
years for the development
of children and their success in the future," said
Patricia Amos, a member
of the Family Alliance to Stop Abuse and Neglect in
New Jersey.

"How do we know we're not messing that up by
starting children on one
medication, then adding on another and another,
until their brains are
hyperaroused, overstimulated and permanently
altered?"

But others say the more early intervention, the
better.

"The biggest public-health crisis facing the state
and nation is the number
of children with mental illness who fail to receive
any care or treatment,"
said Michael Hogan, director of the Ohio Department
of Mental Health.

"It's true children are more likely to get
medication than counseling or
other behavioral therapy if they go to their
pediatrician or family doctor.
But at the end of the day, meds are quite safe and
effective."

There is such a shortage of child psychiatrists that
the wait often is three
months or more for an appointment. Many parents
simply can't wait that long,
so they take their kids to a family doctor.

One survey said as much as 70 percent of psychiatric
drugs are prescribed by
family doctors.

Struggling youngsters lucky enough to get into the
mental-health system are
three times as likely to receive therapy as to
receive drugs, Hogan said.
Research suggests that children who receive both are
more likely to be
successful than those who receive one or the other,
he said.

Still, 80 percent of troubled youths nationwide fail
to receive any help,
said Terry Russell, executive director of the Ohio
chapter of the National
Alliance for the Mentally Ill.

"Psychotropic medications for young children should
be used only when
anticipated benefits outweigh the risks," Russell
said. "But we'd hate to
see doctors' hands tied, because research shows that
reaching children with
mental illness early significantly improves their
long-term prognosis."

Big profits in medications

Psychiatric medications are big business.

In 2002, drug companies made $12 billion in profits
from antidepressants
alone. Those numbers continue to grow, largely
because of increasing use on
children.

Nationwide, the number of children using psychiatric
medications tripled
between 1987 and '99.

But researchers say they don't have the data to know
whether kids are being
given risky combinations or dosages, practices
experts say occur frequently.

Concerned by these issues, the Ohio departments of
Mental Health and Job and
Family Services are reviewing two years of Medicaid
claims for red flags,
including children who are on three or more
mental-health drugs.

A consultant hired by the state will begin sending
letters next month to
physicians whose practices raise concerns, said
Margaret Scott, a state
pharmacologist.

The consultant, Comprehensive Neuroscience, of White
Plains, N.Y., has
helped several states, including Florida, where 442
doctors have received
such letters.

Private insurance plans don't report how psychiatric
drugs are used by their
clients, but because Medicaid is government-run,
more information is
available.

Nearly 40,000 Ohio children on Medicaid were taking
drugs for anxiety,
depression, delusions, hyperactivity and violent
behavior as of July. For
the entire year, the Ohio Department of Job and
Family Services paid out
about $65.5 million for kids' mental-health drugs.

Concerns also have been raised nationally about the
high number of children
being medicated in foster care, residential
treatment and youth prisons.

In Ohio, 31 percent of children ages 6 to 18 in
foster and group homes took
mental-health medications in July. And 22 percent of
children in detention
were on a psychiatric drug as of January. Many were
on five or more.

Those who defend the use of medications on these
youths note that they often
have been victimized.

"A lot of these kids have been beaten, sexually
assaulted and emotionally
wrung through the wringer," said Laura Moskow Sigal,
executive director of
the Mental Health Association of Franklin County.
"They have poor
self-esteem, feel unloved and suffer from severe
psychiatric problems."

Still, parent concerns have prompted other states to
respond.

In Texas, Controller Carole Keeton Strayhorn
criticized her state's
child-welfare agency for spending as much as $4
million a year on
mental-health drugs without enough oversight. She
also blasted the agency
for giving children drugs to make them docile and so
"doctors and drug
companies can make a buck."

Some people think drugs are the cheapest, easiest
way to subdue kids for
overburdened foster parents and understaffed
residential centers. Most pills
cost from 2 cents to 17 cents, while child
psychiatrists can earn more than
$500 per day.

Others think some foster parents want children on
drugs so they can get more
government money for being classified as a
"treatment" or "therapeutic"
home.

A few say the only way to solve the overmedication
problem is to keep
children with their parents.

"Only a parent, or another close relative, is likely
to put up with
difficult behavior from a child, because only family
loves that child enough
to put up with it," said Richard Wexler, executive
director of the National
Coalition for Child Protection Reform in Alexandria,
Va.

Doctors may know the disease best, but parents
generally know their children
best, Wexler said.

Even infants put on pills

Advocates are equally distressed by the high numbers
of drugged-up infants.
In 1994, 3,000 prescriptions for Prozac were written
nationwide for children
younger than 1 year old, according to the Journal of
the American Medical
Association.

Almost all psychiatric prescriptions for toddlers
and preschool children are
"off label" -- without dosage recommendations and
for conditions other than
those for which the drugs were created.

Physicians frequently "dose down" adult medications
by adjusting for a
child's weight.

At least 696 Ohio children who were newborn to 3
years old received
mental-health drugs through Medicaid in July.
Hydroxyzine was prescribed
most often, with about three-quarters taking it.

The drug, a long-acting antihistamine, has many
uses. It relieves itching
caused by allergies, controls vomiting and reduces
anxiety. It's given most
often to young children for its sedative effects.

"it's generally calming, has low side effects and is
pretty inexpensive,"
said Bob Reid, pharmacy program director for Job and
Family Services. "It's
a real bargain."

But Bassuk, the Harvard psychiatrist, says doctors
should avoid giving
babies, especially those still in diapers,
unnecessary medications.

"Sure, there are drugs that make kids sleepy, but
what's the point if they
don't have any medical purposes?" she said.

More than 90 of the children were on another
antihistamine, 48 were taking
anti-anxiety medication and 28 were prescribed
antidepressants, including
Paxil, Prozac and Zoloft, which have been found to
increase suicidal
thoughts and behaviors in some children.
Twenty-seven received Valium, and
18 were on antipsychotics.

"It's troubling," said John Saros, executive
director of Franklin County
Children Services. "How do doctors even determine
that a 2-year-old is
anxious? There's a reason they call it the terrible
twos."

But Martha Hellander, of the Child and Adolescent
Bipolar Foundation in
Illinois, says she has seen babies who cry for
hours, 2-year-olds who fly
into unprovoked rages and 3-year-olds who try to
jump out of moving cars.

"The medication is essential for these kids," said
Hellander, the group's
research policy director.

Girl's death haunts parents

Mike and Janet Hall, of Canton, can't help wondering
whether their daughter
Stephanie would still be alive if they hadn't agreed
to medicate her.
Stephanie died of a heart attack in January 1996,
the morning after a doctor doubled her daily dose of Ritalin.

The Halls say Stephanie's first-grade teacher
pressured them to drug their
daughter when she was 6. She remained on medication
for attention-deficit
hyperactivity disorder for years and died in her
sleep six days before her
12th birthday.

"I almost wish she had died 12 hours later at
school, on their doorstep,"
said Mrs. Hall, 40. "They started this thing by
telling us she had to be onmedication because
she had a problem getting up out
of her chair. What do
they expect from a 6-year-old?"

The day before she died, Stephanie was "out of it"
in the morning but seemed
fine later, Mrs. Hall said.

When her father tried to wake her the next morning,
she didn't move.

"At first, we thought she had the flu," Mrs. Hall
said. "But then I noticed
she was cold and blue."

They sued the company that makes Ritalin in January
2000, but the case was
thrown out because the statute of limitations had
expired.

Today, the Halls warn other parents to research the
pros and cons before
placing their child on psychiatric medications.

"Stephanie used to tell me, 'Mom, I'm going to be a
firefighter or paramedic
because I'm going to save people,' " Mrs. Hall said.
"But who could save
her? No one. She was just a human guinea pig in a
failed medical
experiment."

epyle@dispatch.com


Box Story:/What kids are taking
The number of children taking mental-health drugs
tripled from 1987 to '99,
even though many of the drugs had not been approved
for pediatric use. Some
of the most common prescriptions (generic name in
parentheses), with some
pros and cons:

ANTI-ANXIETY DRUGS
Used to treat anxiety, obsessive-compulsive
disorder, panic attacks, phobias
and post-traumatic stress.

* Ativan (lorazepam): Fast-acting, can be taken in
small doses and has
relatively few side effects. Drowsiness and loss of
coordination are most
common.

* BuSpar (buspirone): Must be taken for at least two
weeks to achieve
results. Doesn't have sedative effect.

* Klonopin (clonazepam): Longer-acting than some
drugs. Sometimes causes
depression.

ANTIDEPRESSANTS
Elevate mood, improve self-esteem and ease feelings
of hopelessness. The FDA
has warned that 10 drugs, including those below,
could increase risk of
suicide.

* Paxil (paroxetine): Improvement may be noticed in
a week or two, but full
effect may take six weeks. Side effects generally
are mild.

* Prozac (fluoxetine): Only drug approved to treat
kids as young as 8. Can
take four weeks to work, but effects often last up
to nine months after a
three-month regimen.

* Zoloft (sertraline): Improvements can occur within
days. Study in the
Journal of the American Medical Association found it
to be "effective and
well-tolerated."

ANTIPSYCHOTICS
Treat disorders such as schizophrenia and reduce
symptoms such as delusions
and hallucinations. The FDA has warned that new
antipsychotics may cause
diabetes and increased cholesterol.

* Haldol (haloperidol): Frequently used for
short-term treatment of behavior
problems, including combativeness and hyperactivity.
Side effects can
include difficult breathing, fast heartbeat,
involuntary muscle contractions
and seizures.

* Risperdal (risperidone): Also used to treat autism
and conduct disorders.
Side effects can range from dry mouth, fatigue and
weight gain to diabetes,
stroke and other potentially fatal illnesses.

* Zyprexa (olanzapine): Also used to treat mania and
bipolar disorder. Some
people note more motivation and less social
isolation. Can cause dizziness,
increased appetite, restlessness, sleepiness and
weight gain.

MOOD STABILIZERS
Reduce mood swings associated with bipolar disorder.

* Depakote (valproic acid): Available in three
tablet strengths. Can cause
serious or even fatal liver damage, especially
during first six months of
treatment. Children younger than 2 are most
vulnerable.

* Lithonate (lithium carbonate): Once mania
subsides, it often can be given
in lower doses to prevent future episodes. Frequent
blood tests needed to
prevent lithium poisoning.

* Tegretol (carbamazepine): Also used to control
seizures. Children require
higher doses than adults because they absorb the
drug quicker. Might cause
blood levels to fluctuate wildly.

STIMULANTS
Treat attention-deficit hyperactivity disorder.

* Adderall (amphetamine): Effects begin after a few
doses and it causes
fewer peaks and valleys than other drugs. Canada has
taken it off-market,
citing 20 deaths.

* Concerta (methylphenidate): Pills last 12 hours
but can be difficult to
digest. Isn't recommended for kids under age 6. Can
cause headaches, loss of
appetite, moodiness, psychosis, stomachache and
upper respiratory infection.

* Ritalin (methylphenidate): Available in short- and
long-acting forms.
Common side effects are abdominal pain, dizziness,
insomnia, irregular
heartbeat, nervousness and weight gain. Long-term
use has been linked to
abnormal brain development.

Sources: National Alliance for the Mentally Ill,
National Institutes of
Health, National Mental Health Association and U.S.
Food and Drug
Administration
----------------
About this series
Encarnacion Pyle's research for the stories in this
series was conducted
with the help of a Journalism Fellowship in Child
and Family Policy. The
University of Maryland program is funded by the
Foundation for Child
Development.