I’ve argued before that declaring American kids and teens to be “overmedicated” is something of a cop-out.
How can people say what constitutes overmedication when they can’t – or won’t – specify what would constitute an acceptable number or percentage of kids taking psychiatric meds?
Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems.
A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all – key measurements of youth medication use.
Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.
Many children with autism spectrum disorders (ASD) take psychotropic medications to treat associated symptoms of their conditions, such as irritability and anxiety. Usage has increased in recent years, and some recent studies have questioned the evidence base supporting the drugs’ effectiveness in young people with ASD.
A new study, published in a supplement to the November issue of Pediatrics, suggests that coexisting psychiatric conditions and problem behaviors might account for much of that prescribing.
The study, which examined children and teens ages 2 and 17 with autism spectrum disorders, found that 80 percent of children with a comorbid psychiatric condition were taking medication, compared to just 15 percent without any psychiatric comorbidity.
Depending on the condition in question, those with a comorbid disorder were between 5 and 17 times more likely to be taking a psychotropic medication as those without the additional disorder.
The study included 2853 children enrolled in a registry run by the Autism Treatment Network, a consortium of 17 academic medical centers in the United States and Canada that is associated with the advocacy group Autism Speaks.
The registry used DSM-IV-TR criteria and the Autism Diagnostic Observation Schedule to diagnose autistic disorder, Asperger syndrome, or pervasive developmental disorder not otherwise specified. It relied on parent reports for information about comorbid psychiatric diagnoses and medication use.
Some metaanalyses have questioned the effectiveness of treating ASD with psychiatric medications, though they have not always taken psychiatric comorbidity into account. Comorbidity is very common in autism spectrum disorders, with studies finding that between 70% and 95% percent qualify for at least one additional psychiatric diagnosis. Other researchers, however, have said these high rates partly reflect overlapping symptoms and problems with diagnostic criteria.
The Pediatrics study didn’t collect information about why the children and teens had been prescribed medication – that is, whether the meds were to treat the comorbid condition, symptoms of the ASD, or both.
However, it found that current psychotropic use was also correlated with high scores on the Child Behavior Checklist, a measure of overall problem behavior. That …
In reality, though, many people taking psych meds drink anyway. They have various reasons: not wanting to curtail their fun, not putting much stock in the warnings, or simply thinking it’s easier to take a proffered drink than explain why they’re turning it down.
Doctors oftentimes don’t bother to talk to patients about potential dangers. Or they tell patients not to drink, but don’t explain why. To make matters worse, because of a lack of studies on the subject, patients inclined to do their own research will have a hard time just how risky it is to drink while taking various kinds of psychiatric medications (I’ve written elsewhere about this troubling lack of evidence).
A widely publicized study that came out last month in the journal Neurology underscores the problem. The findings, which pooled data from 16 studies, showed that people taking SSRI antidepressants like Zoloft or Celexa were 40 percent more likely to suffer a type of stroke caused by bleeding in the brain and 50 percent more likely to suffer any bleeding in the skull.
A recent article in USA Today about the challenges of dealing with ADHD at college suggested students keep their conditions – and their prescriptions – secret from their peers.
The reason? Abuse of stimulant medications like Adderall and Ritalin is rampant on college campuses, where the medications are used as “study drugs” and also to provide a boost of energy during long nights of drinking and partying.
As a result, students with such prescriptions can find themselves under intense pressure to share or sell their pills.
But when students keep their meds a secret from peers, does anyone actually benefit?
People who take psychiatric medications long-term are no strangers to stigma, or the threat of it. We perennially face, for example, the question of whether it’s worth risking others’ judgment and the potential negative repercussions of disclosing our conditions — and the fact that we take medication for them.
But you can commit to taking medications long-term and still perpetuate or further the stigma associated with meds. And I don’t just mean that in the sense of keeping your medication regimen secret. Most of us do so in another way altogether that we’re largely unaware of.
The fact is, most people have some kind of internal barometer when it comes to medications – which ones they are willing to take, and which ones they’re not.
This weekend a mother published a New York Times column about how her son came to be diagnosed with ADHD and became a member of the ballooning “Ritalin Generation.”
“Just a little medication,” the teacher told the boy’s mother, “could really turn things around” for the boy, who was having trouble focusing on class worksheets and lining up quietly for transitions between classes.
When the mother firmly responded that she and her husband weren’t going to medicate their son, the teacher backtracked, sounding mock-horrified.
She wasn’t explicitly suggesting medication, she said. The law prohibited such a thing. She just didn’t want him to fall through the cracks – and thus was was merely suggesting the boy’s parents have him evaluated by a psychologist.
The boy was evaluated, and sure enough, he ended up on Ritalin for a short-time, though he quit it on his own a year later, matured out of his former inattentiveness, and eventually ended up a well-adjusted, school-loving honor-roll student – and medication-free.
Such stories are commonly invoked as cautionary tales about the alleged over-diagnosis of ADHD and other behavior disorders and over-prescribing of drugs like Ritalin to keep children’s behavior in check. Teachers recommending meds for disruptive students often feature prominently. In fact, the debate over school involvement in medicating disruptive children showed up as early as the early 1970s.
We don’t know, for example, how taking them from a young age affects long-term brain and psychological development in kids. They have myriad of side effects, some serious, like diabetes, high cholesterol, neurological impairment and birth defects when taken in pregnancy. They carry stigma, both from others and self-imposed.
But I’m not talking metaphorically about costs here. I’m talking straight-up financial outlays. Taking psychiatric medications can really add up, even for those who have health insurance, and even when they can take generic instead of brand-name drugs.
One big reason is the so-called “medication merry-go-round.”
With all the attention on the misuse of psychiatric drugs, I think it’s worth taking a look at how the increased scrutiny affects people who have a diagnosis and a legitimate prescription.
I don’t mean to suggest that just because someone has been diagnosed and a doctor has seen fit to prescribe her medication that she necessarily needs the meds – or even that she “should” be on them. Plenty of people have unjustified diagnoses and unneeded prescriptions.
But for those who do benefit from treatment, you’ve got to wonder how all the media attention affects their experience.
In a recent post, I explored the question of whether meds can help reduce bullying behavior in kids with psychiatric conditions, since they are more likely to bully peers than kids without such problems.
But research shows that kids with psychiatric problems are also more likely to be bullied – and that those who are bullied are at elevated risk of suffering from psychiatric disorders later on.
In my own research for my book on young adults who grew up taking psychiatric meds, I was struck that almost everyone I interviewed reported having been bullied during childhood or adolescence (some also reported bullying other kids).
So how does taking psychiatric meds affect the likelihood of kids being bullied? Do the drugs enhance kids’ self-esteem and behavior so that they’re less likely to be picked on? Or do kids get teased because they take meds?
Last week, I featured a guest post from M., a reader from Texas who began taking Ritalin for ADHD when she was 12, then quit before college.
M. concluded in retrospect that taking that taking Ritalin taught her she couldn’t rely on herself to control her behavior. Instead, she learned to look to others for feedback, which she thinks provoked her anxiety.
Today, I’m following up with the second half of M.’s medication story, about her experience starting Zoloft in her mid-20s to treat some of that residual anxiety. Read on to find out how she fared during a second stab at medication treatment.