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Cheaper to Medicate

“Children are one-third of our population and all of our future”– unknown

The overmedication of babies, children and teenagers is gaining more and more media attention both in Australia and around the world.

The over prescribing of anti-depressant and antipsychotic medications in particular is becoming increasingly concerning.   The decision to use of these drugs to treat children and adolescents should not be taken lightly and parents and carers should be warned of the potential dangers before agreement is reached to treat the child in their care with these medications.

Recent reports regarding the deaths of children and young people that are linked to antidepressants and antipsychotics include babies dying when their mothers had taken anti-depressant medications whilst pregnant and a four year old child dying from an overdose of medication prescribed to her by her psychiatrist to treat bipolar disorder.

Last year the New York Times reported on the case of a boy who had been prescribed antipsychotics at the age of 18 months to deal with severe temper tantrums. The article highlighted that more than 500,000 American children and adolescents were taking these powerful medications.  In Australia the figures are also alarming.  2011 Federal health department data that relates to the period from 2009 to 2010 reveals prescribing rates of the controversial drugs in children younger than 6 years old have risen 50%.  In the same period five deaths were also linked to anti-depressants in children aged 10 to 19 and 89 adverse reactions were linked to anti-depressants in children aged nine and under.

The unfortunate reality is that figures collated in America show that it is cheaper to medicate than to provide therapy and therefore that children living in poverty are the most likely to be given drugs rather than therapy.   A study by Rutgers University found that children from low-income families were four times as likely to receive antipsychotics as their privately insured counterparts.  In addition, children in foster care seem to be medicated more often.  In the USA, this has prompted a Senate panel to ask the Government Accountability Office to investigate such practices

Disadvantaged children in Australia are faring no better.  When we look at children in out of home care what we see is nothing short of disturbing.  Babies as young as 12 months being are prescribed ADHD drugs against the national guidelines issued by the Royal Australasian College of Physicians and National Health and Medical Research Council. The guidelines state: “Medication should not be used as first-line treatment for ADHD in preschool-aged children.”

The statistics relating to children in out of home care should cause alarm:

  • One in every fourteen children under the age of six in out of home care is being prescribed antipsychotic medication.
  • 50 per cent of children under 12 who live in residential care are being prescribed antipsychotic medication.
  • 44 per cent of Aboriginal children in residential care are medicated on drugs such as Ritalin, Strattera and Zoloft.

Many of these medications have not been proved safe for use in young children.  We need to do better –the rate of medication for Attention Deficit Hyperactivity Disorder among young people in foster homes is more than double that in the general population.

A recent example that highlights why we should be far more cautious when prescribing strong education to young people is the tragic suicide deaths of two 16 year old girls in Maryborough.  The hidden side of antidepressants: are they putting young lives at risk?  Published recently in The Conversation examined the cases of Zoe and Felicia.

Coroner’s reports have confirmed Felicia Goodson had traces of the “prescribed anti-depressant” Venlafaxine in her system when she died, and Zoe Gough had been taking the anti-depressant Zoloft for a number of months prior to her death.  Both these medications have been banned for use in young people in Britain and America as they have been linked to juvenile suicide.

Let’s look at some of the facts.

  • The World Health Organization figures show that pre-schoolers are the fastest-growing market for antidepressants. At least four precent of pre-schoolers have been diagnosed as being clinically depressed.
  • In 2004 the Australian Adverse Drug Reaction Advisory Committee warned that Venlafaxine and Sertraline (Zoloft) had been linked to an increased risk of suicide and self-harm among children and adolescents but both these drugs continue to be prescribed ‘off-label’.
  • In the United States and the United Kingdom, Prozac is the only antidepressant approved for adolescent depression.
  • Standard antidepressants have been revealed to have serious risks and are linked to suicide, violence, psychosis, abnormal bleeding and brain tumours.
  • In the US, all antidepressants have a mandatory black box warning of increased risk of suicide in under-25s.
  • In Australia, no antidepressant is currently approved for the treatment of major depression in young people, although unapproved, “off-label” prescription is common.

Quoted in The Australian newspaper, Adelaide psychiatry professor Jon Jureidini said there were “many reasons to be concerned about the prescription of such drugs to the girls.  We should be very cautious about prescribing anti-depressants to young people in any circumstances and we should be doubly cautious when the medicine is not being properly supervised.”

In practice, anyone directly involved in working with children and young people should be actively questioning which, if any medications children are being prescribed and advising their parents, carers or the relevant authority of the potential dangers involved.

If we do nothing it may soon be too late for another Queensland youngster.

Tess Vincent.  PeakCare Queensland

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8 Comments Post a comment
  1. Thanks for an excellent article – absolutely horrifying stats that need to be known.

    October 31, 2011
    • Thank you Stella.

      I believe it is absolutely vital that anyone involved with the care of children is aware of the potential dangers of these medications. We just may save a life by ensuring the facts are known by parents, carers and child protection workers.

      Tess.

      November 1, 2011
      • Alarm at drugs for children – Related news story

        by: Sue Dunlevy
        From: The Australian
        October 29, 2011 12:00AM

        LEADING psychiatrists are alarmed at the growing practice of using anti-psychotic drugs to treat preschoolers and are pushing for an inquiry into the issue.

        More than 759 preschoolers were prescribed anti-psychotic drugs last year and use of these medications in children aged under six has leapt 43 per cent in the past three years.

        Figures released by the Department of Health and Ageing show a further 3481 children aged seven to 11 are using the powerful medications, even though psychosis does not usually develop until late adolescence.

        “We need an audit of children on anti-psychotic drugs and people should be asked to justify their use,” argues child psychiatrist Jon Jureidini from Flinders University, who is head of the department of psychological medicine at the Women’s and Children’s Hospital in Adelaide.

        Experts such as Jureidini claim anti-psychosis drugs are increasingly used to treat childhood autism and behaviour problems, despite the fact their effect on the development of a child’s brain has not been properly studied. Risperidone, a drug used in the treatment of schizophrenia and bipolar disorder, is the anti-psychotic medicine most commonly prescribed for two to six-year-olds. In 2009-10, this drug was used by 672 children aged two to six and 3147 children aged seven to 11.

        It has been associated with weight gain, metabolic disorder and type 2 diabetes. It also causes unco-ordinated movement and increased risk of hyperglycaemia.

        According to Jureidini, such medicines are prescribed to manage difficult behaviour rather than psychosis.

        “They are increasingly being promoted as broad-spectrum drugs by key opinion leaders who are saying things that are worrying me about broadening their use beyond psychosis,” he tells Weekend Health.

        University of NSW senior lecturer in psychiatry Michael Dudley says schizophrenia and bipolar disorder typically develop in late adolescence, adding that it’s “very rare” for young children to have such problems.

        He suggests anti-psychotics are sometimes used to treat autism or intellectual disabilities in youngsters. Like Jureidini, Dudley says statistics on the use of these drugs by children should be released regularly. “These practices should be open to inspection. We need to make the profession accountable.”

        Martin Whitely, a Labor state MP in Western Australia who campaigns against the use of drugs to treat attention deficit hyperactivity disorder, goes further, calling for a parliamentary inquiry into the use of a range of mental health drugs on young children.

        Juredini says there’s some justification for their use in children with unmanageable dangerous behaviour – although but only in a multi-disciplinary setting – as anti-psychotics have a numbing and dampening effect on behaviour.

        “[But] my guess is they’re being used at a much lower threshold,” he says, noting he’s treated a few children who had been prescribed the drugs by other doctors. “In my experience it’s been a positive thing to take the child off the drugs,” he says.

        The nation’s medicines watchdog, the Therapeutic Goods Administration, which collects data on adverse reactions to medicines, has identified a large jump in the number of deaths, in all age groups, associated with one anti-psychotic drug clozapine.

        Eighty-three deaths associated with the drug were reported in 2009 and 60 last year. But in the period January to September this year, 151 deaths were reported.

        The TGA says it continues to monitor the adverse-event reports: “The balance between the benefits offered by a medicine and the potential risks associated with its use need to be considered when any medicine is prescribed.” Used only in people with severe psychiatric disturbance, clozapine carries the risk of serious side effects, including a reduction in the white blood cell count, which increases the risk of serious infections. Its use is highly controlled.

        The Department of Health provided the above figures to the Citizens Committee of Human Rights, an organisation set up by the Church of Scientology to campaign against psychiatric violations of human rights, , but it verified their accuracy at Weekend Health’s request.

        Tess Vincent c/o The Weekend Australian

        November 1, 2011
  2. Moebius #

    I would suspect that this issue goes much deeper.

    A number of years ago I found out my daughter, then aged 6, was put on a powerful tranquilising-antidepressant. This had been presecribed to her by a paediatrician who had the reputation of being one of the ‘best’ in Queensland. I researched the drug and found out it had been banned in the U.S. for use in adults because it was so dangerous. Understand, my daugter had not been diagnosed with anything.

    It took me a while to hunt this creep down and I finally managed to ask why my daughter had been presecribed this drug. He explained to me that my daughter was being abused, and the impact on her was going to be life-long. However it was not the kind of thing that he was prepared to even make a report to the Department of Child Safety about. In his words, the drugs were to help my daugter to ‘survive her own childhood’. This of course served to numb her out to the abuse that she was undergoing. In effect, the natural and normal response of being a squeaky wheel to being harmed through abuse was to silence her and make her live with it. The justification for the medication to was, as she couldn’t label her with anything else, to call her an ‘anxious’ child. And clearly she was, because she had such an emotional father, angry enough to question his authority.

    This paediatrician’s other reason was that he thought it would pacify the mother who wanted my daughter put on the drugs to make her easier to handle (not to mention the sympathy of having such a disturbed child that she HAD to care for) and because the paediatrician recognised Mum as being a ‘doctor shopper’ by giving mum exactly what she wanted so that he could be responsible. Ironically there has been countless other psychiatrists, psychologists, counsellors, therapy groups, paediatricians, and other so-called professionals since, who have all done their little bit of damage.

    The result of all of this is that I have a daughter who has a set of survival behaviours, who is becoming increasingly aware of what her role and lot in life is, and a fundamental distrust of any professional because in the end they don’t have her interests at heart, only their own professional reputation and their obligations (or at least, what they can get away with) under the law. After all, if nobody takes you seriously, if no-one believes you, why bother speaking up at all.

    Sadly, as her father, she also doesn’t believe in me. Because I cannot make the difference she needs in her life, I am just another adult who has let her down. My role then is to quietly wait (and perhaps even dare to hope) that one day she might figure things out enough to seek out my support.

    But at least she is not (currently) at the mercy of some arsehole paediatrician or psychiatrist, wanting to make up a diagnosis and ply her with drugs. Professionals so limited in talent, that because their only tool is a hammer, they treat everything as a nail.

    November 2, 2011
  3. Anthony #

    Stories like this one are very much needed.

    November 9, 2011
  4. Her is another related article on the over-medication of children in care.

    http://www.news.com.au/national/outrage-at-child-services-threat-to-parents-of-adhd-kids/story-e6frfkvr-1226200961492

    November 23, 2011
  5. YANQ’s now got a youtube channel, and this month they have a few experts on ‘ADHD’ to give their opinions on overmedication.

    Visit http://www.youtube.com/user/celebratedontmed?blend=1&ob=video-mustangbase to view some interesting clips.

    January 16, 2012
  6. http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html?_r=1

    Another interesting article highlighting the over medication of children and questioning it’s usefulness.

    January 30, 2012

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