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Risks and Benefits of medicating Kids Mental Problems
Mental health problems in young people are of great concern, but there is a perception among the general public that our kids are being over-medicated and given dangerous substances by the medical profession. Much of this may be fueled by sensationalist media reporting. There is actually a reluctance on the part of many doctors to treat depression, anxiety and similar problems with medication, and with good reason.
Medications are generally not designed for children or adolescents; not tested with or for them. There are a number of methods for converting adult doses for children, but they provide estimates only; there is still a good deal of trial and error involved in getting the dose right~ kids are a lot less predictable in their reactions than are adults, whose neurology and metabolism has stabilised. Additionally, mental illnesses do not present in with the same symptoms in children as they do in adults: depression might look like stomach upsets, or as school refusal, or as regression to an earlier stage of development (say, beginning to wet the bed again), so the standard tests and investigations that we use to determine if an adult should start a course of medication may give a false impression if applied to an adolescent or child. They may be given medication when it isn't appropriate, or refused it when it is. In an ideal world, medications would resolve the disorder which is producing the symptoms of an illness. In this world, what people demand is relief of their symptoms, and they expect a medication will provide that; unfortunately, medications used for mental health conditions do just that. That sounds fine, but it leads people to expect results and to pressure health professionals to prescribe when that may not be in the patient's best interests. They want to feel better NOW! Anxiolytics like diazepam (Valium) and antidepressants relieve the symptoms rather than treat the underlying condition, or at best, relieve the symptoms long before the disorder has resolved. Why is that a problem? Anti-anxiety medications relieve the need to deal with problems or even to recognise their source; kids on these drugs may never develop useful coping strategies, becoming dependant instead on taking something to handle the normal stresses of life. Thankfully, they are rarely given to young people. Antidepressants are, and this is of real concern. Dreadful as they are, the symptoms of depression provide a measure of protection against suicide. Depression robs the sufferers of energy, sleep, the ability to plan and weigh ideas, to think clearly. In adults, it usually requires a couple of weeks of medication before the deep sadness and pessimism of depression starts to lift, and probably at least as long for children. But the other symptoms resolve much more quickly, and with the ability to think and plan, and with enough energy to put a plan into action while you are still gripped by the emotions of depression, suicide becomes a real risk. It is one that some young people have acted on! Blaming this on the antidepressants, or even on the prescriber is a natural enough reaction. Claiming it as evidence that children should not receive medication is something else. Last year the US FDA required labelling of antidepressants to call attention to the risk of suicide. This has also been taken by some to mean that these drugs are dangerous for young people. All medications carry a degree of risk. That risk has to be balanced against the potential benefits and the relative risk of doing without the medication. In the case of antidepressants, it is probably a risk worth taking, because the risk of suicide and other complications, is much higher when medications are not prescribed than when they are. Not every child who is depressed benefits from them, but about 60% of kids with Major Depressive Disorder do, and 70% of kids with anxiety disorders do better with antidepressants than without (some antidepressants relieve anxiety; these are not the same as the drugs such as Valium referred to above). When used by knowledgeable and experienced clinicians for appropriate conditions, there is a real place for them in treating young people. Careful monitoring is essential and they seem to be more useful for patients with anxiety disorders compared to those with Major Depression.
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This intel was contributed by David Rich
David Rich
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May, 2012
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