By Judy Lin
Published Oct 1, 2007 8:00 AM
Copyright ©Illustration by Charles Hess, Chess Design
America's apparent love affair with prescription drugs — per-person prescriptions rose from an average of seven in 1993 to a dozen by 2004 — has a lot to do with all the dosing we do to our kids, and it's far from a healthy trend, claims Greg Critser M.A. '83, author of the book Generation Rx: How Prescription Drugs are Altering American Lives, Minds, and Bodies.
"Today the expectation is that pills can and will do everything," he writes, "from guarding us against our excesses to increasing our children's performance at school." What's more, he says, "young people who've been on medication for years may begin to discount their own ability to begin to modulate the rhythms of their lives."
Indeed, psychiatric prescriptions for children and adolescents nearly tripled from 1987 to 1996 — from 1.4 to 3.9 prescriptions per 100 persons, according to the Journal of the American Academy of Child & Adolescent Psychiatry. Groups such as the Alliance for Human Research Protection accuse doctors of "abusive, haphazard" prescribing of drugs for children. They point to a rapid rise in the diagnosis of ADHD as evidence that the disorder is no more than an invention of doctors and drug companies.
Whether or not that's true, the drug-prescription trend certainly is fueled by advertising aimed directly to consumers, says Dominick L. Frosch, assistant professor at UCLA's David Geffen School of Medicine. A decade ago, the Food and Drug Administration (FDA) changed the guidelines regulating advertising by pharmaceutical companies directly to consumers. That unleashed a tidal wave of drug messaging, mostly on television, which is so ubiquitous it has become part of popular culture. Frosch did a study on these ads and concluded they are "persuading Americans that they are sicker than they really are and in greater need of medication."
"The major risk that we face with patients with depression is untreated illness," says psychiatrist Andrew Leuchter, director of the Division of Adult Psychiatry in the Semel Institute for Neuroscience and Human Behavior at UCLA. "By far and away, the biggest risk of suicide comes from untreated depression — not from the use of medications."
Evidence of the effectiveness of psychiatric medication is well documented, experts say. Take Ritalin, for instance, a psychostimulant that's been used for nearly four decades to treat many of the estimated 5 to 10 percent of kids who suffer from attention-deficit/hyperactivity disorder (ADHD).
James McCracken, director of the Division of Child & Adolescent Psychiatry at UCLA, points to a decade of research supporting the efficacy of medication. "I think the important news that has come through," he says, "is that a number of treatments are highly effective for a range of both common and severe mental disorders in children," including ADHD, depression, anxiety, autism and related disorders.
The confidence that physicians have in psychotropic meds can be seen among students seeking treatment at UCLA's Student Psychological Services. Many students arrive on campus with a history of taking these drugs, says Director Elizabeth Gong-Guy M.A. '79, Ph.D. '85.
"For primary care providers and pediatricians diagnosing psychiatric disorders," she says, "the first line of defense often is medication. That's what their training dictates and what insurance more easily covers." (She notes, however, that the counseling center opts for non-drug therapy before meds.)
Yet some students, upon first arriving on campus, abruptly stop their meds, Gong-Guy says. "Suddenly they don't have their parents putting their pill next to their juice in the morning. They want to try without it."
The consequences of this may play out in the classroom where, she says, faculty members are often the first to see students "who are not only in distress, but who are distressing." Students nodding off in class or behaving in strange ways may signal a problem with skipped meds, for example.
Psychologist John Piacentini, director of UCLA's Child & Adolescent OCD, Anxiety and Tic Disorders Program, empathizes with parents' fears about medications yet urges an open mind.
"The many parents of kids with OCD and other conditions are very concerned about medications but these conditions can be very impairing," he says. "Some of the stories we hear on the phone from families contacting us for the first time — it's just horrible. They're desperate."
"I think it's a disservice not to use medication when we know a kid is really suffering," says Smalley. "And I think it's really problematic that our culture has a bias that it's bad to use medication in kids, because I've seen the flip side, the tremendous effect medication can have on reducing a child's suffering. Yet we all need to recognize that even if a medication is used, it is not a panacea."