There seems to be a growing movement, in our hurry-up modern world, to prescribe psych meds to young children. Perhaps inspired by over-concerned parents, or over-zealous practitioners, the trend might be a search for a magic bullet for the often difficult trials and travails of parenting a child who might not fit into the stereotypes we call “normal.” We also look at parent attitudes about their kids and drugs, and how those differ from what they think other teens. And finally a brief discussion of “smart-drugs.”
Transcript (edited):
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. Today we’ll be talking about children and drugs. That is a broad category, but there are a couple of stories that deal with our perceptions of teen drug use and an article on prescribing drugs for young children that might involve social issues, that otherwise would have been addressed in ways other than with strong psychotropic drugs. Smart drugs are also in the news. So, Darryl, let me just toss the question to you – what are your impressions of these stories and how do they tie in with our general understanding of drugs, especially prescription drugs. I think we are talking more about prescription rather than illicit drugs. But our relationship with our children and alcohol and marijuana is certainly a part of it.
DARRYL: I think there are a lot of different angles that need to be looked at when we talk about medicating children with childhood emotional disorders, or growth disorders. There is some thought that maybe we should treat these children at a young age and thereby prevent exposing them to a lot of harmful emotional effects. There are emotional issues that hit children at a young age and children with a lot of childhood trauma, a lot of emotional stress which does impair the function of their brain and makes them more vulnerable to things like addiction and mental disorders down the road, so we should be paying attention to our children. That said – there is a tendency to over-prescribe or over diagnosis. People look at normal kids who are a little bit shy or a little bit detached or maybe going through the terrible twos or oppositional threes and assume they have some horrendous new medical disorder — psychiatric disorder that may be expanded in the DSM5 when it comes out in 2013 –and there is a jump to prescribe medications, not because the child really has that disorder, but because of the anxiety in the parents or teachers or the doctor – making sure they treat this kid in case he might have the disorder.
HOWARD: Well, is it wanting a quick fix because our society has increasingly sped up? We want a quick fix answer – the magic pill, rather than going through the work that is necessary. A lot of these challenges that children face are part of growing and are important.
DARRYL: Absolutely. And it helps them grow.
HOWARD: Exactly.
DARRYL: I think, people also want a quick diagnosis. They dont want to think their child as abnormal or maybe a little bit different from the mainstream and therefore, you know, if their kid is a little shy, theyre going to want to look to somebody who says, well, your kid is shy because he is depressed or they are shy because she has social anxiety disorder or whatever.
HOWARD: So give them some Xanax.
DARRYL: Yes, give them either Xanax for the depression and the social anxiety or give them Prozac for depression or give them Ritalin, or something like that. There is a huge increase I forget the actual statistics, but Ive reviewed several reports on the huge increase in prescribing psychiatric medications for very young children. The other angle that needs to be looked at is we know that the brain is essentially an endocrine organ, an organ that tries to maintain homeostasis, tries to maintain its normal balance in that any time we introduce a lot of external chemicals to mix up the brain chemistry or to mess with the self regulating system of the neurotransmitters in the brain, there are going to be imbalances that manifest, and create the need to maintain an imbalance just to function. Thats the allostasis that we see in addiction. We should be deeply concerned about giving young people antidepressants – what does that do to their own ability to regulate their serotonin levels and their adrenaline and their dopamine levels?
HOWARD: The body stops making it, right?
DARRYL: Right. The young person may have needed that challenge or the environmental stimulus to grow, to allow their brain to regulate itself, to help them mature into better thinking. When we interfere with that process in an artificial way – we might be forcing that brain to just continue to atrophy, to diminish its ability to self-regulate.
HOWARD: That reminds me of a different story on a study that came out about people’s perception of new medication and the degree of its efficacy and side effects. And as it turns out, according to this study, people believe that the FDA and similar entities around the world wouldn’t approve drugs that are not proven effective or more effective than similar drugs already approved, or drugs with serious, very serious, side effects. Both of these things turn out to not be true.
DARRYL: And I think theres an added thing to that too. Drug companies are now advertising on Main Street .
HOWARD: Yes, they advertise on T.V.
DARRYL: Yes, making viewers afraid that theyre missing out on something, convincing them they need to take these things or whatever.
HOWARD: Ive really been bothered by that since it started.
DARRYL: The FDA has a charge to make sure that every new drug they approve for an indication say a new drug for just hypertension, that the new drug has some sort of niche. It has to have some efficacy that makes it, you know, unique, in terms of all the other medications that are out there – and part of that uniqueness might be greater safety it has less horrendous side effects than the ones before it. But the wealth and power the drug companies have can twist these factors in tremendous ways. All the new medications out there that get approved by the FDA are advertised by implying “dont take that old generic medication – it won’t be beneficial – you need this one” and I think all the studies are showing that there really isnt greater efficacy in new medications that are introduced by the FDA over the old established ones that are generic and more affordable.
HOWARD: The difference is the amount of money that a pharmaceutical company can make on a new patented drug. Again, follow the money.
DARRYL: That seems to be your theme and I think you probably are right. I’d like to get back to an earlier topic – prescribing psychiatric and other medications to young children so that they can perform better or be less shy or maybe grow faster so they can compete athletically – things like that. The other side of that though is if your child is morbidly shy . and is actually impaired by their shyness and you dont treat it in some way by getting proper counseling or even proper medication, is that kid being set up to find their own medication, to self-medicate themselves when they become exposed to marijuana or alcohol? Both of those drugs foster a social interaction. I remember one of my clients who was a very, very shy woman all her life and was introduced to cocaine in high school, and she said all of a sudden she was this happy, you know, outgoing .life of the party – she was who she wanted to be for the first time in her life and then she became a crack addict. And so you know, there is that angle too so we need to be sensitive enough to recognize the severity. The problem is there are gray areas – I think there are definitely young children who have who meet all the criteria for diagnosis of a major mental health disorder and definitely need treatment … to save them from suffering as well, to help them participate in society like everyone else. But there are a lot of kids who are shy or who are, you know, oppositional or whatever, but not really that far off the norm or somewhere in this continuum, who shouldnt be prescribed stuff, but unfortunately parents are so, you know, into their children and wanting their children to be the best or whatever, that they get so anxious, they may be pushing some kid who doesnt need it into . not the kid himself, but the doctor into responding inappropriately …pushing some sort of major medication when none is really needed.
HOWARD: Right. Your example of the client who discovered cocaine, that person would probably have been a prime candidate for some intervention. But, Im wondering about the new DSM. If the DSM5 is going to introduce an inclination for more prescribing …what are the parameters now?
DARRYL: DSM is a diagnostic standard manual, statistical, so they really do their homework in terms of looking at and laying out diagnostic criteria …how does a condition fit this diagnostic criteria? So based upon that itself, I think it would help to make sure that only the appropriate patient or the appropriate child gets an appropriate diagnosis and is given the proper, either clinical intervention or medical intervention to help them live more of a normal life. But the problem is that the majority of psychiatric medication or mental health medication is not prescribed by psychiatrists, or physicians who are trained in using the DSM nor do they even refer to the DSM, instead they defer to their gut level instincts or listen to their patient complaints about what is going on. The DSM5 is coming out in 2013 and will have more aggressive, more expanded information stating that young children can manifest a variety of emotional problems and major mental health problems, this may give an overall impression to doctors that they need to do more, to look for it more and to prescribe more medications to treat it these conditions – and thats the real danger of it.
HOWARD: That calls to mind the need for increased or better training around these kinds of mental health and addiction issues for a lot of our health care providers.
DARRYL: Its been a continued struggle. The mental health parody act has been in place maybe 12 or 13 years and now, mental health equity act and the addiction equity act has been in place for only 2 years, so these conditions haven’t been in the mainstream of medicine. They were sort of a unique specialty and are still considered a unique specialty of medicine when they encompass more people than the regular medical conditions encompass, in terms of people affected. More people have mental and substance abuse disorders than have diabetes or hypertension or heart disease or arthritis or any of these other things. But still, the bulk of the training and the emphasis in medical school is on physical illnesses.
HOWARD: Which are of course easier to identify, to articulate because its more physical than the ephemeral properties of mental illness.
DARRYL: Well, thats why we have an equity act and a parody act because they (insurance companies, the government, health care industry) didnt see in the brain the overall differences between somebody who has a mental disorder and somebody who doesn’t. They just stigmatized the condition – that these people didn’t take responsibility for their lives, or didn’t want to participate or serve in the Army, and were acting like they had some weird emotional problems. But now the developed science on brain imaging and neurochemistry provides much more definitive diagnostic criteria that people really are different. But – that old stigma still exists that people with mental illness and substance abuse are really slackers and weak willed and people who don’t participate in our society and thats the cause of their problems. Well, until medical schools come to grips with really making sure their physicians are trained to interact with the major mental conditions that theyre going to encounter in society, well, we are going to continue to have this lack of education, lack of training in mental health in the substance abuse arena.
HOWARD: Well, it is important that we continue these discussions so that it can be more widely understood.
DARRYL: You mentioned the Smart drugs and I am kind of fascinated by the Smart drugs. Theyve been around for a long time and theyre called nootropics in the field and theyre usually homeopathic doses or very low doses of some medications that are thought to be or have been proven to be effective in improving memory, improving thought process, providing people with sharper minds and quicker reactions. More elderly people are coming across them and are looking for them on the Internet they order them because theyre legal. They are sold as vitamins and herbs and things like that and claim to be of benefit. I thought maybe somebody should generate some research on whether or not these things are really helpful and whether or not they really improve brain processes because theyre sure getting a lot of anecdotal reports from the people who are taking them. Piracetam, gingko biloba for instance just high doses of mega vitamins and B vitamins and things that continue to claim that theyre really useful in offsetting the symptoms of Alzheimers and other conditions that may need a closer look.
HOWARD: I agree, but weve also discussed the fact that this kind of research is expensive and theres no return on an investment looking at vitamins and herbs, you know, traditional herbs that have been around and used effectively for thousands of years, tens of thousands of years perhaps, because theres no way to make a buck on it.
DARRYL: That is the real shame of it. It seems to me our Congress used to care – you hope to elect somebody who cares about the overall health of the country rather than the health of their party or their own election or whatever. But again, its always about money and they dont care. Theyre just looking out for their own interests and thats the same thing with medicine. There should be a part of medicine where the focus is on the overall health of the country and not whether or there is a buck to be made. We have the Departments of Health in our country with resources, they have taxpayer resources. They say theyre not in the business of developing drugs, but maybe they should – drugs that are not profitable but are beneficial – drugs that can benefit a lot more people and that pharmaceutical companies these are called orphan drugs because pharmaceutical companies realize theyre not going to make a buck on developing them, so nobody cares enough to look at the anecdotal research or other evidence that indicates they might be good in certain health conditions. Maybe those are the drugs our Health Department dedicates its resources to teasing out those orphan drugs and sending a message to go out there and buy this or that herb – it’s cheap and its going to save your life from a lot of misery.
HOWARD: To look at aspects of health as opposed to aspects of illness.
DARRYL: Absolutely.
HOWARD: Well, these are important topics and we will talk about them again. That wraps our pod for today. Thanks for visiting and check back soon for the next in the series. Your comments and questions are always welcome. email info@cnsproductions.com until next time.