Medicating Young Minds

Sunday, Oct. 26, 2003 By JEFFREY KLUGER
STEVE LISS FOR TIME
Article Tools
Print
Reprints
Sphere
RSS

(3 of 5)
Which is why Teresa Hatten of Fort Wayne, Ind., hesitated little when it came time to put her granddaughter Monica on medication. Hatten's grown daughter, Monica's mom, suffers from bipolar disorder, and so does Monica, 13. To give Monica a chance at a stable upbringing, Hatten took on the job of raising her, and one of the first things she had to do was get the violent mood swings of the bipolar disorder under control. It's been a long, tough slog. An initial drug combination of Ritalin and Prozac, prescribed when Monica was 6, simply collapsed her alternating depressed and manic moods into a single state with sad and wild features. By the time she was 8, her behavior was so unhinged, her school tried to expel her.

Related Articles

Next Monica was switched to Zyprexa, an antipsychotic, that led to serious weight gain. "At 12 years old she had stretch marks," says Hatten. Now, a year later, Monica is taking a four-drug cocktail that includes Tegretol, an anticonvulsant, and Abilify, an antipsychotic. That, at last, seems to have solved the problem. "She's the best I've ever seen her," says Hatten. "She's smiling. Her moods are consistent. I'm cautiously optimistic." Monica agrees: "I'm in a better mood." Next up in the family's wellness campaign: Monica's 8-year-old cousin Jamari, who is on Zyprexa for a mood disorder. All along the disorder spectrum there are such pharmacological success stories. In the October issue of the Archives of General Psychiatry, Dr. Mark Olfson of the New York State Psychiatric Institute reports that every time the use of antidepressants jumps 1%, suicide rates among kids 10 to 19 decrease, although only slightly. But that doesn't include the nonsuicidal depressed kids whose misery is eased thanks to the same pills.

ARE WE MEDDLING WITH NORMAL DEVELOPMENT?
For children with less severe problems—children who are somber but not depressed, antsy but not clinically hyperactive, who rely on some repetitive behaviors for comfort but are not patently obsessive compulsive—the pros and cons of using drugs are far less obvious. "Unless there is careful assessment, we might start medicating normal variations (in behavior)," says Stephen Hinshaw, chairman of psychology at the University of California, Berkeley.

The world would be a far less interesting place if all the eccentric kids were medicated toward some golden mean. Besides, there are just too many unanswered questions about giving mind drugs to kids to feel comfortable with ever broadening usage. What worries some doctors is that if you medicate a child's developing brain, you may be burning the village to save it. What does any kind of psychopharmacological meddling do, not just to brain chemistry but also to the acquisition of emotional skills—when, for example, antianxiety drugs are prescribed for a child who has not yet acquired the experience of managing stress without the meds? And what about side effects, from weight gain to jitteriness to flattened personality—all the things you don't want in the social crucible of grade school and, worse, high school.

Adding to the worries is a growing body of knowledge showing just how incompletely formed a child's brain truly is. "We now know from imaging studies that frontal lobes, which are vital to executive functions like managing feelings and thought, don't fully mature until age 30," says Hinshaw. That's a lot of time for drugs to muck around with cerebral clay.

For that reason, it may not always be worth pulling the pharmacological rip cord, particularly when symptoms are relatively mild. Child psychologists point out that often nonpharmaceutical treatments can reduce or eliminate the need for drugs. Anxiety disorders such as phobias can respond well to behavioral therapy—in which patients are gently exposed to graduated levels of the very things they fear until the brain habituates to the escalating risk.

Depression too may respond to new, streamlined therapy techniques, especially cognitive therapy—a treatment aimed at helping patients reframe their view of the world so that setbacks and losses are put in less catastrophic perspective. "The therapist teaches relaxation skills and positive thinking," says Denise Chavira, clinical psychologist at the University of California at San Diego. "It goes beyond talk therapy." Unfortunately, medical insurance pays more readily for pills than these other treatments for adults and children.