Is the Use of Psychotropic Drugs in the Treatment of Children Viable?

Abstract
In order to understand how psychotropic drugs affect children, this report will look at two unrelated, completed papers that incorporate several different studies. The drugs used in these studies are used extensively in the treatment of mental disease in both adults and children. While we know the side-effects in adults, there is not a lot of research involving children and the benefits or drawbacks of using psychotropic drugs in their treatment. Is it ethical, professional or feasible to give drugs (that have not been approved for children), to children? Method: selective review of completed studies concerned with children and the use of psychotropic drugs. The results of these studies will be presented and discussed in this paper. This paper will also present findings and suggestions for further research.

Is the Use of Psychotropic Drugs in the Treatment of Children Viable?

Introduction

Children diagnosed with mental disease and given psychotropic drugs encounter a range of side-effects from those medications that adult’s rarely, if ever, see. Are the only side-effects the ones we can see at the time of treatment? If some of these medications affect a child’s ability to interact with others and learn at a higher level, are they worth it?

The directional research hypothesis which states the prediction of the specific outcome would be: Psychotropic drugs change the normal growth and development of children’s minds and bodies when compared to the growth and development of children who are not taking psychotropic drugs. The non directional research hypothesis would be: Do the benefits of psychiatric drug use in children outweigh the possible costs? Through this report the author will attempt to discover an answer to the above question.

Statement of the Problem

There has been a large increase in the diagnosis of pediatric mental disease over the last few years. Are our children’s mental faculties degrading or are they being mis-diagnosed? The diagnosis of a child, (pre-adolescent), as bi-polar or with a mental disease of any kind is a huge step in a child’s life. Once such a diagnosis has been made, it is a lifetime blemish. Everything else in the child’s life is “tainted” by this diagnosis. If the child should get frustrated at school and wind up in a scuffle, it becomes because of his “mental disease” rather than simple frustration leading to aggressiveness. If a child is merely curious and investigative, does that mean he is ADD/ADHD or bi-polar? The author believes that these diagnosis’ are much over used and that the medicines involved in “helping” the child achieve control may actually be detrimental to the child in the long run. It takes a lot of work to diagnose an adult with mental disease, then longer yet to differentiate between the different possible problems. Some are so close in signs and symptoms that it takes in-depth psychological/psychiatric testing as well as observation and counseling in order to differentiate between them. How can Doctors and therapists differentiate between normal and abnormal behaviors in children without observation and study of the individual child? There are so many other possible answers to the supposed problems. When we give these children mind-altering drugs, we must take into consideration that we are changing what cannot be un-changed.

Literature Review

The first article was called “Endocrine and Metabolic Adverse Effects of Psychotropic Medications in Children and Adolescents.” (Correll, C.U. & Carlson, H.E. 2006). The topic was just what the title states, the adverse effects of psychotropic drugs on the endocrine and metabolic systems of children. They found that Lithium and Valproate in particular may cause some serious problems. Lithium (lithobid) can cause mild reversible growth retardation, clinically significant reductions in adult height and, as with adults, thyroid dysfunction. Valproate (depakote, depakene) can cause polycystic ovary syndrome and weight gain. The authors found that information regarding the efficacy and safety of these drugs is in short supply and that “these side-effects are some of the most concerning.” (Correll & Carlson, 2006, pg. 771). The authors go on to state that “Although more data are required, children and adolescents appear to be at higher risk than adults for antipsychotic-induced hyperprolactinemia, weight gain, and possibly, associated metabolic abnormalities.” (Correll & Carlson, 2006, pg. 771) What this means in layman’s terms is that these drugs can cause children to suffer from hypothalamic-pituitary dysfunction, which is where hormones are produced. This can cause an excess of estrogen to be produced in the child’s body, both male and female. This in turn, can cause the child to be shorter than they would otherwise be, and/or cause young boys to develop breasts, early development of breasts, and a delay or complete absence of menstruation. These drugs can have a considerable impact on long term psychological and physical health within the child and adolescent population.

The weight gain mentioned above is referring to childhood obesity. Weight gain sounds like simply a cosmetic problem, but it is much more than that. Obesity carries a whole host of associated medical problems such as: insulin resistance, diabetes, coronary heart disease, increased glucose (sugar) levels, increased lipid (fat) levels, Multiple complications include psychosocial, pulmonary (lung), gastrointestinal (stomach), renal (kidney), musculoskeletal (bone), endocrine, cardiovascular (heart), and neurological (brain) consequences. Metabolic and endocrine effects include type 2 diabetes, precocious puberty (very early onset), polycystic ovary syndrome (ovarian cysts) in girls, and hypogonadism (abnormally small testes) in boys.

Studies measuring weight gain associated with Geodon, Risperdal, and Abilify verified that these drugs cause excess weight gain in children. Geodon caused the most weight gain in these studies, with risperdal second and abilify third. C.U. Correll reviewed and combined these studies in his paper entitled: “Weight Gain and Metabolic Effects of Mood Stabilizers and Antipsychotics in Pediatric Bipolar Disorder: A Systematic Review and Pooled Analysis of Short-Term Trials.’ (2007). In another study, also used in Correll’s paper and reported by the American Diabetes Association; Geodon, Risperdal, Abilify, Clozapine and Seroquel all caused weight gain, an increased risk for diabetes and a worsening lipid profile. (American Diabetes Assoc., 2004, pp. 596-601).

The second article was entitled “Prenatal and Perinatal Effects of Psychotropic Drugs on Neuro-cognitive Development in the Fetus” (Bercovici, 2007) This article is aimed at summarizing the detrimental effects of commonly used psychotropic drugs on the fetus. “It is hypothesized that these drugs can alter development via two pathways. First, prenatal effects on neurotransmitters can alter brain circuitry, thereby predisposing children to later learning and behavioral deficits. Second, prenatal events caused by drug withdrawal upon delivery of the baby, may have long lasting effects on cognitive developments, as suggested by numerous animal and human studies. Various motor and respiratory side effects resulting in especially low Apgar scores may have deleterious consequences.” (Bercovici, 2007, pg. 1). The Apgar is a system for evaluating an infant’s physical condition at birth. Scores can range from 1-10, with 10 being excellent.

In study after study used in this report, SSRI’s (Selective Serotonin Reuptake Inhibitors) were shown to significantly reduce the Apgar score of the newborn infant as compared to newborn’s whose mother’s were not taking SSRI’s. SSRI’s are the most commonly used drugs to treat depression, obsessive compulsive disorders, eating disorders, etc.

Findings

The drugs discussed in this paper are used in the treatment of children with supposed mental diseases such as bi-polar, depression, ADHD and many others. These drugs have not been approved for use with children. Further studies are required to determine exactly how these drugs affect children and what, if anything, can be done to counteract the adverse effects. At this point research even points to these drugs actually causing more problems than they are supposed to fix. It is safe to say that women who are pregnant or may become pregnant are placing their fetus’ at high risk for neurological problems as well as suffering from withdrawals immediately following birth when they continue to take these drugs. The child who has been diagnosed with a mental disease and placed on these drugs is also at high risk, albeit for different reasons.

Discussion

Children grow so fast and go through so many changes in a single year. How is it determined that a child has a mental disease? We cannot test a child like we do adults. The child may simply being be adapting to changes, overly curious, shy, or any of many different reasons for the questionable actions.

It is astounding that there are children who are being diagnosed with mental diseases and immediately put on drugs rather than being taught coping skills. In the United States it is illegal to prescribe drugs to adults (that have not been through considerable testing and FDA approval), psychotropic or otherwise. How then, should we be able to give drugs to children that have not been tested and approved for use in children? Especially when what little testing that has been done, shows serious problems occurring. There are many alternatives to drug therapy that should be encouraged. Drug therapy should always be a last resort, especially when dealing with a child. Children go through so many changes in such a short time period that what is perceived as mental disease today may well be “outgrown” tomorrow. Children are given these drugs at a time in their lives when the body is growing and changing. This time in a child’s life will not be repeated and any disruption of the normal process cannot lead to good results. Children and parents can be taught coping skills to help them deal with their problems until such a time as the child’s body and mind have matured enough to allow these drugs to work without devastation.

Conclusion

While these drugs can be effective in children, the potential side-effects are such that there use is highly questionable. Although a child may in fact have a mental disease, drug therapy should be possibly be postponed until late adolescence due to evolving brain and body growth. All parents should be advised of potential complications concerning their child’s growth, both mental and physical, as the side effects of these drugs can be devastating. Pregnant and nursing mothers “should avoid the use of such drugs unless they are deemed absolutely necessary to both mother and child. If drugs must be utilized, strict guidelines should be set to ensure that fetal withdrawal or dependency from these drugs does not occur. Finally, perinatal events should be meticulously noted for future reference during the development of the child” (Bercovici, 2007, pg. 1) The drugs mentioned in this article have not been approved for use with children and therefore Doctor’s should approach their use of these drugs with extreme caution when treating children or pregnant mothers. Further research is needed, both medical and psychological in this area. The potential complications of these drugs when used in treating children, desperately needs complete evaluation.

References

American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004, 27 (2): 596-601.

Bercovici, E (2004). Prenatal and Perinatal Effects of Psychotropic Drugs on Neuro-cognitive Development in the Fetus. Journal on Developmental Disabilities 45(2), 1-20 Retrieved February 11, 2008, from oadd.org journal database.

Correll, Christoph U. & Carlson, Harold E. (2006). Endocrine and Metabolic Adverse Effects of Psychotropic Medications in Children and Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 45(7), 771-791. Retrieved February 12, 2008, from Research Library database. (Document ID: 1090265801).

Correll, Christoph U. (2007). Weight Gain and Metabolic Effects of Mood Stabilizers and Antipsychotics in Pediatric Bipolar Disorder: A Systematic Review and Pooled Analysis of Short-Term Trials. Journal of the American Academy of Child and Adolescent Psychiatry, 46(6), 687-700. Retrieved February 25, 2008, from Research Library database. (Document ID: 1284526381).

Smith, R., A., & Davis, S., F. (2007). The psychologist as detective: An introduction to conducting research in psychology (4th ed). New Jersey: Pearson-Hall.

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