Childhood Medications: Time To Wake Up
Posted by Dr. Vollmer on August 13, 2013
Now we have data to support my long-running rant that many child psychiatrists, working in community settings, are prescribing antipsychotics to children, not because they are psychotic, but because they are angry, traumatized and very difficult to manage. This is an “off-label” use of medications as these medications are not indicated to control difficult behavior, but as a side effect, they do help kids and adults calm down. The disparity among the privately insured versus the publicly funded children could be explained by the fact that these two populations have very different mental health issues. Generally speaking, publicly funded children have more social stressors, and hence they have more traumatic experiences in which they have to deal with, often with a limited environment that does not give them the opportunity to discover the language of feelings and hardship. Plus, many of the children in foster care need to stay in foster care, so there is a strong push to use all available tools to prevent a child from yet, another traumatic transition. Still, to get these medications, there is a doctor prescribing them, and this is where I want to focus. Child psychiatrists are often hired out of training, where they have been primed to think about how psychotropic medications impact children. They need jobs out of training and community jobs both provide employment, but also an opportunity to serve the under-served. Yet, when these young physicians land in their first job, they are confronted with an ethical dilemma. The staff at these agencies want these kids to calm down. Atypical antipsychotics can do this. For a short time, an atypical could calm down a tough situation, and so that might make sense. The problem is that this “short time” becomes year after year, and placement after placement, leaving these children in a compromised mental space. These atypicals dull thinking, and cause the metabolic syndrome, meaning truncal weight gain, and a high likelihood of type II diabetes. So, do we deal with the short-term crisis of aggressive behavior, or do we think more long-term about the exposure to detrimental side-effects? I think we need to understand these children, as most of them falling under the umbrella of trauma, and as such, they need to cope with their trauma through understanding and modeling. Psychotropics present short-term gain, for long-term pain. It is not worth it. Child Psychiatrists should use this data as a point of advocacy. We have to be part of the solution, not the problem.