Medications for Children and Youth With Mental Health Symptoms

                                               
Is your child or adolescent on medication for their symptoms of depression, anxiety or other mental health diagnoses? Do you know anyone who’s child is? Do you know that these medications were designed for adults and not for children? And do you know that such medication could permanently change your child’s brain?

I have been working in children’s mental health for 25 years and continue to be astounded by the numbers of children I see who are taking adult psychotropic medications for their mental health symptoms. Psychotropic medications, including antidepressant, stimulant, and antipsychotic drugs, were designed primarily for adult usage only. There are many concerning facts regarding children taking these medications.

In 2015 the Canadian Institute for Health Information reported that children and youth who were diagnosed with serious mental health disorders were often prescribed psychotropic medications as a first-line intervention to their issues. Serious mental health disorders were considered to be: depression, bipolar disorder, anxiety disorders and schizophrenia.

There are very few tests conducted on the long-term effects of these medications on children’s developing brains. Although there have been many advances in psychiatric medicine, the studies on the effects of these medications have been mainly conducted on adults.

There are safety concerns about antidepressants in the pediatric population; increased suicidal ideation is the most concerning. Other adverse side effects of psychotropic agents include radical weight gain, increased blood pressure, blood fats and increased risk of diabetes (references below). Stimulant medication side effects include insomnia, reduction in appetite, irritability (Connor & Barkley, 2006) and growth suppression (Swanson et al., 2006). Safety for long-term use of any of these medications has not been extensively explored in children. There has also been very little research about the differential metabolizing of medications in children according to their gender, race and ethnicity.

In 2003-2004, the FDA and European Medicines Agency contraindicated Selective Serotonin Reuptake Inhibitors (SSRI’s) for treating depression in the younger population due to the increase in suicide risk that was found in young people taking these medications. SSRI’s are still the most popular medication given to young people today for a variety of issues.
Bottelier et al (2014) concluded that long-term effects of medication on children’s brains are possibly delayed, becoming present once the brain matures in adulthood. Also known as ‘neuronal imprinting,’ this refers to the process of a drug’s effects long outlasting the drug’s presence in the bloodstream.  They recommend behavioral therapy as a likely safer and more effective treatment than medication for children and youth with mental health symptoms.

A three-year study conducted in the US by Dr. Susan dosReis, et al. (2014) concluded that approximately 12% of children age six and younger in foster care for one year or more received at least one psychotropic medication and that as they grew older, the amount of psychotropics they received increased with each year of age. The study found that the use of three or more psychotropic classes began among children as young as age four. They specifically determined that 13% of children less than four years old, 29% of four-year-olds and 58% of five-year-olds were receiving psychotropics with 77% receiving more than one. The results of the study suggested a trend toward what they called “chronic use” and they expressed concern about the effects of these medications on brain development, and metabolic adverse effects. Upon investigation, they also concluded that few patients received routine metabolic monitoring and that the literature about the effects of these medications long-term is scant. To offset these trends, they recommended an adequate trial of psychosocial treatment prior to psychotropic intervention and routine metabolic monitoring to minimize the risk of potentially life-long adverse effects of these medications. There is a critical need for long-term studies to evaluate the effect of chronic exposure on children’s health and well-being.

The National Youth in Care Network conducted a study around this time funded by Health Canada and discovered that another common concern was that many of the youth in care were being diagnosed with mental health disorders and prescribed psychotropics by a family doctor rather than a mental health professional. In many cases, they had never visited a child psychiatrist, psychologist or another doctor for a second opinion. This remains a fact for many of the children and youth in care in Alberta to date.

There has been evidence to support an increase of all psychotropic medications being prescribed to children and youth, whether they are in care or not, over the past three decades and this could be the result of overreliance on pharmacotherapy as a first-line treatment and/or use of these medications for unapproved diagnoses (Ninan, A. et al, 2014).

Not only have psychotropic medications not been designed for children nor are the long-term results of them clear but there are few of these medications that are approved by Health Canada for administration to anyone under 18 years of age. Reportedly, some doctors use a method called “off-label” to prescribe antidepressants for children with depression, anxiety and obsessive-compulsive disorders and antipsychotics for children with ADHD, conduct disorders, aggression and other behavioral challenges (Kirkey, S. National Post, 2016).

In a nutshell and well said by Dr. Morris, J. and Stone, G. (2010), “there is little evidence available to warrant the widespread use of psychotropic drugs for children, and little long-term data regarding its long-term impact on development.” They further state that mental health medications were designed to treat adults, and that they are often “misused to treat children and adolescents.”

The news is not all bad. Although it is true that very young children are put on psychotropic medications that were initially designed for adults and that the long-term effects of these medications on their developing brains is not clear, it is also true that there is safety data for the short-term use of single medications used to treat many childhood psychiatric disorders (Walkup, J., 2009) and that these medications do alleviate symptoms and allow children to navigate their daily life more adeptly.

What is the best approach to treating children’s mental health symptoms? The preponderance of available evidence in child psychopharmacology indicates that psychosocial treatments (e.g., counselling, therapy, behavior management approaches) are the best first-line intervention in children’s mental health and recommend that these are tried before the introduction of psychotropic medications. It is also widely agreed upon that when these do not work or are not available, that a combination of medication and psychological treatment may be a reasonable approach.

Psychosocial treatments are the most recommended and effective treatments for mental health disorders in children Unfortunately, many communities lack skillful providers of such treatments and many provinces do not provide coverage to access these services under their healthcare models. If they did, this could potentially alleviate the constantly increasing numbers of children and youth receiving psychopharmacology treatments rather than skilled psychological assistance. This is the reality of why so many of our children and youth are receiving psychotropic medications. Due to it being the only treatment available in some cases, we acknowledge that, in these cases, psychopharmacology may be saving their lives.  

In Alberta, I am part of a network of Psychologists called EPIC, Expert Psychologists Interagency Clinical Network (epicpsychology.net) who have petitioned the government to increase access to private psychologist practitioners. Through provision of first-line psychosocial intervention for our young people, it is expected that over-prescription of psychopharmacological treatment would decrease.

As parents or others who may be concerned about the impacts of adult psychotropic medications utilized in the treatment of children and youth, you can help by signing our Petition · Petition to provide Provincially Funded Psychological Services in Alberta · Change.org, by contacting your local member of parliament to advise of this issue, by lobbying for funding to be provided to test for the long-term impact of these medications on our young, by sharing this article and by querying your doctors for any information or research they may have about the effects of these medications on young people.

Given the expressed concerns by parents and the medical community about the increasing exposure of children to psychotropic medications, further scientific study of this issue is warranted, especially pertaining to the long-term effects on their developing brains.  

Eileen Bona
Registered Psychologist
CEO and Executive Director of Dreamcatcher Nature Assisted Therapy
March 11, 2020