With the new knowledge in brain chemistry of the past few decades have in fact emerged new and improved ways to tackle psychiatric disorders through what may be seen as revolutionary new medications. New medications have been found applicable not only to the more extreme forms of mental illness, but to more common disorders and conditions that many within the general population may experience during their lifetimes, such as depression and anxiety. Getting rid of depression with a pill is obviously an appealing concept to anyone that has ever experienced this difficult condition, so imagine the excitement experienced throughout the world as we learned of Selective Serotonin Reuptake Inhibitors, best known as SSRIs, the new generation of psychiatric drugs that promised to achieve just that. Alongside the new antidepressants, psycho-stimulants such as Ritalin became established as the solution to Attention Deficit Disorder, a new phenomenon that seemed to be affecting an overwhelming number of school children. It was the beginning of a true revolution in psychiatry. The notion of medicating the psyche of the average person was born. A notion that is gradually becoming established as the norm in the mainstream psychiatry and psychology of today, to the point, for example, that it is gradually replacing counseling and therapy as the most common treatment for depression. And the medication trend does not extend only to the adult population. The chemical solution is increasingly being applied as the answer to the problems of our young. But before proceeding further in finding out why this might be an issue, lets first take a look at a few facts and figures.
Statistics show that as many as 19 million Americans have been prescribed SSRI antidepressant drugs from 1993 to 2002 with 3 million new patients being prescribed such antidepressants in 2002 alone. And there are indicators that the trend has been increasing in the past two years. A recent article in
By looking at the statistics it becomes clear that psychiatric medications are being prescribed to children in unprecedented numbers. With this increasing trend, some questions must be asked. How safe are these drugs? What are the long term effects? Why are so many children being diagnosed with psychiatric disorders? These are just a few of the questions that we might ask ourselves with regard to this growing phenomenon. Lets explore a few of them together.
Are these drugs safe?
The two main categories of drugs that are being prescribed to children are SSRI antidepressants, such as Prozac and Paxil, and psychostimulants, such as Ritalin and Adderall. SRRIs are prescribed for the treatment of major depression and psycho-stimulants for the treatment of ADD/ADHD. Amongst SSRI antidepressants Prozac is the only one that has been approved by the FDA for use with children. The use of Paxil in children has been linked to suicide and at present, Glaxo Smith Kline, the company that produces Paxil, sold in England as Seroxat, is undergoing a class action suit to establish if it has failed to comply with UK and European regulations. Glaxo is in fact suspected of concealing research findings that establish links between suicide and the use of this SSRI drug in children and adolescents. There is also suspicion that Paxil might create dependency, with people complaining of difficulties in discontinuing treatment. The safety of Paxil is definitely under question, with even the FDA warning of possible risks. The truth is that all SSRIs have been linked to suicidal ideation in adults, some of which seem to also experience atypical violent thoughts and/or behavior when on these drugs. Psychiatrist Peter Breggin was concerned about the existence of these side effects as far back as 1995 in his very interesting book “Talking back to Prozac”. You can find some details on Dr Breggin’s work in the reference section of this article.
Obviously not all people that take these drugs proceed to take their lives or harm others, or we would all know about it, considering how many people are on SSRI medication, but there is enough evidence to suggest that suicidal ideation, thoughts of self harm and thoughts of harming others are being experienced by some users. The pharmaceutical companies and the advocates of the drugs argue that the people that are experiencing these symptoms would probably be experiencing them even if they were not taking medication, as part of the symptoms of their depressive disorder. But many of the patients and their families disagree, claiming that the symptoms are more intense and uncharacteristic of those they were experiencing before taking the drugs. It is worth keeping these facts in mind when faced with the possibility of medication a young person alongside the fact that the long term effects of these drugs are not quite known.
In the case of psycho-stimulants, such as Ritalin and Adderall it is important to know that these are amphetamine-like drugs. In higher doses amphetamines are known to be harmful and addictive, causing in some cases psychosis, heart problems, liver problems and kidney problems. Here are some of the side effects of Ritalin as reported by investigative journalist Jon Rappoport, where at least one instance of each side effect has been reported in medical literature: paranoid delusions, paranoid psychosis, hypomanic and manic symptoms, amphetamine-like psychosis, activation of psychotic symptoms, toxic psychosis, visual hallucinations, auditory hallucinations, pathological thought processes, extreme withdrawal, terrified affect, screaming, aggressiveness, insomnia. It is to be noted that some of the above side effects are quite rare. Not all children will have these particular reactions to Ritalin. The side effects list gives nevertheless an indication that these psycho-stimulants are far from risk free.
Examining the diagnostic process
Medication risks aside, the diagnostic process itself presents it own set of problems. In the US the diagnosis for both ADD/ADHD and depression are made following the criteria indicated in the DSM_ IV, the Diagnostic and Statistical Manual of Mental Disorders. If you look up the definitions and the criteria for ADD/ADHD you will find that the disorder is diagnosed on the basis of subjective observation of behavior alone. That means that the diagnosis is made in this way: a mental health professional or a medical practitioner observes the behavior of a child or listens to the parent’s description of such behavior. If the child is seen to display a certain number of behaviors that belong to the diagnostic list, the child is diagnosed with the disorder. The key words here are “observes” and “behavior”. “Observes” implies that we are relying on the subjective evaluation of that professional’s interpretation of how the child has been behaving. And referring to “behavior” alone indicates that there are no tests of a medical or biochemical nature that are carried out to make the diagnosis. I have already written an article about the issues involved in the diagnostic process for ADD/ADHD in the 2004 Winter issue of this magazine, so I will not go into much more detail here. Just keep in mind that it is very likely that children are being over-diagnosed with ADD/ADHD due to the diagnostic process itself.
The diagnostic criteria for the various forms of depression are much better than for those of ADD/ADHD although, even in these cases, the nature of the depression is still mostly deduced from subjective observation of symptoms such as depressed mood, difficulty sleeping or changes in appetite. The criteria work well in ascertaining if a person or a child are indeed depressed, but are not so good in determining if the person or the child are depressed due to imbalances in brain chemistry or for other reasons. Even if some causes, such as bereavement and hypothyroidism, are investigated prior to making a diagnosis of depression, it would seem that there is still not enough attention given to other underlying causes. This was not much of an issue before the widespread use of medication for the treatment of depression. Now that SSRIs are being prescribed so liberally for the treatment of kids and adults alike, I feel clearer distinctions need to be made. In light of the fact that the solutions that are now so often thrown at both ADD/ADHD and depression are chemical in nature i.e. drugs, we would expect to see the requirement of some sort of biological evidence of a biochemical imbalance as part of the diagnostic process. Call me old fashioned, but I would expect that only disorders caused by a brain chemistry malfunction should be corrected with brain chemistry altering drugs. But within the DSM-IV we do not find the requirement for biological-type tests as part of the diagnostic criteria for these disorders that are now so often chemically treated. As things stand there seems to be a lot of room for interpretation and errors of judgment.
It is my strong opinion that the DSM-IV needs revising in light of the new widespread use of medication as a treatment. Clear distinctions need to be made between conditions caused by inborn brain chemistry malfunction and disorders with other root causes. When making a diagnosis mental health professional should not limit to observations of symptoms, but should also be required to investigate the possible causes of such symptoms, before rushing ahead to fix problems with medications that, as we have seen, are not without their own dangers. Many alternative practitioners, for example, have become aware that the symptoms of ADD are often caused by nutritional deficiencies, food sensitivities, malfunction of the adrenal glands or environmental toxicity. Similar behaviors do not always indicate that we are dealing with the same problem. And different problems require different solutions. And even when chemical imbalances are found, they do not always need to be corrected with harsh pharmaceuticals. Medication is only one of the solutions and one not to be taken lightly. If your child is ever diagnosed with a psychiatric disorder, make sure to ask mental health professionals following what criteria your child is being diagnosed. Demand to be convinced and do not take things at face value. Get a copy of the DSM-IV or, if you live outside the US, of an equivalent mental health reference text and read the diagnosis criteria. Ask for a second opinion. Explore all available treatment options that are available to you. You will find that there are many. You will find many alternative solutions right here amongst the articles and resources of Children of the New Earth.
A few words about depression
As the trend of medicating depression in our kids is on the rise, it is worth spending a few words on the nature of depression itself. Very few depressed people are actually congenitally clinically depressed, i.e. born with a brain condition that does not allow them to feel happy. Most people are simply reacting to issues in their lives or to traumatic events in their past. In this sense depression is a very healthy reaction of the psyche, a reaction that tells us about the adjustments that need to be made to move into a healthier and more wholesome life experience. From a spiritual
Depression is a very similar mechanism to pain in the physical body. If my foot hurts, I better check to see what is wrong with it, as pain is the signal the body gives me in order to tell me that all is not well with my foot. Leprosy, for example, is an illness where, amongst other things, some of such pain signals do not work properly. So a person affected by leprosy may not know when he or she is doing something harmful to its feet or hands, like knocking into things or stabbing one’s toes or touching a hot stove, as there is no feeling of pain. As a result people with leprosy often loose toes and fingers through injury and burns, as the brain is not receiving the painful but very useful signals that would alert them that what they are doing is damaging their extremities. I believe it is the same with depression. Medicating depression may get rid of the painful emotions, but what happens to the issues that caused them? If a child is telling us through his depression that he is not being fed or nurtured properly, that he feels unsafe or that she is being abused, will that information still be conveyed when numbed by the comforting but perhaps illusory blanket that drug treatment provides? These are questions that need to be answered in a time in which a mechanical world view in medicine and mental health, increasingly concerned with mechanisms and molecules, seems to be forgetting the deeper aspects of what it means to be human.
We and our children are not just complex biological machines; we are subtle beings whose lives were created with the purpose of evolving and growing into deeper and deeper consciousness. Our ailments of body and mind, taken out of this context, stripped of Soul and meaning to the naked scaffolding of our biology, cannot but be seen as faulty mechanisms that need fixing with all available mechanic means. But we and our children are so much more than a set of chemical reactions. We are not just our brain but beings of Spirit and Soul. And as such, we need solutions that address our children as the multifaceted creations that they are. Or we may run the risk of raising a generation of kids that are out of touch with the signals of their Soul.
To be continued. Part 2 will appear in the February issues of Children of the New Earth.
Note: As it is obviously impossible to cover in detail the contents of the DSMIV in the context of such a small article, be aware that some of the information here presented loses in accuracy when speaking in general terms. None of the statement made in this article are meant to replace the advice of a trained mental health professional. The author’s opinions here expressed are offered to stimulate awareness and raise questions, not as substitute for appropriate medical advice, diagnosis and treatment. If your child is on medication, know that it is dangerous and at times life threatening to discontinue medication without the support of a licensed mental health professional. Never stop psychiatric medication without appropriate assistance and supervision.
©2005 Katie Gallanti. All rights reserved. http://katiespapaers.blogspot.com. This article was first published in Children of the New Earth Magazine in January 2005.
American Psychiatric Association. 1997. Diagnostic and Statistical Manual of Psychiatric Disorders. Fourth edition. APA.
Breggins P, Breggin G. 1994. Talking back to Prozac. Mass Market Paperback.
Breggin P. 2004. Antidepressant-induced suicidality and violence
Durman P. and Rushe D. 2004. Glaxo faces criminal action in Britain over ‘suicide’ pills. The times. http://business.timesonline.co.uk/article/0,,8209-1135320,00.html
Freudenheim M. 2004. Behavior drugs lead in sales for children. New York Times.
Gallanti C. 2004. ADD/ADHD: why are we drugging our kids? Winter Issue 2004. Children of the New Earth.
Glaxo/Seroxat class action suit http://www.ahrp.org/infomail/04/06/07.php
Rappoport Jon 2004. The hidden Ritalin facts. http://www.nomorefakenews.com/archives/archiveview.php?key=1693
Vedantam S. 2004. Antidepressant Use in Children Soars Despite Efficacy Doubts.