By Ellen Kuwana
Neuroscience for Kids Staff Writer
April 14, 2000
Increasing Use of Stimulants and Antidepressants
In the past few years, drugs such as Prozac (an antidepressant) and
Ritalin (a stimulant used to treat Attention
Deficit Hyperactivity Disorder [ADHD]) have
become household names.
These drugs ease a variety of symptoms and have
been approved for use by people six years of age and older. Because of the
dramatic behavioral and generally beneficial changes that Prozac and
Ritalin can bring about, these drugs are commonly prescribed and used to
treat
mood disorders. However, an alarming trend has surfaced in which
these medications are being routinely prescribed and administered to very
young children between two and four years old.
In a study published in
the February 23, 2000 issue of the Journal of the American Medical
Association, researchers found found that the use of antidepressants
and stimulants in children two to four years old had doubled, and in some
cases tripled,
between 1991 and 1995 in the US. These findings seriously trouble many
child health and development professionals.
Study Raises Red Flags
First and foremost, there have been no
long-term studies examining the effects of these drugs on children under the age of six. Children's brains and adults'
brains respond very differently to some medications. There have been no
research studies that examine how these drugs work in very young children.
On the other hand, there have been several studies that suggest these
drugs cause changes in the brains of young animals. For example, drugs
(such as Prozac) that affect the reuptake of the neurotransmitter serotonin, appear to decrease the
number of synapses in the developing rat cortex. Young rats exposed to
these drugs developed memory problems that persisted into
adulthood.
During development, neurons in the brain make many connections,
and drugs may affect how these connections are made. The number of
synapses in the cortex is greatest at about the age of three in humans,
and then selective elimination ("pruning") occurs, as other connections
strengthen over the following years. How these drugs affect the developing
brain is not currently known. They could alter how neurons are generated
or "born," how neurons migrate to the proper places in the brain, how
axons grow, or how synapses form. Because of these unknowns, the label on
Ritalin warns against using this drug in children under the age of six.
Second, the widespread use of these drugs highlights a problem
in the health care system: limited health care professionals. It is
estimated that there are seven to 12
million children in the US with some form of mental illness, yet there are
only 5,500 child psychiatrists in the US. This number of child
psychiatrists is not adequate. Many children with psychiatric problems
see doctors who do not specialize in behavioral issues and are
not fully trained to diagnose or treat these disorders.
Many of these disorders, such as ADHD, cannot be diagnosed with certainty
at these young ages.
A
third concern is that prescribing a pill has become a "quick fix." Many
doctors may not try less invasive treatments, such as behavioral
interventions. This situation is further complicated by insurance issues,
which often limit the number and/or type of doctor visits that are
covered. Perhaps this is like having a car with an engine that is not
working properly. Instead of taking it to a mechanic to get the problem
diagnosed and fixed, the owner buys a loud car stereo instead, to cover up
the engine noise. Although this works for a time, it is only a short-term
solution, and does not work on the main problem. Furthermore, the loud
music may be damaging the owner's ears!
What is Being Done to Address these Concerns The
public needs more information about how Ritalin and Prozac affect children
under the age of six. This study is limited in scope because it is a
cross-sectional study, meaning it looked at medication use in children at
one point in time. A long-term study is needed to see how long the
children were on the medications, and how it affected their brain
development. The National Institute of Mental Health is planning a
$6 million, five-year study on the use of Ritalin in children under the
age of six. |