Neuroscience for Kids - In the News

Increasing Use of Stimulants and Antidepressants
In Children Sounds an Alarm

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.

References:

More tots are given Prozac, Ritalin; researchers troubled by increasing use, Seattle Times, February 23, 2000.
American Academy of Child and Adolescent Psychiatry
Magno Zito, J, Safer, D.J., dosReis, S., Gardner, J.F., Boles, M., Lynch, F., Trends in the prescribing of psychotropic medications to preschoolers, JAMA, Vol. 283 No. 8, February 23, 2000.
Coyle, J.T., Psychotropic drug use in very young children, JAMA, February 23, 2000, pp. 1059-1060.

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