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Cheaper to Medicate

by PeakCare on 31st October 2011

Home -> Articles -> 2011 -> October -> Cheaper to Medicate

“Children are one-third of our population and all of our future”-unknown

The overmedication of babies, children and teenagers is gaining more and more media attention both in Australia and around the world.

The over prescribing of anti-depressant and antipsychotic medications in particular is becoming increasingly concerning. The decision to use of these drugs to treat children and adolescents should not be taken lightly and parents and carers should be warned of the potential dangers before agreement is reached to treat the child in their care with these medications.

Recent reports regarding the deaths of children and young people that are linked to antidepressants and antipsychotics include babies dying when their mothers had taken anti-depressant medications whilst pregnant and a four year old child dying from an overdose of medication prescribed to her by her psychiatrist to treat bipolar disorder.

Last year the New York Times reported on the case of a boy who had been prescribed antipsychotics at the age of 18 months to deal with severe temper tantrums. The article highlighted that more than 500,000 American children and adolescents were taking these powerful medications. In Australia the figures are also alarming. 2011 Federal health department data that relates to the period from 2009 to 2010 reveals prescribing rates of the controversial drugs in children younger than 6 years old have risen 50%. In the same period five deaths were also linked to anti-depressants in children aged 10 to 19 and 89 adverse reactions were linked to anti-depressants in children aged nine and under.

The unfortunate reality is that figures collated in America show that it is cheaper to medicate than to provide therapy and therefore that children living in poverty are the most likely to be given drugs rather than therapy. A study by Rutgers University found that children from low-income families were four times as likely to receive antipsychotics as their privately insured counterparts. In addition, children in foster care seem to be medicated more often. In the USA, this has prompted a Senate panel to ask the Government Accountability Office to investigate such practices

Disadvantaged children in Australia are faring no better. When we look at children in out of home care what we see is nothing short of disturbing. Babies as young as 12 months being are prescribed ADHD drugs against the national guidelines issued by the Royal Australasian College of Physicians and National Health and Medical Research Council. The guidelines state: “Medication should not be used as first-line treatment for ADHD in preschool-aged children.”

The statistics relating to children in out of home care should cause alarm:

  • One in every fourteen children under the age of six in out of home care is being prescribed antipsychotic medication.
  • 50 per cent of children under 12 who live in residential care are being prescribed antipsychotic medication.
  • 44 per cent of Aboriginal children in residential care are medicated on drugs such as Ritalin, Strattera and Zoloft.

Many of these medications have not been proved safe for use in young children. We need to do better –the rate of medication for Attention Deficit Hyperactivity Disorder among young people in foster homes is more than double that in the general population.

A recent example that highlights why we should be far more cautious when prescribing strong education to young people is the tragic suicide deaths of two 16 year old girls in Maryborough. The hidden side of antidepressants: are they putting young lives atrisk? Published recently in The Conversation examined the cases of Zoe and Felicia.

Coroner’s reports have confirmed Felicia Goodson had traces of the “prescribed anti-depressant” Venlafaxine in her system when she died, and Zoe Gough had been taking the anti-depressant Zoloft for a number of months prior to her death. Both these medications have been banned for use in young people in Britain and America as they have been linked to juvenile suicide.

Let’s look at some of the facts.

  • The World Health Organization figures show that pre-schoolers are the fastest-growing market for antidepressants. At least four precent of pre-schoolers have been diagnosed as being clinically depressed.
  • In 2004 the Australian Adverse Drug Reaction Advisory Committee warned that Venlafaxine and Sertraline (Zoloft) had been linked to an increased risk of suicide and self-harm among children and adolescents but both these drugs continue to be prescribed ‘off-label’.
  • In the United States and the United Kingdom, Prozac is the only antidepressant approved for adolescent depression.
  • Standard antidepressants have been revealed to have serious risks and are linked to suicide, violence, psychosis, abnormal bleeding and brain tumours.
  • In the US, all antidepressants have a mandatory black box warning of increased risk of suicide in under-25s.
  • In Australia, no antidepressant is currently approved for the treatment of major depression in young people, although unapproved, “off-label” prescription is common.

Quoted in The Australian newspaper, Adelaide psychiatry professor Jon Jureidini said there were “many reasons to be concerned about the prescription of such drugs to the girls. We should be very cautious about prescribing anti-depressants to young people in any circumstances and we should be doubly cautious when the medicine is not being properly supervised.”

In practice, anyone directly involved in working with children and young people should be actively questioning which, if any medications children are being prescribed and advising their parents, carers or the relevant authority of the potential dangers involved.

If we do nothing it may soon be too late for another Queensland youngster.

Tess Vincent. PeakCare Queensland