Are we ‘overmedicating’ today’s youth with Ritalin and Prozac? The issue routinely gets dredged up by parents and media outlets, but it’s hardly a new concern. In the 1980s and 1990s, kids and teens who in a previous generation may have received therapy (or gone untreated) began to routinely be prescribed psychotropic drugs–antidepressants, antipsychotics, stimulants, mood stabilizers. It’s not uncommon for 20- and 30-somethings today to have spent the better part of their lives on such medications. Meanwhile, the consequences of their long-term use is virtually unknown.
“We’re the first generation to be widely prescribed psychiatric medications,” says Kaitlin Bell Barnett. “People love to weigh in on whether these medications are good or bad for kids, but we rarely hear from young people” who were or are on them.
Barnett is a Brooklyn-based, Gen Y journalist whose first book, Dosed: The Medication Generation Grows Up, was released in April 2012. In it, she weaves together research, commentary and the personal stories of a half dozen or so young adults who have been medicated since childhood to explore how “this grand experiment” is working out for those at its forefront. “The book is neither pro-medication or anti-medication,” she says. “It comes down on the side of ‘medication can be extremely helpful, but it has a lot of physical and social side effects.’”
In the book, you note that most psychotropic drugs were or are prescribed to young people without official FDA approval to be used for their age group or condition.
KBB: That has changed a little bit. In the 90s, almost none of these were approved for children. The exception was drugs for ADD like Ritalin and some new formulations, like Concerta. There were really no studies of even antidepressants for kids — the first study didn’t come out until the late 90s — so there’s just an absence of data there. The fact that they’re not approved by the FDA for use in children doesn’t mean they can’t be helpful. Doctors are allowed to prescribe drugs in this off-label way. Back then, they were going on the fact that many of these drugs had worked on adults, and there weren’t any better medications for children, so they would try it out.
There still haven’t been many significant long-term studies on these drugs and children, right?
KBB: There are some large federal studies; one notable study called the MTA study was of kids who are taking ADHD meds. But in terms of this phenomenon where people take these drugs for years and years on end, it’s really hard to replicate that in a controlled study.
What psychiatric meds most commonly prescribed to young people?
KBB: That depends a little bit on what time period we’re talking about … Medications for ADHD have been prescribed widely and have basically been just increasing since the late 80s. As far as controlled meds – stimulants, anti-anxiety meds, sleeping pills — the prescribing of controlled medications to kids has something like doubled in the past 15 years.
Antidepressants used to be very uncommon for children to be prescribed, because the older ones had a lot more side effects,. But as the 90s went on more kids were prescribed antidepressants to deal with anxiety, depression, obsessive-compulsive disorder and a whole range of conditions. There was a steady increase going on, but then in 2004 the FDA issued a black box warning (saying antidepressants could raise suicide risk in young people) so there was a bit of a drop-off in prescribing; we haven’t seen any big increases since then.
The big changes — there are two, really. These mood stabilizing drugs, like Tegretol or Depakote — those were increasingly prescribed in the 90s, and continue to be, to kids with bipolar disorder or problems regulating their aggression. It used to be if kids had behavioral problems, they got Ritalin and that’s it. Now they’ll probably get a mood stabilizer, and maybe Ritalin, too. Similar to that, the atypical antipsychotics — a whole bunch of new ones came on the market in the 90s and in the last decade, things like Seroquel, Geodon. There’s been a massive increase in prescribing those to children, in response to this increase in diagnoses of childhood bipolar disorder and similarly just for general aggression, hostility and behavioral problems.
It’s funny because there are all these media uproars about kids being overmedicated, and especially about ADHD meds, like it’s this new issue. But you mention in the book that the same sort of debates were happening in the 1970s and 1980s.
Yes, this is something that we could see as early as the early 1970s. There was a public freakout over stimulants being prescribed to kids who had problems focusing — they didn’t call it ADHD then. There were congressional hearings, and prescribing of these drugs dropped off, into the mid 1980s, partly because of this public freakout over alleged overmedication. So it’s a theme that’s not really new, and I think it is very potent in our culture. It’s an easy thing to judge, to say that kids in general are overmedicated, but … what would be the proper number? I don’t think people who are making these judgments know.