The Chill Pill Kids

The Chill Pill Kids

Sunday Herald | November 21 2004

More and more children, some just five years old, are being prescribed antidepressants. Yet nobody is sure of these drugs’ effects. So why are we using our young people as guinea pigs?

IT took just 25 minutes for Dr Patrick Cosgrove to diagnose 10-year-old Anthony with attention deficit hyperactivity disorder (ADHD). Without speaking to or examining the boy, Cosgrove, a consultant child and adolescent psychiatrist, took his pen and issued a prescription for the stimulant Ritalin and with it, Liz Thompson, Anthony’s mother, thought he had handed over the answer to her prayers.
Although her child had displayed behavioural problems since the age of four, a succession of doctors in Scotland had failed to find him either a final diagnosis or an effective treatment. In desperation, she travelled hundreds of miles from her Glasgow home to Cosgrove’s private Priory Clinic in Bristol.

The diagnosis of ADHD, a disorder that includes symptoms such as impulsiveness, hyperactivity and sometimes violence, meant that Anthony Thompson could no longer be labelled a ‘‘bad child’’. There was, in fact, something medically wrong with him.

Soon after his diagnosis, Anthony stopped sleeping and eating properly. His mother contacted Cosgrove again and a second drug, Risperidone – normally used to treat schizophrenia – was prescribed. For three years he took both drugs and, although he was initially less disruptive, Thompson says he appeared to be “doped up”. With her son now on a constant cocktail of drugs, his behaviour again began to deteriorate so badly that she turned to another psychiatrist for help.

This time she saw a specialist in Glasgow who was so concerned about Anthony’s health and the combination of the drugs he was taking, he immediately began steps to wean him off both. Of greatest concern was Risperidone.

“When I first went to see Dr Cosgrove I though he was a godsend ,” says Thompson. “I asked if Anthony still needed help along with the drugs and he said he would not need any whatsoever, that these drugs would take away any of the problems he had been experiencing. Nothing could be further from the truth.”

She adds: “I went to see another adolescent psychiatrist who was immediately unhappy that [Anthony] was on Risperidone and did a blood test which showed the levels of one of his blood cell types were down.”

Thompson claims that Cosgrove never recommended that Anthony had tests to check out how his body was dealing with the medication. Now 18, her son still has psychological problems, which she believes were masked but not treated by the drugs.

So incensed was she about her son’s treatment that Thompson and Edinburgh-based charity Overload Network complained to the General Medical Council (GMC) about Cosgrove’s conduct. In June, the GMC found the doctor guilty of serious professional misconduct and criticised him for failing to properly monitor Anthony and another patient to whom he had prescribed powerful drugs, such as Ritalin and Risperidone.

In a statement, Professor Norman Mackay, the GMC committee chairman, says: “Dr Cosgrove prescribed drugs to these patients but did not take appropriate steps to monitor the patients while they were taking the drugs prescribed and as such acted irresponsibly.” The GMC ruled that although he had retired from medical practice, Cosgrove should be suspended for 12 months.

Although the two-week inquiry in Manchester into Cosgrove’s conduct received little press coverage, campaigners say it is indicative of a major problem that is spiralling out of control. Last week, two major studies pub lished by researchers from London University found that soaring numbers of children in the UK were being prescribed antidepressants and other mind-altering drugs. The first, published in Archives Of Disease In Childhood, found that the rate doctors were putting young people on antidepressants had jumped by 68% in recent years, rising more quickly than in eight other major countries: France, Germany, Spain, Canada, US, Argentina, Brazil and Mexico.

A second, in the same publication, focused on the rise in antidepressant prescriptions for children in the UK from 1992 to 2001. During this time, researchers found that almost 25,000 children and adolescents up to the age of 18 were given a total of 93,000 prescriptions. Children as young as five appeared to be among those receiving the drugs. Overall, it found the rate of prescriptions for anti depressants for children rose by 70% in a decade. But while the rate for tricyclics, the older generation of antidepressants, fell by 30%, prescriptions for SSRIs (selective serotonin re-uptake inhibitors), including Prozac and Seroxat, increased tenfold.

The findings have fuelled fears among Scottish health experts at the increasing “medicalisation” of children’s problems. In September, research by the Scottish Executive revealed that hundreds of Scottish children, some as young as two, had been diagnosed by GPs as suffering from depression last year. Meanwhile, the bill for antidepressants is also soaring, quadrupling to £55 million over the past decade.

Child psychiatrists and GPs are being blamed in large part for the increase of antidepressant use. Although no anti depressants are licensed for use among under-16s, doctors can prescribe them where they feel it is clinically appropriate.

Dr Des Spence, a GP in Glasgow, accuses medical colleagues of having a mindset in which children’s unhappiness is addressed by drugs rather than alternative therapies such as counselling. “There is this idea that life can be broken down into a collection of chemical interactions, but in reality it’s nothing like that,” he says. “It’s very convenient to give someone a tablet and try to cure them. The more their problems are medicalised, the more people will try to treat them with medication. Surely there are better ways to treat children.”

Spence, also the UK spokesman for the No Free Lunch Campaign, a group of healthcare professionals concerned at the undue influence of the pharmaceutical industry on doctors in promoting drug products, believes another reason for the rise is the drugs companies’ successful marketing of their products.

He adds: “ Recently there were figures which showed that 90% of postgraduate education in medicine is funded through the pharmaceutical industry. The people who set the agenda influence what happens.

“Medicalising kids’ problems deflects us from the real question about why they are becoming depressed. There needs to be distance between pharmaceutical companies and healthcare professionals.”

Janice Hill, founder and director of the Overload Network, an Edinburgh-based charity that campaigns on behalf of ADHD sufferers and their parents, warns that children were becoming addicted to antidepressants and had little help to come off them.

She says: “It’s all very well prescribing mind-altering drugs to children but when they want to come off these drugs it’s very hard. There’s no facility for them to do so. There’s also very little safety data on how these drugs will affect children. The norm is to have no hard information on their effects on children.”

Hill says the organisation was calling for an all-out ban for all psychiatric drugs in children under six years old. “Children are not fully developed,” she adds. “The effects on their long-term health are uncertain. We’re using our children as guinea pigs. It’s really a public health scandal.”

Those behind the latest research into prescribing rates also expressed concern at the lack of scientific evidence of the drugs’ safety. The research team, led by Ian Wong and Macey Murray from the university’s Centre for Paediatric Pharmacy Research, call for more studies to assess their suitability for young people.

They say it should always be remembered that “children are not small adults” and research on adult patients should not automatically apply to children. They add: “The observed increase in so many countries should raise concern, as little research has been conducted in children to study the effects of most psychotropic medications.”

In the US, all antidepressant drugs must now carry the strongest possible public warning that they could cause children to harm themselves or commit suicide. The landmark ruling, made in September, went beyond the unilateral action taken in December 2003 by the UK regulator, the Medicines and Healthcare Products Regulatory Authority (MHRA), which banned the use of certain drugs in children under 18. A UK expert working group warned that all but one of the SSRIs should not be given to children and that there were risks of children becoming suicidal, aggressive and suffering mood swings, and the drugs were anyway not very effective. Prozac, known by the generic name of fluoxetine, was the exception.

Currently, the MHRA is considering a licence application by Eli Lilly, the makers of Prozac, to treat children with depression in the UK and Europe with the drug. However, the Sunday Herald has learned that unpublished clinical studies carried out on children by the company show that youngsters who used Prozac appeared to have problems with physical development.

Documents held by the Federal Drug Administration, which licenses drugs in the US, reveal that its own investigators had concerns about Prozac in 2001. Its medical officer, Andrew Mosholder, writes: “Nineteen weeks of fluoxetine treatment was associated with reduced growth velocity relative to placebo. On balance, I believe that this trial provides evidence of reduced growth velocity with fluoxetine treatment.”

Other studies into fluoxetine on mice and beagles show marked decreases in testicular weight. Research on mice, analysed by the FDA in 1984, found that testis weight was 12% below the control group at the end of the dosing period and 26% below the control group in some of the animals after a one-month recovery period. In the tests on dogs, testis weights ended up being 26% below the control group.

The studies, which had never before been made public, were unearthed by Dr David Healy, of north Wales, an expert on psychiatric drugs. His warnings that antidepressant drugs like Seroxat and Prozac could cause suicide led to the entire class of antidepressants, except Prozac, being banned last year from use on children.

He says the newly unearthed evidence about the potential side effects of Prozac should be of great concern. “There does seem to be hazards with these drugs. The research showing testicular shrinkage could be a real issue for teenage boys. There have been so few tests on these drugs that we simply don’t know if there is a risk there or not.”

But he too believes that medical experts are looking for a “quick fix”. “It’s unquestionably the case that teenagers and children have problems, but I don’t think they are having any more than they had before. There will be a few kids who in their teens will have a genuine illness. At the moment we’re in a situation where the problems of the teenage years are being made into an illness. The risks of kids being put on pills that are not going to help them is hugely greater now than it was five years ago.

“I think that GPs do think they are being helpful and that these pills couldn’t do much harm, but in actual fact they haven’t been told what the risks are.”

But Dr Iain McClure, a child and adolescent psychiatrist and spokesman for the Royal College of Psychiatrists in Scotland, says that young people benefited from being prescribed antidepressants. He says instead of the medicalisation of children’s problems, factors such as better recognition of the symptoms of depression may account for the increase.

“Primary care could be recognising the symptoms of depression better than it has done in the past,” he says. “Therefore, doctors are prescribing more antidepressants because depression is revealed.

“Also, it could be that there is more distress in the community and that what we’re witnessing is an increasing social phenomena of young people experiencing mental health difficulties because of the pressures of modern life.

“Other social factors, such as family breakdown, pressures on young people to grow up sooner than they feel able to do, could be putting young people under more pressure now than they have ever been.

“What mustn’t be lost sight of is that there are young people who do require these medications and can benefit from them.”

Mental health charities such as Penumbra have begun promoting alternatives to medication. Pat Little, the charity’s development manager for young people’s services, says: “We are alarmed at the rise in young people prescribed medication, particularly antidepressants.

“We need to provide access to counselling and support so that young people can work through the difficulties they’re experiencing. If people are going to use medication to deal with things, it’s the wrong road to go down.

“A lot of the work that we do now is about helping young people keep themselves well. We need to provide opportunities for young people to talk about things and offer them support when they need it.”

A spokeswoman for the department of health describes the drop in antidepressant prescribing since the MHRA’s unilateral ban last year as “enormous”. She adds: “The figures in the two studies are out of date. They relate to 2002 and we put out our advice, that all antidepressants should be banned for use in children, in 2003. The drop has been huge since last year.”

WHAT THEY’RE TAKING
Drug name: Tryptizol
Trade name: Amitriptyline

Drug class: Tricyclic

Uses include: Treats spontaneous endogenous depression and is extremely sedating.

Side effects may include: Blurred vision, constipation, racing heartbeat, seizures.

Drug name: Doxepin

Trade name: Sinequan

Drug class: Tricyclic

Uses include: Treats many types of depression. Also used for treatment of anxiety and post traumatic stress disorder.

Side effects may include: Constipation, blurred vision, seizures, sexual problems.

Drug name: Paroxetine

Trade name: Seroxat

Drug class: SSRI

Uses include: Treatment of obsessive-compulsive disorder, depression, diabetic nerve pain and chronic tension headaches.

Side effects may include: Blurred vision, loss of appetite, nervousness, nausea, liver toxicity, hypomania, feelings of suicide.

Drug name: Fluoxetine

Trade name: Prozac

Drug class: SSRI

Uses include: Mainly in the treatment of depression. Also used to treat other psychological disorders.

Side effects may include:

Anxiety or nervousness, trouble sleeping,

abnormal sweating, sedation, seizure.

Drug name: Methylphenidate

Trade name: Ritalin

Drug class: Central nervous system (CNS) stimulant

Uses include: The drug of first choice for treatment of attention deficit hyperactivity disorder in children.

Side effects may include: Nausea, difficulty sleeping, mood changes, joint/chest pain, unusal movements.