Imagine Giving An Infant A Psychiatric Drug

by Michelle Sicignano, LMSW, Staff Writer, Social Justice Solutions

I cannot imagine any circumstance in which an infant age one or under would ever be prescribed an anti-anxiety medication, let alone one in the benzodiazepine family. I cannot even imagine children under 5 prescribed psychiatric medication, yet, as taken from the Government Accountability Office (GAO) report, it happens, and it happens routinely.  Anti-anxiety medications, antidepressants and anti-psychotics are prescribed to infants and children more frequently than I would ever imagine.  One suggestion is that at least some of these types of prescriptions are written for uninsured care-givers. While that may be commendable, and highlights a flaw in the system, that cannot possibly explain every circumstance.

An ABC news story, based on the December 2011 Federal Government Accountability Office’s (GAO) report, says foster children receive psychiatric medications up to 13 times more often than kids in the general population.

The GAO report stemmed from a two-year-long investigation, looking at five states — Florida, Massachusetts, Michigan, Oregon and Texas:

Some highlights reveal:

“For the most vulnerable foster children, those less than 1 year old, foster children were nearly twice as likely to be prescribed a psychiatric drug compared to non-foster children.

Foster children were also more than nine times more likely than non-foster children to be prescribed drugs for which there was no FDA-recommended dose for their age.

In some parts of the country, as many as half of foster kids are on one or more psychiatric medications compared to just 4 percent of kids in the general population.

Thousands of foster children were being prescribed psychiatric medications at doses higher than the maximum levels approved by the Food and Drug Administration (FDA) in these five states alone. And hundreds of foster children received five or more psychiatric drugs at the same time despite absolutely no evidence supporting the simultaneous use or safety of this number of psychiatric drugs taken together.”

According to a follow up report, Antipsychotics for Foster Kids: Most Commonly Prescribed Meds, the most common drugs which are routinely prescribed to kids:

“Abilify Abilify is FDA approved to treat schizophrenia, bipolar disorder in some adolescent and teens, as well as irritability associated with autism spectrum disorder. But the drug is prescribed off-label in children as a mood stabilizer and to treat ADHD symptoms. Abilify received a black box warning label for inducing suicidal feelings in children. In 2009, sales of the drug reached $4 billion.

Seroquel/Seroquel XR Seroquel is approved to treat schizophrenia and acute manic episodes of bipolar disorder in some adolescents and teens. Its long-releasing version, Seroquel XR, is not approved for children. However, both drugs are used off-label as a sedative for children with sleep and anxiety disorders.

Risperdal Risperdal is FDA-approved to treat acute manic episodes of bipolar disorder and schizophrenia in children as young as age 10. It is also used to manage irritability in children with autism spectrum disorder. The drug is used off-label to treat Tourette syndrome, and anxiety and eating disorders. Risperdal was Johnson & Johnson’s fourth-largest-selling drug in 2008, making more than $2 billion in sales.

Zyprexa Zyprexa, also approved to treat acute manic episodes of bipolar disorder and schizophrenia in children as young as age 10, is also used off-label to treat anxiety and eating disorders, depression and Tourette syndrome. One of the most common side effects noted in the drug has been serious weight gain. In 2007, manufacturer Eli Lilly agreed to pay $500 million to settle 18,000 lawsuits from people who claimed they developed diabetes from taking Zyprexa.”

This is a link to the GAO report:   http://www.gao.gov/assets/590/586570.pdf

This disturbing trend of medicating kids in the system, whether in foster care or any other type of placement, as a means of control is unethical. They are not receiving needed therapeutic care, evidence based care which is known to be effective, and are much more routinely simply being made easily controllable. Further, it creates long-term public health concerns as these children will become adults who are neither unable to self-regulate nor self-direct. Most disturbing, this trend shows no signs of slowing. Given the new addition to the soon to be released DSM 5, Disruptive Mood Dysregulation, which medicalizes childhood tantrum behavior instead of seeing it as a normal reaction to unclear and inconstant rules and expectations, and the explosion of childhood diagnoses of bipolar disorder, it’s likely that many more children will be prescribed medications despite unknown long-term effects of these powerful drugs on developing bodies and minds.