Prescribing Antidepressants and Antipsychotics to Children Under 10

I was surprised when a friend told me that a psychologist had recently placed his four year-old nephew on abilify, an antipsychotic used to treat schizophrenia and bipolar disorder. This led me to ask if and how a child is diagnosed with either and is it safe for children this young to be on medication so severe? According to the National Alliance on Mental Illness, "At this time there are several ongoing studies of how to best treat children, but until more scientific data is available clinicians are left using their best judgment on how to manage using medications that have been effective in adults."

Symptoms that a child with bipolar disorder will display include: irritability, hyperactivity, distractibility, elated mood, grandiose behaviors, flight of ideas, decreased need for sleep and hypersexuality. Because many of these behaviors closely mimic symptoms that children with attention deficit disorder display many children go undiagnosed.

Although abilify (the medication my friend's nephew was prescribed) was given FDA approval to treat pediatric patients, the clinical trials and approval was for 10-17 year old children and not for children as young as 4. A posting in the Winter 2003, Vol. 13 of The Bipolar Child Newsletter, included three reports from parents and grandparents of children under 10 years old prescribed low doses of abilify and the great improvement that they saw in these children.

There still remains a great debate in the world of psychology if it is even possible to diagnose a child as young as 10 with bipolar disorder. Many people claim it is just a product of over diagnosing. A paper last year reported that the number of times US doctors consulted children or adolescents diagnosed with bipolar disorder increased 40-fold between 1994-95 and 2002-03, rising to 1003 per 100,000. Not to mention that is appears that side effects such as weight gain and diabetes tend to be more severe in children that experience them. Often doctors and parents place their children on these drugs before even trying to resolve them through behavioral modification therapy or seeking underlying causes of the behavioral issues.

In a March 24, 2007 USA Today article, a 4 year old child in Massachusetts died after being diagnosed ADHD and bipolar and being placed on the drugs Clonidine, a blood pressure medication prescribed for ADHD and Depakote, an anti-seizure and mood-stabilizing drug prescribed for the little girl's bipolar disorder. In the article a child psychologist noted, "As a clinician, I can tell you it's just very difficult to say whether someone is just throwing tantrums or has bipolar disorder," said Oscar Bukstein, a child psychiatrist and associate professor at the University of Pittsburgh

As a paralegal, the firm I worked for once handled a case where a young woman was suing for medical malpractice after receiving electro-shock therapy, and this was in 2006. Yes, believe it or not, even though fairly rare and in very extreme cases psychiatrist still implement this outdated and controversial therapy in their practice. This leads me to believe that how the mind works and mental illness in general is still a long way from being fully understood. The shift from psychotherapy and talk therapy to medication has been clearly prevalent in the last decade, but the trend of treating children with antidepressants and antipsychotics is one that was, until now, completely unknown to me. While you would like to place your trust in a doctor's judgment, I think as a responsible parents you should not place your child on these types of drugs at such a young age as 4 until all other outlets are exhausted. Many times simple things like improving the diet of your child (for instance, the child I know on medication eat a diet filled with sugar and fast food, which can not help hyperactivity and a lack of concentration). If after all other routes are explored you chose to put your child on medications this severe that is a personal choice, and although I am not a medical expert, logically I can not imagine that this is a safe option for a young, developing brain. Clearly, not even the medical experts can agree themselves.