The Corpus Callosum

Hoisted from the comments:

I find it particularly alarming that children are prescribed some of these drugs. How much is truly known about how various psychiatric drugs affect the development of the brain? If a fifteen-year-old is put on a regimen of SSRI inhibitors, how will it affect him down the road? If he's on them long enough, will he experience any adverse effects when he's thirty-five or forty? For that reason, I think that physicians should be extremely sparing in prescribing psychiatric medication to children.

This is an important concern, one that deserves some consideration.

There is always a risk that something bad will happen it the future.  There always are risks to treating, just as there are risks to not treating.  There is no risk-free path to the future, so we cannot let the existence of unknown risks prevent us from all action.  

The comment pertains to unknown risks.  What is important is to balance the risks.  This is a nettlesome task when the risks are not known.  Everyone has their own way of assessing and responding to risk, which is one of the reasons that there never will be a single approach to psychopharmacology that pleases everyone.  

Looking at the situation alluded to in the comment: an adolescent with depression, who could be treated with an SSRI.  On one hand, there is evidence that untreated depression is bad for the brain (Am J Psychiatry 2003 160: 1516-1518 [Abstract] [Full Text] [PDF]).  On the other hand, there is always going to be at least a theoretical risk that treatment could make things worse.  The evidence for lasting harm from untreated depression is not conclusive, by any means, but it is worrisome nonetheless.  

People weigh risks differently.  Some people disregard unknown risks.  Others may weigh them rather heavily.  In the idea situation, the patient and the doctor would have identical strategies for managing unknown and partly-known risks, but I doubt that such a symmetry arises very often.  One reason for that is that people tend to be more fearful of unfamiliar risks than they are of familiar risks.  Doctors, who think about these risks often, are likely to be inured to them.  Patients, especially those who are confronting these risks for the first time, generally will not have that degree of familiarity.  Thus there is a systematic trend toward a discounting of risk by physicians.  

I can't entirely agree with the suggestion, " that physicians should be extremely sparing in prescribing psychiatric medication to children."  As I read that, I interpret it as meaning that physicians should only rarely prescribe psychiatric medication to children.  What I would say instead is that physicians should be mindful of the risks, both known and unknown, and be mindful of the fact that the persons who are exposed to the risk will have a different way of assessing those risks.  

There is more to say, of course.  Fortunately, there is a very good treatment of this (and other, related) issues in an article that is openly accessible at BioMed Central:  Understanding the agreements and controversies surrounding childhood psychopharmacology.  It is a summary of the outcome of a multidisciplinary workshop that included representatives from the fields of child  psychiatry, neurobiology, epidemiology, philosophy, anthropology, and sociology.  At least one patient advocate attended as well. The article is 32 pages long, but worth reading for those who are interested.