Controversies Surrounding Childhood Psychopharmacology

Hoisted href="http://scienceblogs.com/corpuscallosum/2008/02/clear_think_about_the_overmedi.php#comment-768312">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 ( color="#4a4a4a">Am
J Psychiatry 2003 160: 1516-1518 href="http://ajp.psychiatryonline.org/cgi/content/abstract/160/8/1516">[Abstract]
href="http://ajp.psychiatryonline.org/cgi/content/full/160/8/1516">[Full
Text] href="http://ajp.psychiatryonline.org/cgi/reprint/160/8/1516">[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: href="http://www.capmh.com/content/2/1/5"> 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.