Medicating children for behaviors: antidepressants and anticonvulsants

(This is entry #7 in a series of posts regarding medicating children for behaviors)
In my previous posts, I have lead you down the winding road of medications currently being used to treat ADD/ADHD. It is no longer a disorder for which the child receives a stimulant medication and everyone is satisfied. In an alarming new treatment trend, additional medications such as antipsychotics, blood pressure medications, anticonvulsant (seizure) medications and antidepressants are now being added to the daily medication schedule.

Ritalin, Adderal and Concerta are the stimulant medications most commonly prescribed for ADD/ADHD. Today, they are available in a long-acting form initially intended to allow the child to fore go a lunchtime dose and still receive the calming effects of the medication for the entire day. The frightening new trend I am seeing regularly is the long-acting medication is prescribed for both morning and lunchtime, resulting in an overlap of medication in the latter part of the day. Predictably, when this higher dose of stimulant takes effect, the child becomes nervous, agitated, refuses to eat, shows mood swings and explosiveness. When this behavior is demonstrated, parents seek additional medical help, and the child is often diagnosed "bipolar."

According to the National Institute of Mental Health, youth with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode.

Antidepressant medications often prescribed for "bipolar" are Trasadone, Tofranil, Zoloft, Prozac, Paxil, Remeron, and Sinequan. According to manufacturers' labels, many of these medications come with their own risks of side effects, including: irritability, acne, headaches, sleep disorders, and emotional side effects. You should know that the FDA has issued a "black box warning" for worsening depression and suicidal thoughts in adolescents using antidepressants. Further, some antidepressant medications change the liver's ability to break down other medications, potentially causing a dangerously high level of some medications in the bloodstream.

Doctors who prescribe antidepressants for bipolar disorder usually prescribe an anticonvulsant medication to be used as a mood stabilizer at the same time. The anticonvulsant medications most commonly prescribed are Tegretol, Trileptal, Depakote, Neurontin, Lamictal and Topamax. Again, according to manufacturers' labels, many of these medications come with their own risks of side effects, including: drowsiness, headache, constipation and diarrhea. However, Depakote may cause a reduction in blood count levels, or an inflammation of the liver. The risk of liver damage is increased when Depakote is used with other anticonvulsant medications in children under the age of 10 years. Now combine this risk of liver damage with the liver problems associated with antidepressants; these drugs are routinely being prescribed together!

Please take the time to read all of my previous posts discussing this subject; my hope is that this information will help you to wade through all of the advice, recommendations, expectations, and fears which will inevitably come with parenting a child with behavior difficulties.

Medicating children for behaviors; underlying dangers

(This entry is #3 in a series of posts regarding medicating children for behaviors)
In my first two posts I discussed the frightening new approach for ADD/ADHD treatment which often includes an added diagnosis of "bipolar" (the former name for this was "manic-depressive"). The source of this additional diagnosis, I believe, is very predictable. Stimulant medications such as Ritalin, Concerta or Adderal are prescribed for the initial diagnosis of ADD/ADHD. When side effects of increased dosages of stimulants lead to agitated, combative or explosive behavior in the child, the new method of treatment adds antidepressant or antipsychotic medications in attempt to quell this predictable behavior and label it with a new diagnosis of "bipolar". Unfortunately, most of these medications contain a black box warning against the use in children or teenagers.

A black box warning means that medical studies indicate that the drug carries a significant risk of serious or even life-threatening side effects. Black box warnings on medications frequently prescribed for bipolar include: Desyrel (trazadone), Paxil, Prozac, Remeron, Seroquel, Tofranil (imipramine), and Zoloft. In 2006, the FDA recommended a black box warning for Ritalin due to adverse affects on the heart ; a month later the warning was removed by an FDA advisory panel.

What should this mean to the average parent struggling for answers about the treatment of their child? Education about every medication that is prescribed is necessary: What is the medication? What classification is this medication (such as stimulant, antipsychotic, antidepressant, blood pressure medication, antihistamine)? What is it being prescribed for? Are additional medications being prescribed to combat predictable side effects from others? What are the long-term benefits of the medication versus the risks?

This is a very complicated issue. Only in the past decade have I witnessed medications of this nature prescribed to our youngest school age children; 5 year-olds are receiving long acting stimulants along with the antidepressants, antipsychotics and blood pressure medications I've just named all in the same "hand full" at lunchtime! I am concerned about how their immature bodies can process this assault to their systems.

In my next post, I will try to simplify this. We will start with understanding the basics, then move into more detailed descriptions about medications--risks and benefits.