Vatican Conference: Revisiting Psychiatric Treatment of Children (Part 1)

Questioning Effectiveness, Safety of Psychotropic Drugs

Rome, ( Ann Schneible | 2197 hits

Experts gathered in the Vatican over the weekend to examine the growing trend of prescribing psychotropic medications to children, and whether these drugs are doing more harm than good.

Titled "The Child as a Person and as a Patient: Therapeutic Approaches Compared," the conference, sponsored by the Pontifical Council for Health Care Ministry, aimed to address the needs of children in need of medical and psychiatric care, and the best ways of treating them.

One of the keynote speakers at the conference was Robert Whitaker, a journalist and author who has written extensively on the subject of psychiatric treatment, and the use of medications to treat mental illness. He has published books on the subject called Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, in 2002, and Anatomy of an Epidemic, 2010.

Speaking with ZENIT, Whitaker addressed his hope for a reassessment of how children suffering from mental illness are being treated.

ZENIT: What do you hope to see come from this conference?

Whitaker: I hope that the conference will bring widespread public attention to this question, of whether the medicating of children with psychiatric drugs is helping those children grow up and thrive, or whether this practice, on the whole, is causing a great deal of harm. This is a very profound question, and I hope this conference will encourage societies to investigate it. 

ZENIT: As one of the keynote speakers, you were asked to speak about the general history of psychiatric treatment, while others spoke about what science has to say about their effects. Could you highlight some of the main points in your talk?

Whitaker: The accepted wisdom is that the arrival of chlorpromazine in asylum medicine in 1955 kicked off a psychopharmacological revolution, this great advance in care. Chlorpromazine is remembered today as the first "antipsychotic," and soon the field gained new antidepressants, and new anti-anxiety drugs. Then, starting in the late 1980s, a second generation of psychiatric drugs came to market, said to be safer and more effective than the first. That is a story of continual medical progress.

Yet, as this revolution has unfolded, the burden of mental illness in western societies has increased. Disability rates due to mental illness have soared, and this is particularly true during the past 25 years, since Prozac came to market. Furthermore, the long-term outcomes for major mental disorders have, if anything, gotten worse during the last 25 years.

Thus, you have a puzzle: if the medications are so helpful, why is the burden of mental illness increasing? Why haven't long-term outcomes improved?

The prescribing of psychiatric drugs in children really began in the United States in 1980, when the American Psychiatric Association created the diagnosis of attention deficit disorder for the first time, when it published the third edition of its diagnostic and statistical manual. Then, if you look at the growth of this practice, of prescribing psychiatric medications to children, it is easy to identify the commercial forces involved. And finally, this is being done in the absence of good evidence that the medications help the children over the long term. 

ZENIT: This conference focused a great deal on the negative ramifications of psychotropic drugs. In your research, have you found there to be cases where the use of such drugs, even in children, may be necessary? Cases where psychotherapy simply is not an option?

Whitaker: There certainly is evidence that psychiatric drugs can be helpful in some adults over the short term, and there are some adults who do well on them over the long term. The problem is that you don't find evidence that the medications improve long-term outcomes in the aggregate. 

As for whether there are times when the use of drugs in children may be necessary, I don't really know how to answer that. I suppose there are times when they can be helpful, say in quieting a disturbed child, but the problem is that initial use opens the door to long-term use. And long-term use is going to change that child's brain, and we don't have evidence that is likely to help the child. 

I know that some people think there is good evidence that the short-term use of stimulants in children diagnosed with ADHD can be helpful. But again, I don't know of evidence that shows that this benefits children in the long term, and there is plenty of evidence of risks associated with long-term use of ADHD medications. 

So, personally, I wish societies would put their money and efforts into developing other ways to help disturbed children, methods that don't rely on psychiatric drugs. 

And remember, human societies have existed for several thousand years, and, up until recently, were able to raise their children without using psychiatric drugs. Why do we suddenly find it so impossible to do that today?

[Part 2 of this interview will be published Tuesday.]