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Those experiments, however, are often driven by dire need. When a child is suffering or suicidal, is it fair not to turn to the prescription pad in conjunction with therapy? Is it even safe? Untreated depression has a lifetime suicide rate of 15%--with still more deaths caused by related behaviors like self-medicating with alcohol and drugs. Kids with severe and untreated ADHD have been linked, according to some studies, to higher rates of substance abuse, dropping out of school and trouble with the law. Bipolar kids have a tendency to injure and kill themselves and others with uncontrolled behavior like brawling or reckless driving. They are also more prone to suicide.
Which is why Teresa Hatten of Fort Wayne, Ind., hesitated little when it came time to put her granddaughter Monica on medication. Hatten's grown daughter, Monica's mom, suffers from bipolar disorder, and so does Monica, 13. To give Monica a chance at a stable upbringing, Hatten took on the job of raising her, and one of the first things she had to do was get the violent mood swings of the bipolar disorder under control. It's been a long, tough slog. An initial drug combination of Ritalin and Prozac, prescribed when Monica was 6, simply collapsed her alternating depressed and manic moods into a single state with sad and wild features. By the time she was 8, her behavior was so unhinged, her school tried to expel her. Next Monica was switched to Zyprexa, an antipsychotic, that led to serious weight gain. "At 12 years old she had stretch marks," says Hatten. Now, a year later, Monica is taking a four-drug cocktail that includes Tegretol, an anticonvulsant, and Abilify, an antipsychotic. That, at last, seems to have solved the problem. "She's the best I've ever seen her," says Hatten. "She's smiling. Her moods are consistent. I'm cautiously optimistic." Monica agrees: "I'm in a better mood." Next up in the family's wellness campaign: Monica's 8-year-old cousin Jamari, who is on Zyprexa for a mood disorder.
All along the disorder spectrum there are such pharmacological success stories. In the October issue of the Archives of General Psychiatry, Dr. Mark Olfson of the New York State Psychiatric Institute reports that every time the use of antidepressants jumps 1%, suicide rates among kids 10 to 19 decrease, although only slightly. But that doesn't include the nonsuicidal depressed kids whose misery is eased thanks to the same pills.
ARE WE MEDDLING WITH NORMAL DEVELOPMENT?
For children with less severe problems--children who are somber but not depressed, antsy but not clinically hyperactive, who rely on some repetitive behaviors for comfort but are not patently obsessive compulsive--the pros and cons of using drugs are far less obvious. "Unless there is careful assessment, we might start medicating normal variations [in behavior]," says Stephen Hinshaw, chairman of psychology at the University of California, Berkeley.