Children as young as two are being prescribed powerful mood-changing drugs such as Prozac and other antidepressants. Although usage usually begins at the age of six and then carries on until the age of 19, the number of two- to four-year-olds taking stimulants (such as Ritalin), antidepressants (such as Prozac), antipsychotics and clonidine (used to treat adult high blood pressure and insomnia in hyperactive children) has skyrocketed.
Data from America show that, from 1988 to 1994, antidepressant use in children increased 400 per cent (Pediatrics, 2002; 109: 721-7). Today, around 2 per cent of all youths are taking antidepressants.
In one review carried out in France, 12 per cent of the children beginning school were receiving psychotropic medications, mostly phenothiazines; 76 per cent of these had started treatment by age four (Rev Epidemiol Santé Publ, 1992; 40: 467-71).
Last year, UK doctors wrote 170,000 prescriptions of antidepressants for children.
Of all the antidepressants, the increased use of selective serotonin reuptake inhibitors (SSRIs) among children has been the most dramatic, with a 10-fold increase from 1993 to 1997 (Can J Psychiatry, 1998; 43: 571-5).
Only eight per cent of GPs and paediatricians have received adequate training in the management of childhood depression. Yet, that has not stopped 72 per cent of them from prescribing SSRIs (such as Prozac) to children under 18 (Pediatrics, 2000; 105: e82).
In addition, 57 per cent of these physicians acknowledged having prescribed an SSRI for a diagnosis other than depression in an under-18-year-old patient. These included children diagnosed with attention-deficit and hyperactivity disorder (ADHD), obsessive-compulsive disorder, aggression/conduct disorder and even enuresis (bed-wetting).
Off the label
Once a drug is approved and on the market, further studies to determine its safety and efficacy in infants and children are rarely conducted (Curr Opin Pediatr, 1995; 7: 195-8). So, many medicines used for children are not licensed (have marketing authorisation) or are used ‘off-label’ (outside the terms of the product licence) (Arch Dis Child, 1999; 80: F142-5). Such prescriptions depend on little more than ‘educated guesswork’ and ‘experiences of peers’; they are not supported by scientific evaluation.
Concerns over the use of unlicensed and off-label drugs in children were first raised in the late 1960s (J Pediatr, 1968: 72; 119-20). The alarm went unheeded, however, and the practice of off-label prescribing for children is now a worldwide phenomenon (JAMA, 2000; 283: 1059-60).
A recent survey of five European hospitals analysed 2262 prescriptions given to 624 children and found that nearly half were either unlicensed or off-label. On the whole, 67 per cent of children received an unlicensed or off-label prescription (BMJ, 2000; 320: 79-82).
Drug safety in children cannot be inferred from widespread use. Nor can safety in adults be used to infer safety in children, as they are not ‘little adults’. Indeed, off-label use in children on paediatric wards has been shown to produce many more adverse effects than drugs properly licensed for use by children (Acta Paediatr, 1999; 88: 965-8).
Suicide and self-harm
With children, the picture of adverse drug reactions is complicated, as they often react to drugs in a completely different way from adults. Consider the paradoxical responses to phenobarbital in children vs adults. Phenobarbital acts like a sedative in adults, yet produces hyperactivity in children.