Our Kids' (Legal) Drug Problem

Teens are being prescribed drugs for anxiety, depression, and other mental health disorders at alarming rates with little concern for the serious side effects.

Statistics on polypharmacy—the use of multiple medications—usually deal with older Americans. For example, we know that 44 percent of men and 57 percent of women older than 65 years take five or more medications; 12 percent take 10 or more medications per week. While this isn’t exactly good news, it isn’t all that shocking: older people tend to have more health problems, and our medical system uses drugs to deal with those problems. But what is shocking is the rise of polypharmacy among teens, particularly teens starting antipsychotic treatment. That our nation’s young people are prescribed multiple mind-altering medications with little regard for the long-term effects of these drugs is deeply troubling.

A recent New York Times piece profiled a young woman who, by the time she graduated high school in 2021, was taking seven drugs, including one for seizures and migraines prescribed off-label for its mood stabilizing effects, a schizophrenia drug also prescribed off-label to dull the side effects of the other medications, and not one, but two antidepressants.

The girl’s story is unfortunately emblematic of a much larger trend of prescribing powerful psychiatric drugs to adolescents. According to the Times story, ExpressScripts, a mail-order pharmacy, reported that prescriptions for antidepressants for teenagers rose 38 percent from 2015 to 2019, compared with 12 percent for adults. A 2006 study looked at doctor visits by people younger than 20 and found a rise in visits involving the prescription of antipsychotic drugs, from 200,000 in 1993 to 1.2 million in 2002. A 2020 study found that 4 in 10 kids  prescribed drugs for attention deficit hyperactivity disorder (ADHD) were also prescribed at least one drug for a mental health or mood disorder.

And all this is before COVID, which we know took a heavy toll on mental health, particularly in adolescents.

Experts say that these drugs are, in some cases, needed and can be vital to stabilize teens and save lives. But in the same breath, experts also warn that these medications are given out too easily. Additionally, most of these drugs have not been approved to treat patients under the age of 18; nor have the combination of these drugs ever been studied

We’ve written before about the serious and debilitating side effects of these drugs. They are generally intended for short term use but can be prescribed for years. They can cause psychotic episodes, suicidal behavior, weight gain, and interfere with reproductive development, to name just a few of the side effects.

Does the benefit compensate for these scary side effects? In the words of one doctor interviewed for the Timesarticle, “the meds don’t work all that well.” Studies on antidepressants for adolescents, for example, show only a modest upside. It is this ineffectiveness that seems to drive polypharmacy: kids end up on multiple medications because none of them really work.

Clinical guidelines and standards have also (surprise, surprise) contributed to the over prescription of ADHD medications. The clinical definition of ADHD used for medical diagnosis used to be if the patient exhibited “some hyperactive-impulsive or inattentive symptoms that caused impairment.” In 2013, the requirement for “impairment” was dropped, leading to significantly more ADHD diagnoses. 

Integrative medicine has a lot to offer in the treatment of mental health disorders. This approach appreciates the connection between the brain and the body—how the body, and especially the gut, can have a profound effect on the brain, and vice versa. In some cases, it is a simple nutrient that is missing. It is often B vitamins, or it may be a mineral such as magnesium.

An integrative approach to medicine also addresses the imbalances in the body that may cause our mood to be out of whack. Consider that 95% of the body’s serotonin, the chemical that most depression drugs try to increase, is found in the gut. The standard American diet does not optimize either serotonin or gut health, leading to leaky gut syndrome and sustained inflammation.

We’ve reported on other lifestyle and dietary interventions for depression here.

Sadly, there is evidence that the use of mind-altering drugs plays a part in many instances of violent shootings that have occurred in the US. In 2011, ANH submitted a Citizen Petition to the FDA asking the FDA to expand the current black box warning on antidepressants to include the danger of violent actions toward other people, in addition to the current suicide warning. Let’s get some momentum going behind his petition.

Action Alert! Write to the FDA and Congress, asking them to expand the black box warning on SSRIs to include danger of violent actions to others. Please send your message immediately.