Are Children and Adolescents Overprescribed Psychiatric Medications?

On August 13th several hundred people registered to take part in an online "town hall meeting," and 1,600 watched live via streaming on Facebook. The topic was "The Psychiatric Drugging of Our Children: A Developing International Crisis." The title seems a little melodramatic — until one looks at the data.

In the USA, 8.5 percent of children under 18 (1 in 12) are on "medication for ADD/ADHD, autism/ASD, or difficulties with emotions, concentration, or behavior," according to a national survey. This includes 1.2 percent of pre-schoolers and 12.9 percent of 12- to 17-year-olds (1 in 8).

The rate is highly variable, reaching 14.2 percent in West Virginia and 16.1 percent in Louisiana (1 in 6). The predictors of the variation are social as well as geographical. For example, only 5.4 percent of children who have experienced no adversities are on these drugs, compared to 16.3 percent of those with two or more childhood adversities (1 in 6). Overall, the figures are 6.3 percent for girls and 10.3 percent for boys (17.8 percent of Louisiana boys).

Some (0.2 percent) very young children (2 to 7 years) are even being forced to take powerful antipsychotic drugs in the USA, mostly for the particularly vague diagnosis of "pervasive developmental disorder" and mostly in conjunction with one or more other psychiatric drugs.

Psychiatric Drug Use in Youth Is Increasing in Many Countries

The consumption of psychiatric drugs by children (and adults) is far higher in the US than elsewhere, partly because of direct-to-consumer advertising by drug companies, which is illegal almost everywhere else.

One country that comes close, however, is Australia, which has been adopting an increasingly narrow, "medical model" approach to its mental health services for the past decade or more. Fortunately, the Australian government keeps detailed and accessible data. The rates of Australian children currently on "mental health-related medications" is:

• under 5s: 0.2 percent;
• 5- to 11-year-olds: 4.3 percent;
• 12- to 17-year-olds: 8.2 percent.

The fastest growth for antidepressants over the past six years is among 5- to 11-year-olds (10.1 percent annual growth). For ADHD drugs and antipsychotics, however, the fastest annual growth is, alarmingly, among pre-schoolers (12.7 percent and 7.9 percent, respectively)

Some European countries are catching up with the USA and Australia. In the UK, for example (if we can still call ourselves part of Europe), 7.0 percent of adolescents were already using at least one psychotropic medication by 2004, most commonly antidepressants. The number of our children under 16 using stimulants to treat ADHD increased 34-fold between 1992 and 2013, from 1.5 to 51.1 per 10,000 children.

The number of UK children under 17 years prescribed antidepressants increased by 26 percent between April 2015 and April 2020, and has accelerated even faster during the pandemic. Twice as many girls as boys receive antidepressants.

By 2018, the number of prescriptions of antidepressants to under 18s in the UK had already surpassed a third of a million, with the fastest growth among children under 12 years old.

Furthermore, prescribing rates for psychiatric drugs in the UK are higher among those with learning difficulties and those living in deprived neighbourhoods.

In every country surveyed, besides the USA, the UK and Australia, the psychiatric drugging of our children has been steadily increasing for many years, including in New Zealand, Denmark, the Netherlands, France and Canada.

How Do Psychiatric Drugs Affect the Developing Brain?

These trends are of concern because very little is known about the effects of these drugs, taken alone or in combination, on the developing brain. Most of the prescribing is "off-label," meaning, essentially, unlicensed and with unproven efficacy and safety.

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For example, a 2021 Cochrane review of 26 studies on antidepressants in children concluded that:

Findings suggest that most newer antidepressants may reduce depression symptoms in a small and unimportant way compared with placebo. … Suicide-related thinking and behaviour may be increased in those taking these medications.

Polypharmacy is also on the rise everywhere, with little knowledge of how drug interactions alter young brains.

Some psychiatrists have tried to argue that far from representing an epidemic of overprescribing, these figures show that not enough children are being prescribed drugs. They argue that not every child diagnosed with a mental illness is being treated (meaning medicated) so we are under-prescribing. This argument rests on three assumptions: that the diagnostic constructs used to assess our children are reliable, that our children’s distress has a biological basis such as chemical imbalance, and that everyone who receives a diagnosis needs to be medicated. All of these assumptions are, at best, highly questionable.

Town Hall Meeting on Medicating Children

The town hall meeting was the fourth in an ongoing series about psychiatric drugs, hosted by four organisations: the Council for Evidence-based Psychiatry, the International Institute for Psychiatric Drug Withdrawal, A Disorder 4 Everyone, and Mad in America, (whose website includes a section for parents).

Before deciding whether to watch the recording of the meeting, please be aware that some of the personal accounts are distressing. But there was also a feeling of hope among the panelists and in the chatroom shared by participants — hope that more people are becoming aware of the nature and extent of the problem and that long-overdue change is finally starting to emerge.