The current trend of polypharmacy – the simultaneous use of multiple drugs by a single patient for one or more conditions – reflects racism and discrimination in the treatment of Black, Indigenous, and people of color children and teens, according to Dr. Carolyn Coker Ross, an intergenerational trauma expert and eating disorder treatment specialist.
“It has been documented in adults that Black patients with mental illness are more likely to receive substance care and more likely to be diagnosed with psychotic disorders than with depression and anxiety,” Dr. Ross stated.
“The lack of access and availability of therapeutic options to treat mental illness and the lack of understanding and acknowledgment that mental illness in teens and children may have their roots in trauma.”
“Medication will not fix the brain changes caused by childhood trauma experiences and may not even fix the symptoms. Beyond this, medication use in children and teens is risky at best and dangerous at its worst.”
Dr. Ross’ comments are in response to a new report revealing that anxious and depressed teens are using multiple, powerful psychiatric drugs, many of which are untested in adolescents or for use in tandem.
In 2020, the journal Pediatrics reported that 40.7 percent of people ages 2 to 24 who were prescribed a drug for attention deficit hyperactivity disorder also were prescribed at least one other medication for depression, anxiety, or another mood or behavioral disorder.
Further, researchers found more than 50 psychotropic medicines prescribed in such combinations.
“These patterns should spark further inquiry about the appropriateness, efficacy, and safety of psychotherapeutic polypharmacy in children and young adults, particularly within subgroups where the use is high,” the authors concluded.
While the use of multiple psychotropic medications counts as concerning in such a young population, it is also not surprising given the lack of other treatment options, Dr. Ross told the Washington Informer.
“Beyond this, however, is a lack of understanding about the root cause of many of the psychiatric conditions being diagnosed and treated with medications,” Dr. Ross asserted.
“Both during and before the pandemic, BIPOC children and teenagers are exposed to more trauma and adverse events than any white children and teens.”
Given that depression and anxiety have increased in recent years among youth, and young ones who have experienced trauma or childhood adversity (or ACEs – adverse childhood experiences) are more likely to experience depression and anxiety and other health and learning challenges, this is a significant health and social justice conversation, added Sarah Marikos, the executive director of the ACE Resource Network (ARN).
“The issues on prescribing psychotropic medications for children, adolescents, and young people, and lack of access to behavioral health supports for youth who have an increasing need for mental health support is one of the biggest health challenges our country is facing right now,” Marikos wrote in an email.
“This is partly why the U.S. Surgeon General issued an advisory on youth mental health at the end of 2021. When diagnosing and treating depression, anxiety, and ADHD, as well as many more common health conditions, particularly among young people, it is important to have a trauma-informed approach.”
“Giving children and young people, or anyone really, a psychiatric diagnosis with medication has serious, potentially helpful, and potentially harmful consequences. Diagnosis informs treatment. Therefore, if the diagnosis is not right, the treatment may not work, or worse, it could be hurtful.”
“Diagnoses can also impact how young people think and feel about themselves and perhaps define themselves. Doctors and behavioral health providers who understand trauma and seek to understand their patients’ history and experiences, may mean a shift in diagnosis and treatment.”
The New York Times noted a nationwide study published in 2006 examined records of visits to doctors’ offices by people younger than 20 and found a sharp rise in office visits involving the prescription of antipsychotic drugs — to 1.2 million in 2002 from 200,000 in 1993. In addition, the drugs were increasingly prescribed in combinations, particularly among low-income children.
The newspaper added that between 2004 and 2008, a national study of children enrolled in Medicaid found that 85 percent of patients on an antipsychotic drug were also prescribed a second medication, with the highest rates among disabled youngsters and those in foster care.
“It’s a fact that our youth are experiencing more mental health concerns today than ever before,” offered Laura Tietz, a pediatric pharmacist.
She once worked at Cleveland Clinic Children’s Hospital in Ohio.
“While I believe physicians and psychiatrists are probably overprescribing these medications, I don’t believe they do so intentionally,” Tietz stated.
“Unfortunately, they are often left with little choice. Cognitive behavioral therapy (CBT) and other forms of counseling have been shown to be an essential part of managing mental health conditions,” Tietz continued.
However, there are few professionals in the medical field today who practice adolescent psychiatry and can provide this benefit to our youth.
“This leaves prescribers with the task of trying to manage mental health concerns strictly with medication.
“I believe any physician would tell you that they want to help the patient to the best of their ability. Unfortunately, right now, physicians have few tools besides medication to do this.”