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Drug Therapy

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Before the elementary student from Toledo, Ohio, started taking Prozac, teachers said he was unmanageable in class. He would kick and scream, tip over in his chair, and crawl to his desk when the bell rang.

The boy, who was diagnosed at age 5 with depression and attention deficit hyperactivity disorder, has taken the anti-depressant for three years. Now, he is calmer in class and excelling academically, according to Kathy Riley, a behavior specialist with the Toledo public schools. "Once he began medication," she says, "his life turned around."

Many educators see Prozac and other anti-depressant medications that have been used by adults for years as a much-needed remedy for children and adolescents with chronic behavior problems in the classroom. Some school nurses and psychologists, however, worry that these drugs are too often seen as a quick fix for young people with emotional problems.

Although anti-depressants have yet to be approved formally by the U.S. Food and Drug Administration for use by children, doctors have the authority to dispense them to minors because the pills have been cleared for use by adults. And doctors appear to be turning to them much more frequently. In 1996, more than 600,000 children and adolescents were prescribed Prozac, Paxil, or Zoloft, according to IMS America, a New York City-based research group that monitors the pharmaceutical industry. Between 1995 and 1996, prescriptions for Prozac alone increased 47 percent among 13- to 18-year-olds.

Anti-depressants are now the second-most-prescribed drug for mood and behavioral disorders in children behind Ritalin, which has been used for decades to treat attention deficit disorder. And drug companies are seeking FDA approval for children's use, which would allow them to market the products specifically for youngsters.

Some physicians who work with depressed children say that the newest anti-depressants provide effective treatment and seem to have fewer short-term side effects than other drugs. Dr. David Steinberg, an assistant professor of clinical psychiatry at New York University and a child psychiatrist, describes a 14-year-old patient with obsessive-compulsive disorder who would wash his hands 20 times a day and brush his teeth until his gums bled. The teenager has been on the anti-depressant Zoloft for three years now and is functioning well enough to return to school.

"When used judiciously with therapy and school interventions, these medications can be lifesaving," Steinberg says.

The National Institute of Mental Health estimates that about 4 million children in the United States—about 5 percent of all youngsters—suffer from some form of depression. A stark indicator is that the suicide rate for children younger than 12 has doubled over the past decade, while the rate among teenagers has risen to equal that of adults. Part of this dramatic climb may be due to better reporting of the problem, researchers concede.

Penny Frese, a mother of four who lives in Hudson, Ohio, doesn't like to think about what might have happened to her family without the drugs. Her children, who now range in age from 15 to 26, have been taking either Zoloft or Prozac since their teenage years. They suffer from such severe, debilitating depression, Frese says, that some might not have survived without medical intervention. "Therapy has not proved particularly helpful with our children because their disorder is biological," Frese says. Her husband is a schizophrenic who has five siblings on anti-depressant drugs.

"It's like trying to talk someone out of diabetes," she says. "It's not going to make their illness go away to talk about it."

For some youngsters, the drug treatment not only improves their outlook and behavior but also their academic performance. "We will see kids who are lethargic or disinterested in school or social activities begin to achieve more in school," says Toledo teacher Riley.

But some school psychologists are concerned about the trend. They worry that doctors may be prescribing medications to teenagers who are simply suffering from typical adolescent angst. "Are we treating normal adolescents because they are occasionally obnoxious?" asks Dwight Sweeney, a professor of educational psychology at California State University-San Bernardino. "That's a question nobody's answered."

Some parents, Sweeney fears, are so eager for a solution to their child's emotional problems or learning disabilities that they rush to a pharmaceutical answer. "Parents need to ask questions," he says. They need to try appropriate behavioral interventions and rule out possible sources of emotional distress. They shouldn't settle for the shortcut, he says.

Medical regimens, whether a last resort or a quick fix, inevitably complicate the work of school staff members. Dorris Luckenbill, president of the National Association of School Nurses in Scarborough, Maine, is pleased that more children's mental illnesses are being diagnosed and treated. But she says parents need to keep nurses informed if their children are being medicated so that school health workers can effectively monitor side effects. "Is this a huge burden? No," Luckenbill says. "But we need to know if the child is taking it."

Nearly 3 percent of all schoolchildren in the nation are on a stimulant such as Ritalin, an anti-depressant like Prozac, a mood stabilizer like Lithium, or an anti-convulsant medication like Tegretol. The newest anti-depressants, drugs like Prozac, Zoloft, and Paxil, can cause nausea, weight loss, sedation, and, less commonly, seizures.

Margie Bradford, a member of the board of directors of the National School Boards Association, says nurses and teachers who are dispensing these medications to students must be prepared to monitor the side effects of the drugs—both for the child's sake and their own. "Every time you dispense medication, a school district is responsible," Bradford says. "When you don't know what will happen in the long run, there is a concern."

To facilitate FDA approval of anti-depressants for children, drug manufacturers are conducting their own effectiveness research. So far, one major independent study has shown that anti-depressants ameliorate the symptoms of severe depression in children. In that study, researchers at the University of Texas Southwestern Medical Center in Dallas found that Prozac was as effective in fighting depression in children as it is in combating adult depression.

But because no research exists on the drugs' long-term effects on children, parents and school staff members need to understand that they are entering uncharted medical territory. Sweeney, for one, is worried. "People are not being told that this is experimental," he says. "It needs to be monitored."

—Jessica Portner



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