Prescribing Antidepressants for Girls: Intergenerational Adverse Consequences

Claudia Gold, MD
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A significant unintended consequence of over-reliance on psychiatric medication for children was brought to light in a recent study showing that children exposed to SSRIs (selective serotonin re-uptake inhibitors — a class of psychiatric medication used to treat anxiety and depression) during pregnancy were diagnosed with depression by age 14 at more than four times the rate of children whose mothers were diagnosed with a psychiatric disorder but did not take the medication. This study follows on the heels of another showing an increase in risk of autism in children whose mothers took SSRI’s during the second and third trimester of pregnancy.

Such reports are usually met, appropriately, with an outpouring of reassurances from clinicians who take care of pregnant women, who need to protect their emotional wellbeing in whatever way they can.

From my perspective as a pediatrician specializing in early childhood mental health our attention must be on prevention. Our culture is quick to medicate young girls without thought to the increasingly well-recognized slow and difficult process of withdrawal from SSRI’s. With multiple studies like those cited above producing a cloud of uncertainty, and limited data on the long-term developmental outcome for a fetus exposed to SSRI’s in utero, we are knowingly putting future mothers in an untenable position.

In addition, recent alarming reports of a tripling of the suicide rate for girls age 10-14, in the context of rapidly rising rates of prescribing of SSRI’s suggest that this approach is failing.

There is another way. Extensive evidence reveals that when parents listen for the meaning of a child’s behavior, they support development of emotional regulation, social adaptation, and overall mental health.

In contrast, when the standard of care is to name and then eliminate problematic behavior, often with a pill, listening is devalued both culturally and monetarily.

A question from a review course offered by the American Academy of Pediatrics (AAP) exemplifies this standard. Presenting a case of a 7-year-old girl with separation anxiety since preschool, bedtime resistance, and frequent tantrums, we are asked to choose the correct treatment. We are told that parents are divorced, she is an only child, and at her father’s house she expresses fear that something would happen to her mother.

While cognitive behavioral therapy to “work on skills to manage her distress” is the “correct” answer, an SSRI is recommended as a second line of treatment.

An explosion of research at the interface of developmental psychology, neuroscience and genetics shows us that rather than labeling behavior and seeking to “manage” or eliminate it, the road to healing lies in listening with curiosity to discover meaning.

Did this young girl observe conflict, perhaps even violence, between her parents in the years preceding their divorce? Is there a family history of anxiety, suggesting a genetic vulnerability? Does she have sensory processing challenges that cause her to be overwhelmed in a stimulating classroom? Some combination of all these factors might exist. Only when we know the story can we find the path to healing.

In my practice, eight-year-old Sophie, diagnosed with anxiety disorder by her previous pediatrician, came to refill a prescription for Prozac. After several hour-long appointments, some with her alone and some with her mother Linda, I learned that, like the child in the vignette, she had divorced parents. During every-other weekend visits with her father Mark, he drank heavily. Quick to explode in rage, he frequently verbally humiliated Sophie and her mother. The primary problem needing treatment was his alcoholism. Sophie’s behavior represented an adaptive response to a frightening situation.

Parents share this kind of information only when they feel safe. Safety comes when we offer time and space for nonjudgmental listening. When parents can make sense of their child’s behavior, they are in an ideal position to support that child, helping to name feelings, identify provocative situations, and develop strategies to manage these challenges.

Another vignette offers a view of both the problem and the solution.

Beth, mother of 3-month-old Logan, a patient in my behavioral pediatrics practice, could have been the girl from the AAP vignette 15 years later. She struggled with feelings of anxiety. Attempts to stop SSRI’s, which she had taken on and off for years, were unsuccessful. Despite reassurances from many doctors, she was plagued by guilt over the possible effects on her baby, who was now “colicky” and not gaining weight.

I worked with the family, drawing on an evidence-based treatment known as child-parent psychotherapy. We sat on the floor, with Logan’s father, Peter, joining in. Logan began to gain weight in parallel with his mother’s improved emotional state.  My aim was simply to listen, and to support Logan’s parents in reflecting on the meaning of his behavior. By six months he was thriving. Beth’s anxiety abated and she was able to come off the SSRI.

Over-reliance on psychiatric medication in children has negative impact on this generation and the next. The unknown effect of psychiatric medication on the developing fetus is but one unintended consequence. As I describe in my new book The Silenced Child: From Labels, Medications, and Quick-Fix Solutions to Listening, Growth, and Lifelong Resilience we silence communication and miss opportunities for prevention. In contrast, when we offer space and time for listening to parents, starting in the earliest weeks of life, we have the opportunity to set development on a healthy path.

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9 COMMENTS

  1. Anxiety? Depression? Shouldn’t give people mood altering chemicals. Some people will prescribe for themselves alcohol and street drugs. Hard to do much about that. But we should be able to stop the people holding medical licenses from putting people on drugs.

    Nomadic

    • I totally agree with you there dude. A forewarning to the children is a first priority. Check out this comment I made on YouTube, in response to a bunch of young folk inquiring about antidepressants, etc.

      If it doesn’t make you feel “GOOD”, and make you feel good “FAST”, it’s probably too good to be true. Antidepressant’s are unique in that they are a class of medicine that can make the user feel worse, yet hooked at the same time. After you’ve given the drug 4 – 6 week’s to chemically acclimate to your CNS you cant just take it out (stop your med’s), even if your having negative side a/effect’s. Here’s a good analogy: Have you ever been riding down the road, and passed a dilapidated house that has succumbed to the elements of Mother Nature? You may have noticed a tree growing through the house and thought, “wow that tree has really destroyed that house.” While the tree (antidepressant’s) did damage the structure of the house (your brain), the house, none the less, is still reliant on that tree to retain what’s left of it’s structural integrity. If the tree is removed, the house becomes unstable, there’s a big hole in the roof, and eventually the roof collapses because it no longer has the support of the tree. So the house has to be completely rebuilt. Well, when you remove your antidepressant, the physical structure of your current “frame of mind” and other neurological functions is also compromised, sometimes for the worse. And long after the drug has left your system the rebuilding process of your brain can take a long time, and a great deal of psychological resilience. YOU CANNOT WIYHDRAWAL FROM A FRONTAL LOBE LOBOTOMY! You have to live with it, and slowly get comfortable with “the new normal.” So any prescriber that claim’s that antidepressant’s and antipsychotic’s are not addictive is guilty of lying by omission (telling a partial truth and omitting the more serious consequences). So, with that being said, Xanax is a much safer first line treatment for depression/anxiety. You don’t have to become dependent on Xanax for it to be effective. It’ doesn’t require week’s of cumulative exposure to work. And if you need drug’s like Xanax, Ativan, Valium, etc. but your doctor wont give them to you because he/she is concerned about “addiction”, then he or she is very chemically uneducated, and or, commercial medicine has compromised their medical integrity to the point that they are no longer concerned with patient welfare, only financial profit’s. Good luck to you all.

      • Tree/house analogy is brilliant. I agree that with the benzos a) there is an immediate effect and b) you don’t have to get addicted. However it is darned easy. I don’t think they are safe for daily use. By the time you rack up what–6 days? 10? Definitely 30–you could feel the need to call 911 if you miss a dose. I sure did. But you didn’t say anything about daily use. Adderall (“amphetamine salts”also works right away, and though potentially addicting and able to cause psychosis, with low doses and limited use, is also an antidepressant that is far less destructive than antidepressants. The withdrawal syndrome is nothing compares to SSRI withdrawal, unless the Adderall user was in full-blown psychosis like Scott Stapp, the rockstar who flipped out on the stuff a few years ago,

        But such ideas are out of vogue, partly because benzos and speed have been accomplices in the ruin of people’s lives, but mainly because the doctrine of SSRI has destroyed so many other lives that to admit it is wholly wrong would be calamitous for those who have preached it for many decades.

        There’s still plausible deniability wrt to SSRIs and addictions. With benzos and speed, there are salient warnings about addiction potential. Not so with antidepressants. Regulators and profiteers rely on fuzzy definitions of addiction and dependency and find reason to avoid using the terms with antidepressants.

        To whit: A stable feature of antidepressant addiction is lack of cravings. Drug-seeking might take place, but only if the sufferer has decided they can’t stand the sensations and emotions of withdrawal and post-withdrawal ill-health and decides that hair of the dog is their only hope. I can imagine a desperate scramble by someone who feels so terrible that they can hardly bear another minute of it. It’s not done to get high; it’s done to prevent suicide.

        Yet cravings and drug-seeking are central to most concepts of addiction, so there’s the wiggle-room needed. If SSRI withdrawal and post-withdrawal features neither, few “experts” would deem them addictive. Experts suck in this case.

        Imagine the reparations due to the harmed users if drugmakers or prescribers ever have to pay? Gloriously large sums of money.

  2. Thank you for is article Dr. Gold. In addition to the generational effects of SSRI treatment, could you comment on any known damage to the developing fetus when mothers are given other psychoactive drugs such as Phenergan? I was given this drug for 5 months during my first pregnancy for severe morning sickness. I worried, resisted it, was reassured and took half the dose. My son, now a young adult, was diagnosed with “high functioning autism” as a young child and has had learning and social difficulties throughout his life. Could my use of Phenergan in pregnancy be related to his developmental challenges in your opinion?

    I worry that the rising rates of diagnoses of autism are related to the rising exposure of pregnant women to pharmaceuticals and other toxins. Please let me know if you have any thoughts on this. I know much more research needs to be done, but I worry that this won’t happen and that our FDA is not properly protecting us from Big Pharma’s focus on profits and their corrupting influence of psychiatric and other medical research.

    Thanks again!

  3. Time with a doctor who has good listening skills is one thing that you don’t receive in the doctor’s office these days. People are herded like cattle through doctors’ offices and clinics. It’s “head ‘um up and move ‘um out”, keep those doggies rolling” plain and simple.

    I don’t think that certain children are born with a genetic predilection towards experiencing anxiety. I don’t think that anxiety and depression run in families by genetic means. I do believe that children often act as barometers that show what is going on in their families. I think that many American parents live stressed out lives with the kinds of responsibilities that they face for taking good care of their families. Trying to work more than one job, making enough money to have two and three cars per family, paying huge mortgages on nice enough houses, paying tuition for schooling in the right schools, trying to cart the kids to all the functions they’re involved in after school and in the summer so that they can be socially popular and accepted by peers, worrying about the political climate of our nation, trying to make ends meet when we work more hours now than we did 30 yrs. ago and make less money; families live tense lives these days. The children may not know or realize what’s going on with their parents anxiety and stress-wise, but they innately can feel that stress being communicated to them in many non-verbal ways. And what do we do? We “medicate” and drug the barometers for having the nerve to reflect back to us what is radiating outwards from us in all directions. Perhaps parents need to take some time to sit down and evaluate what is going on with themselves before they so willingly run to the doctor to get the kids drugged. And then perhaps they need to start sitting down and talking, and especially listening to their kids on a daily basis. Maybe we need to go back to the practice of having three generations of families live in one house so that everyone eventually gets the attention that they need.

    • Children also act as barometers to the trauma that runs intergenerationally through many families in our society. This trauma is not known outside of the family often because there’s an old dictum of “what happens in this family stays in this family.” Children are only the innocent reflectors of what is happening around them. And yet we drug them for doing what they can’t help but do.

  4. Dr. Gold, did you oblige the 8 year old with a prescription for Prozac? I’m sure you did. Was she persistent? Was her demeanor aggressive? Did she smell of alcohol? What kind of automobile did she drive to your establishment? LMFAO!

    “early childhood mental health” You try and portray yourself (to the viewer’s) as a noble practitioner who criticizes and takes into account the risk’s of putting chemicals into the still developing CNS’s of very young children, while simultaneously justifying it with all of this “distraction talk” about traumatic life circumstances, etc. And why was “Beth” on an SSRI (Xanax doesn’t have a BLACK BOX WARNING)? let me guess! Your trained in addictionology as well. And when you say, “second line of treatment”, does that mean “with” the CBT, or as a back-up plan if you feel the CBT alone is ineffective?

    Like the kid who loved Orangutans; only to find himself later in life, in a psychopharmacology lab, faced with the tough decision of the administration of agent A, or agent B, into the Orangutans bloodstream in order to probe a new theoretical pathway to the mammalian central nervous system. In “Big Pharma/Government” science, there are no good or bad results. Suicide, homicide, fetus deformation, and all the other aforementioned misfortunes are considered acceptable losses with great potential value for future preventative medicine. And what’s even more distressing is your role in the administration of agent A, and agent B, to subject A, and subject B, while masquerading as a caring doctor.

    I try and avoid a fundamental stance on the philosophies of race, religion, politics and other things similar. But when it comes to thing’s like rape, murder, theft, dishonesty, I can say without a doubt, that’s “wrong”. And what you do for a living (or maybe for a thrill) – rape of the undeveloped adolescent body, murder of kinder soul, theft of the innocent mind, and the dishonest rationale that allows you to continue, is just “wrong”

    D. A. C.