This Teen Was Prescribed 10 Psychiatric Drugs. She’s Not Alone.

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From The New York Times: “Her senior yearbook photo shows her smiling broadly, ‘but I felt terrible that day,’ said [Renae] Smith, who is now 19 and attends a local community college. ‘I’ve gotten good at wearing a mask.’

She had come to exemplify a medical practice common among her generation: the simultaneous use of multiple heavy-duty psychiatric drugs.

Psychiatrists and other clinicians . . . [caution that] such medications are too readily doled out, often as an easy alternative to therapy that families cannot afford or find, or aren’t interested in.

These drugs, generally intended for short-term use, are sometimes prescribed for years, even though they can have severe side effects — including psychotic episodes, suicidal behavior, weight gain and interference with reproductive development, according to a recent study published in Frontiers in Psychiatry.

Moreover, many psychiatric drugs commonly prescribed to adolescents are not approved for people under 18. And they are being prescribed in combinations that have not been studied for safety or for their long-term impact on the developing brain.

‘You can very cogently argue that we don’t have evidence about what it means to be on multiple psychotropic medications,’ said Lisa Cosgrove, a clinical psychologist at the University of Massachusetts, Boston. ‘This is a generation of guinea pigs.’

. . . Public health officials first grew concerned about the problem of multiple medication use, or polypharmacy, a decade ago, when it emerged among young people in foster care and low-income settings. Legislative reforms were passed to curb the practice in those settings, but it has since widened to include affluent and middle-class families.

‘It’s gone mainstream,’ said Julie Zito, professor of pharmacy and psychology at the University of Maryland.

The Rise of Polypharmacy

. . . The path toward polypharmacy often starts with drugs that are used to treat A.D.H.D. The condition is the ‘foundation of polypharmacy,’ said Dr. David Lohr, a child psychiatrist at the University of Louisville and the medical director for the Department for Community Based Services, which oversees Kentucky’s child welfare system.

. . . Polypharmacy became even more common after 2013, when the clinical definition of A.D.H.D. was updated and broadened. Previously, the Diagnostic and Statistical Manual of Mental Disorders, the standard reference for the diagnosis of thousands of medical conditions, stated that an A.D.H.D. diagnosis applied if the patient exhibited ‘some hyperactive-impulsive or inattentive symptoms that caused impairment.’

In 2013, the requirement for impairment was dropped, among other changes that together ‘led to significantly increased diagnosis,’ according to an analysis in The Journal of the American Medical Association. By 2015 to 2016, 13.1 percent of adolescents ages 12 to 17 were diagnosed with A.D.H.D., according to the journal’s analysis.”

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5 COMMENTS

  1. Back in the day youth were told NEVER EVER to take street drugs or alcohol or cigarettes. It is perhaps regarded as a tangent but when society “gives up” the battle to keep the brains of children free from those noxious substances it probably makes polypharmacy look more acceptable. Children in any altered state is child neglect. The majority of kids being on drugs, any drugs, in the nineteen forties was unheared of. We have lost the respect parents once had that curtailed some youth from indulging in exuberant drug excesses. Possibly modern era rock stars and celebrities added to the acceptability of the anti-hero romance of being a drug addict. Death won the Oscar awards. Life purpose became meaningless unless your brain was given imported “meaning making” in the form of mind altering substances.

    I think there ought to be a new name for polypharmacy. It sounds too Polyanna playful. Maybe toxic overload or toxic obesity or pollutionpharmacy. Anyway, since antibiotics are now in our drinking water along with forever chemicals all the wild animals are sponging up the rainy residue of polypharmacy. Rain precipitation sooks up ground water peed into by a thousand pill poppers. There may be particles of medication glitterfalling from our clouds. Landing like dandruff on our lapels.

    It is so sad what has become of the sacred time of childhood.

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  2. ‘You can very cogently argue that we don’t have evidence about what it means to be on multiple psychotropic medications,’

    Well … as one from ‘affluent and middle-class families,’ who dealt with egregious poly pharmacy over two decades ago, I can argue that we do have medical evidence of the dangers of being ‘on multiple psychotropic medications.’

    For example, combining the antidepressants and/or the antipsychotics – two of the anticholinergic drug classes – is well known to all doctors to create ‘psychosis’ and ‘hallucinations,’ via anticholinergic toxidrome poisoning.

    https://en.wikipedia.org/wiki/Toxidrome

    Although, I do agree, all doctors do deny being taught this information in med school, especially now that psychiatry’s systemic, intentional poisoning sins are being exposed.

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  3. This topic raises important questions about the use of psychiatric medication for teenagers and the ethical principles that guide medical professionals in prescribing these drugs. In particular, this article focuses on the principle of nonmaleficence, which requires doctors to avoid causing harm to their patients, and the challenges that arise when this principle conflicts with other ethical considerations.

    One of the key issues discussed in the article is the use of antipsychotic medication for teenagers with behavioral and emotional problems. While these drugs can be effective in managing symptoms such as aggression, impulsivity, and mood swings, they also carry significant risks, including weight gain, metabolic problems, and neurological side effects. Moreover, there is limited research on the long-term effects of these medications on adolescent brain development, leading some experts to question whether they should be prescribed at all.

    From an ethical perspective, the use of antipsychotics in teenagers raises a number of complex issues. On the one hand, doctors have a duty to relieve suffering and promote the well-being of their patients, which may require the use of medications to manage symptoms. On the other hand, they must also take into account the risks and potential harms associated with these drugs and ensure that they are not exposing their patients to unnecessary risks.

    In addition to the principle of nonmaleficence, there are many other ethical concepts, laws, and policies that are relevant to the use of psychiatric medication for teenagers. One such concept is autonomy, which refers to a patient’s right to make their own decisions about their medical care. This can be particularly important for teens who may be struggling with issues such as depression, anxiety, or trauma, and who may need to feel that they have some control over their treatment.

    Another relevant ethical concept is that of beneficence, which requires doctors to act in the best interests of their patients. While this may seem straightforward, it can be complicated in cases where there is uncertainty about the risks and benefits of a particular treatment. In the case of antipsychotics for teens, for example, doctors may need to weigh the potential benefits of symptom relief against the risks of long-term side effects.

    There are also a number of laws and policies that govern the use of psychiatric medication for teenagers, including the FDA’s guidelines for drug approval and the rules governing informed consent for medical treatment. These regulations are designed to protect patients from harm and ensure that doctors are acting in their best interests, but they can also be a source of confusion and controversy when there are conflicting opinions about the risks and benefits of a particular treatment.

    Overall, the use of psychiatric medication for teenagers raises important questions about the ethical principles that guide medical practice, and the need for doctors to balance the competing demands of relieving suffering and avoiding harm. While there are no easy answers to these complex issues, it is clear that doctors must be guided by a strong commitment to the well-being of their patients, and a willingness to weigh the risks and benefits of each treatment option carefully before making a decision.

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