Tuesday, March 30, 2010

Glorified Dope Dealers

According to Psychiatric News of 2/5/2010, a study from Arkansas Medicaid showed an explosion of prescriptions from 2001 to 2005 for potentially highly-toxic "atypical," brand-named antipsychotic medications given to non-psychotic children .

Almost half of these prescriptions were given to children diagnosed with conditions for which there is not a single published clinical trial that supports the drugs' effectiveness: ADHD, depression, conduct disorder, oppositional defiant disorder, and adjustment reactions. I suspect that many of the rest were misdiagnosed as bipolar disorder, for which the drugs are in fact indicated, based on specious diagnostic criteria.

This situation is not unique to Arkansas by any means. I have been seeing it here in Memphis and hearing about it from people and psychiatrists all over the country. Agitation, temper tantrums, and acting out have been fraudulently re-labeled as “mood swings.” In my opinion, these drugs are given to children to quiet them down and shut them up so they do not cause distress to their clueless parents and their overwhelmed teachers.

The explosion of the use of these medications in children is an extension of a trend that began in the psychiatric treatment of adults about 15 years ago. I treat patients with personality disorders and also supervise residents as they do initial evaluations in our outpatient clinic. Patient after patient who arrives with an obvious personality disorder, and who comes from highly chaotic dysfunctional family systems,has carried a previous diagnosis of bipolar disorder.

For the vast majority, there is not a shred of evidence that they ever even came close to meeting the well-accepted criteria for bipolar disorder. Many others were actively using cocaine or methamphetamines at the time of their earlier diagnosis, the use of which can mimic mania.


  1. The points made in this post are so relevant, so true, and in my experience as a child psychiatrist, so urgently needed. You have summed up a very dangerous predicament in our field. Unfortunately, in private practice child psychiatry, many of the older practitioners have learned most of their clinical knowledge of the use of atypical antipsychotics from representatives of pharma during free lunches. Prescribing antipsychotics to children with ODD has become such the norm, that many child psychiatrists exhibit shock when encountering a voice of dissent. "Glorified Dope Dealers" is immensely relevant and urgent.

  2. Dr. Allen: Maybe the problem is just that the FDA is behind on its indications. One of the original, or at least early, indications for chlorpromazine (thorazine) was (is?) "behavior problems in children."