Antipsychotic Prescriptions . . . for Children: Is the Medicaid Story Today’s Version of Go Ask Alice?

“They say it’s impossible to stop now, Evelyn Torres, 48, of the Bronx, said of her son’s use of antipsychotics since he received a diagnosis of bipolar disorder at age 3.  Seven years later, the boy is now also afflicted with weight and heart problems. But Ms.  Torres credits Medicaid for making the boy’s mental and physical conditions manageable. “They’re helping with everything,” she said.”

from The New York Times article “Poor Children Likelier to Get Antipsychotics” by Duff Wilson (December 11th, 2009)

Bipolar disorder at age 3?!?  Weight and heart problems at age 10?!?

My earliest memories of childhood that are from the age of 3 or 4, includes flashes of events such as my mother using her knitting yarn to frame the imaginary roads for my Matchbox cars on our living room carpet, or the tears  she had cried when a nice young man was somehow hurt in Dallas in November 1963.

Outside of these transitory memory flashes the only thing polar of which I was aware were the cute and fuzzy white bears in the Winnipeg Zoo.  At three you are more of a receptacle for the events that occur in the world around  you.  The proverbial sponge in which your perception of yourself and of the make-up of the world is being hard wired into your brain.

Against this backdrop I find it hard to even begin to contemplate how any reputable physician can diagnose a bipolar disorder in a three year old, let alone justify the need to prescribe antipsychotic drugs.

I also find it interesting that the drug companies themselves are remaining silent in what could very likely be a misuse and perhaps even abuse of their products.  Especially since a January 17th, 2008 Fox News article titled “FDA: Over-The Counter Cold Medicine Too Risky For Yong Children” reported that “Drug companies last October quit selling dozens of versions targeted specifically to babies and toddlers.”

The logic for the imposition of said restrictions is based on the fact that the reduced dosage for children has questionable benefits, while its use according to the article poses “serious and potentially life-threatening side effects.”  And this is for an over-the-counter cold medicine!

I am certain that all of us can quickly reference the innumerable ads that currently run on television for anti-depressants.  You know, the ones  in which the soothing voice we hear over the melodious score that frames a kind of paradise found picture of personal bliss lists all of the potentially serious and even life threatening side effects associated with the use of the drug by adults.  I can even recall with some clarity the “mention” that thoughts of suicide while on the drug increases for those under the age of 18.

Referencing the January 17th Fox article once again, the increased risk in children with any drug whether prescribed or over-the-counter is generally not known.  This is because “the metabolisms of children differ from the metabolisms of adults, so there’s no way of knowing how the child will metabolize the medication and what potential side effects it will have,” stated Dr. Manny Alvarez,’s  managing editor of health.

As is often the case in situations of great complexity, we tend to try and oversimplify or narrow down our understanding to a single reason or culprit.

For example, one might rage against the inequity of available health care at different economic levels within our society.  This conclusion would likely be based on the data that was referenced in the New York Times article, which indicated that “more than 4 percent of patients ages 6 to 17 in Medicaid fee-for-service programs received antipsychotic drugs, compared with less than 1 percent of privately insured children and adolescents.”

Others might be inclined to point to the “abject greed” on the part of the pharmaceutical companies themselves, given that antipsychotic prescriptions “are the single biggest drug expenditure for Medicaid, costing the program $7.9 billion in 2006, the most recent year for which the data is available.”

Still, other factors such as long waits to see a psychiatrist or parental pressure may mean that a prescription represents the route of least resistance for most physicians.

Finally, some might even be inclined to villanize the parent or parents themselves, such as Evelyn Torres who credits Medicaid for making the boy’s mental and physical conditions manageable.” In essence are these the “stereotypical” parents whose own addictions and miseries have caused them to take the easy route?  The old saying to walk a mile in another person’s shoes come to mind.

While I do not have the answers, I do believe that it perhaps is a combination of all these as well as other factors that have either directly or indirectly contributed to the problem as a whole.

I also believe that this is a problem that should ultimately be of grave concern to all of us.  My reasoning is simply that we do not know when these seemingly unrelated points of “cause and effect” will converge to have a direct and very personal impact on our lives regardless of our present financial circumstances or societal placement.

In short, we need both collaborative and collective answers derived from a position of non-judgmental understanding.

What are your thoughts?  Please feel free to express your opinions here or through our PI Window on Business Poll on LinkedIn and Ecademy.

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