Does Your Toddler Really Need an Anti-Depressant? Report shows that thousands of Michigan preschoolers are being prescribed psychiatric drugs
Activist
Ben Hansen looks like a regular Traverse City nice guy. He’s handsome
with a neatly trimmed gray beard, often dressing in a casual flannel
shirt and a Tiger’s ball cap. He lives in a tiny house in Traverse City
on the tiniest of incomes. But don’t let his modest appearance fool
you. He is asking big questions of pharmaceutical companies, or pharma,
our country’s most powerful industry. And what he wants to know is
this: Why are thousands of foster children and poor children on
Medicaid — children who are too young for kindergarten — being put on
antipsychotics, anti-depressants, anti-hyperactive medicine, as well as
pills that eliminate the tremors caused by these medications? Hansen’s
window into this trend is data compiled by the Michigan Department of
Community Mental Health (MDCH), which oversees the Medicaid and foster
care programs. For nearly two years, Hansen has been going back and
forth with the department with Freedom of Information Act requests.
MDCH has given Hansen much of what he wants, but drew the line on
giving him the names of drugs (as opposed to the general drug classes
such as anti-depressants) that are dispensed to children under the age
of five. They also refused to provide the names of drugs for patients
of any age who are taking five or more psychiatric drugs, citing
patient confidentiality.
DRUG COCKTAILS Hansen assured the
judge he has no interest in confidential information and offered to pay
the labor cost of blacking out names. His suit, accompanied by
supporting documents by experts in the field, argues that researchers
require the data to study the changing prescribing patterns of
psychiatric drugs to young children, as well as the increasing number
of adults taking “psychiatric drug cocktails.” Hansen questions,
for example, why the number of adults taking three are more psychiatric
drugs increased by 68 percent within six months last year (5,544 adults
to 9,328). He believes that it’s harmful to the patients and taxpayers
alike. But he needs to provide specific drug names to researchers to
make his case. Last week, Judge Beverley Nettles-Nickerson of the
Ingham County Circuit Court ruled in favor of the State’s motion to
dismiss Hansen’s FOIA request. The judge also ordered Hansen to
pay $3,500 for the state’s legal costs. Hansen is incensed by the
ruling and intends to request a re-hearing. That’s because the Medicaid
data that he has been given—some 1,000 pages worth—has raised
significant alarms.
TODDLERS AND DRUGS A key report
obtained by Hansen showed that in 2005, some 3,064 psychiatric drug
prescriptions were issued to children, ages four and under. They ranged
from antidepressants to what are called atypical antipsychotics. A
third were sedative hypnotics/anxiolytics (sleeping pills like Ambien
and Lunesta and anxiety reducers), while another third were
antidyskinetics (also called antiparkinsonians) typically prescribed
for trembling in Parkinson’s patients and for movement disorders such
as tics, tremors and restless legs syndrome in children. The report
showed that 46 prescriptions were for ADHD (attention deficit
hyperactive disorder), while 875 were mood
stabilizers/anti-convulsants. Ninety-four children received medicine to
combat depression. These drugs, according to the 2005 report, cost the
state $467,343. The vast majority of these drugs were never approved
for use by children and some may carry a ‘black-box’ warning of
suicidal thoughts and behavior for children. Since that 2005 report,
the state began lump-ing all children under the age of 18 together,
which is one reason why Hansen asked for the “under 5” age breakdown
after 2005.
‘PUBLIC HEALTH DISASTER’ Hansen wonders why the
number of very young Michigan children on anti-Parkinson drugs has
quadrupled in the past two years. He suspects it may be due to
drug-induced movement disorders caused by psychiatric drugs used for
the treatment of ADHD, autism, and depression in children. “If
the increased prescribing of antidyskinetics is the direct result of an
increase in the diagnosis and treatment of ‘mental disorders’ in
American toddlers, then we could be witnessing a public health disaster
of monumental proportions,” Hansen said. Hansen also worries that
the new drugs are being prescribed to children without enough study of
their long-term effects on their bodies and brain development. Doctors
do know of potential, near-term side effects. Depakote, used to treat
mania and seizures, can cause obesity and diabetes. Those who take
Risperdal may suffer from involuntary movements, such as twisting the
neck in a birdlike fashion. Zyprexa is linked to obesity and diabetes.
Lithium can damage the thyroid and kidneys.
TEEN YEARS When
looking at the number of Michigan children on Medicaid or foster care,
17 and under, the numbers really soar. Nearly 13,000 children last year
took Zyprexa or some other atypical antipsychotic at an estimated cost
of more than $3 million, according to MDCH data. These are not just numbers, but real children, Hansen stressed. “I
challenge anyone in the state of Michigan or anyone who works for the
Department of Community Health or any doctor to prove me wrong,” Hansen
said. “Step forward with the data and tell me, ‘Ben Hansen, what you
say is happening is not happening. Our children are not being targeted
by the drug companies simply because once they’re on these drugs, they
are patients for life.’ Believe me, I’d love to be wrong about this.” Last
week, he was on the phone with a foster care caseworker who told him of
a boy, who had acquired a twitch in his neck and was already on at
least two prescription drugs. His doctor then prescribed Adderall (an
anti-ADHD medicine) to quell the twitch, and the boy suddenly died
several days later. His caseworker suspected that drugs played a role,
but shied away from the story when a reporter was mentioned. Hansen
said that he would ideally like to see morbidity data — how many
children and adults die when given psychiatric drug combinations of
three or more. “I know I’ll eventually get my hands on the data I’m
seeking, but how many lives will be destroyed before I do? When
will people wake up to what’s happening? Will it be too late? We’re
talking about real lives here.”
MORE BIPOLAR KIDS? Six years
ago, several leading psy-chiatrists reached a consensus that bipolar
disorder existed and was diagnosable for pre-pubescent children with
the results published in Journal of the American Academy of Child and
Adolescent Psychiatry, according to an article recently published in
the New Yorker. But the article also reported that even now,
clinicians disagree on whether it’s possible to accurately diagnose
bipolar disorder. For one, there’s no consensus on how to define
aberrant behavior in children under six, and also many young children
can’t adequately explain what they’re experiencing, Since 1999,
the percentage of mentally ill children under the age of 18 diagnosed
with bipolar disorder has increased four-fold, the New Yorker article
reported. The frontline treatment for these children are atypical
antipsychotic drugs, such as Zyprexa, Risperdal, Seroquel, Abilify, and
Geodon. MSU Professor Bertram Karon wrote in Hansen’s court filing
that he is “alarmed” by the over-reliance on psychiatric medications
for schizophrenia and other mental disorders. “These medications,
frequently pre-scribed off-label, and mixed in ‘drug cocktail’
combinations, are now being administered to patients at very young
ages, a practice virtually unheard of only a couple decades ago.”
THOUSANDS OF KIDS There are similar concerns throughout the
country. A study of children on Medicaid in Texas was so
disturbing—63,118 children, 18 and under, were put on stimulants,
anti-depressants, or antipsychotics, with nearly a third taking drugs
from at least two of those classes—that Texas established strict
guidelines in dispensing drugs to children. Doctors were also warned
not to over-prescribe drugs or prescribe drugs for off-labels uses. The
New York Times ran a story just last week on “Industry’s Role in
Childrens’ Antipsychotics.” The paper analyzed records in Minnesota,
the only state that requires public reports of all drug company
marketing payments to doctors. Those records provide “rare
doc-umentation of how financial relationships between doctors and drug
makers correspond to the growing use of atypicals in children. “From
2000 to 2005, drug maker payments to Minnesota psychiatrists rose more
than sixfold, to $1.6 million. During those same years, prescriptions
of antipsychotics for children in Minnesota’s Medicaid program rose
more than ninefold,” the article reported. The doctors who received the most money from drug makers prescribed the highest number of antipsychotics, the article reported.
DRUG COCKTAILS Data for adults on Medicaid in Michigan was troubling as well. One
adult, Hansen found, was taking 17 different psychiatric drugs at one
time, all paid for with tax dollars. The most recent data showed a 300
percent increase in the adult ADHD category within a six-month
period—from five people to 20. “Growing numbers of patients are
now prescribed a dozen or more psychiatric drugs concurrently—a
practice in no way supported by scientific evidence,” wrote Bertram
Karon, a professor of clinical psychology at Michigan State University
in support of Hansen’s FOIA request. Hansen said he needs specific
names of drugs dispensed because the numbers often don’t add up in the
reports that were issued. Hansen believes it’s because some drugs
overlap different classes. Assistant Attorney General Thomas
Quasarano represented the State of Michigan in the case. He referred
comments to spokesman Matt Frendeway, who said the records were
confidential and exempt from law, but not specifically why since the
information would not be linked to any individual. The state’s court
filing also contended that the Release of Information for Medical
Research and Education Act exempts this class of records from FOIA.
Hansen would have to qualify as a “review entity” to receive the data. “After
reading and rereading the judge’s decision I do not believe that she
made a substantive ruling on the ‘review entity’ issue. Her ruling
appears to be more of a procedural decision,” said Alan Kellman, who is
handling the FOIA case pro bono for Hansen. Kellman acknowledged in
the suit that MDCH has already provided quite a lot of data. “However,
a line is drawn when it comes to simply providing the names of the
drugs. This is, to be straightforward, incomprehensible. What purpose
is actually served? … Certainly not one of confidentiality. This is
arbitrary. It must not be allowed.”
Next week: An article on Ben Hansen and his own brush with the mental health system, and why he now believes our pill-popping society is losing its mind.
