The XX Factor

Why We Should Fear Preschoolers on Prozac

We’ve noted before that the NYT has a tendency to run multiple stories on the same topic within the same brief time frame, suggesting that sometimes, the Times ’ left hand isn’t reading what the right hand is writing. This morning, the Business section has a lengthy piece on the dangers of prescribing psychosis drugs for young children , profiling a boy with “severe temper tantrums” who was prescribed a substantial cocktail: the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines, and one for attention-deficit disorder, beginning at 18 months and all before the age of three. It’s a cautionary tale, wherein the mother-who was young, inexperienced, and desperate (in fact, you might say the doctors were prescribing to meet the mother’s needs, not the child’s)-realizes that her child’s personality was completely subsumed in medication, that ends in a happy first grader on a relatively normal regimen of only one drug for an attention deficit.

Contrast that with this weekend’s NYT magazine article on depression in preschool-age children , which must have left more than a few anxious readers wondering whether their child was depressed and whehter early intervention might help. The article notes that research doesn’t support the use of antidepressants in young children, but quotes several doctors as fearing that a new clinical diagnosis of preschool depression would result in a further rise of off-label prescribing: exactly the kind of thing that today’s article cautions against. Those doctors favor using more amorphous terms like “adjustment disorder with depressed mood” and “depressive disorder not otherwise specified” to avoid labeling a child and, not incidentally, to avoid encouraging the easy solutions implied by antidepressants. But Dr. Jane Luby, the professor and researcher whose work in support of creating such a diagnosis was a focus of the article, suggests that as many as 84,000 preschoolers could be clinically depressed. That’s a decent number of new customers for the pharmaceutical companies. As one child psychologist told the Times, speaking of “frustrated drug-industry representatives:” “They want to give these kids medicines, but we can’t figure out the diagnoses.”

As Helaine pointed out yesterday, Dr. Luby, who’d like to hand them that diagnosis, has accepted money  from ” Johnson & Johnson, Shire and AstraZeneca to study using atypical antipsychotics in young children ,” a fact that the New York Times’ story didn’t mention even in passing. This morning’s piece, focused on off-label use of medications, didn’t refer back to Dr. Luby, either or suggest that while we should fear off-label overprescribing of antipsychotics, we should also carefully examine anything that might encourage the creation or marketing of additional drugs specifically for children. It should have. An extra burden of disclosure and thoroughness comes with being a paper (and magazine) with as much influence as the Times .

The takeaway for parents seems obvious: Think twice about accepting or encouraging a doctor to prescribe medication for your child. But this is a question of far more than individual importance. The preschoolers in the Sunday magazine article aren’t being medicated for their still theoretical depression; they and their parents are receiving therapy and instruction in handling “depressive symptoms,” like motion regulation, stress management, and guilt reparation. It’s hoped that the therapy will literally change the way their brains operate. But therapy is more expensive, difficult and time consuming than medication, and it always has been. In noting the educational level and existing parenting efforts of the parents of the children profiled, author Pam Paul inadvertently highlights one of the dangers of creating a new, and prescribable, category of clinically depressed preschoolers: The middle-class kids will get therapy. Other kids-poorer, born to younger or less able parents or to parents who need their children to be manageable enough to remain in day care-will get medication.

As this morning’s Times noted, children from low-income families-like Kyle, the child profiled for that article-are four times more likely to be prescribed antipsychotic medications than those with private insurance. It’s not enough to take care of our own children, and to put down the Sunday Times magazine wondering if our own delicate little hothouse flowers might need a little therapy now to help prevent a lifetime on the couch. What we should really focus on is whether kids like Kyle need protection now in order to prevent a lifetime on antipsychotics. We expect pharmaceutical companies to create and market new drugs. We even expect researchers studying mental health to study all therapeutical options, even those that might include medication. But we expect the Times to look at those things with caution, and to raise the obvious ethical concerns that surround any meeting between the two. Big Pharma and Dr. Luby are doing their jobs. The Times , in this case, was not.