New Hampshire kids receive too many psychiatric medications.
A decade before Robert F. Kennedy Jr. raised the alarm on the overprescribing of psych medications to kids, a small group of researchers and clinicians — including some from New Hampshire — were busy trying to understand and reverse the sharp increases being observed.
Not all psych medications are bad. The introduction of antipsychotics may have helped facilitate a major movement towards keeping adults with severe mental illness out of institutions. Many celebrate this win.
The dramatic rise in the use of psych meds like Zoloft, Adderall, and Abilify among kids in the past two decades is not to be celebrated.
Most psych medication prescriptions for kids are not approved by the U.S. Food and Drug Administration, which means that they are used “off-label.” No studies have tested the safety of more than one psych medication at a time. Yet thousands of U.S. kids receive off-label antipsychotics, arguably the highest risk of all psych medications, or multiple medications at once.
Known side effects of psych medications include weight gain, metabolic and neurocognitive problems, sedation, agitation and severe restlessness. A kid taking an antipsychotic will gain eight to 32 pounds per year, 60 out of 100 will feel sleepy and 20 out of 100 will have higher cholesterol. Twenty-five out of 100 kids taking stimulants will have sleep problems and feel less hungry. Five to 10 in every 100 high school kids will misuse, give away or sell their stimulant.
The biggest culprit behind the sharp increase? The pharmaceutical industry. Pharma spent over $10 billion on U.S. marketing in 2023. Pharma provides payments or benefits to doctors and researchers to promote their medicine. Pharma sponsors professional psychiatry and pediatrics meetings, funds much of the medication research and advertises directly to the public in a way that promotes over-diagnoses and down plays side effects. Pharma fingerprints are everywhere, from the Risperdal clocks in the clinic waiting rooms, to the Concerta paper pads used by doctors and secretaries, and the pharma-funded ADHD pamphlets handed out by well-meaning schools and advocacy organizations.
The health care system is also driven by insurance companies looking to profit. Doctors must only diagnose and prescribe medications, and do so quickly so that clinics can bill enough services to stay afloat.
Doctors, parents, teachers, therapists and pharmacists have good intentions. We want to help aggressive or hyper kids stay safe and well. But we have a large appetite for quick, easy solutions. And we have been sold the story of “the magic pill” by seemingly smart, good-looking pharma representatives, actors or social media influencers. We are simply being raised in the era of pharma-influenced health care.
There are solutions. Others have reduced inappropriate antibiotic use among kids and reduced medications among the elderly.
We will always need industry and we will always need psych medications. But we need much tighter guardrails. Policies can ban direct-to-consumer marketing like it is in almost every other country and limit pharma’s benefits to doctors, researchers and influencers and require them to tell their patients or “followers” about the payments or benefits they receive from pharma. Policies can mandate that pharma-funded research allow outside researchers to view and analyze their data and keep pharma out of clinics and schools.
Policies can require recess in schools and install public service announcements about what builds good mental health in kids. Policies can also ensure that medical training promotes a more holistic approach to the care of kids.
Many doctors believe in the concept of “less is more,” but they are not sure how to do it. Doctors deserve training on the use of tools beyond medications. Doctors can learn how to not prescribe meds, how to make shared decisions with kids and parents and how to deprescribe when appropriate. Deprescribing psych medications among kids is building momentum and can be done safely while improving the lives of kids.
Doctors and therapists can shift to strategies that are grounded in evidence, such as how to get kids outdoors and how to teach parents to set limits on behaviors, media and sweets. They can teach schools how to let kids stand in class, create hands-on learning, ban phones from the school-day and ensure outdoor time, physical education and the arts for all kids. Doctors and hospitals can use their clout to promote parks and green spaces, affordable housing and social services. Many already do these things, but it isn’t yet supported by their training, payors or policy.
Psych medications can be saved for the very sick kids. As for most, there is no need (and no evidence-base) for those medications.
Momentum is building. We must accept the flaws of our field, shift the status quo away from quick prescriptions, uphold the integrity of our research and regain public trust.
Erin Barnett, PhD, is a clinical psychologist and Associate Professor of Psychiatry and The Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth and Dartmouth Health. She is also a child and family therapist at a New Hampshire community mental health center.