'This is a generation of guinea pigs': Experts weigh in on the over medication of American teens

Vast numbers of American teens are on psychiatric medications, many of which are not recommended or approved for those under 18. In many cases, teens will be prescribed multiple drugs at once. The impact of psychiatric drugs on developing brains has not been measured.

"You can very cogently argue that we don’t have evidence about what it means to be on multiple psychotropic medications," said UMass' clinical psychologist Lisa Cosgrove, "This is a generation of guinea pigs."

The drugs include Focalin, Prozac, Abilify, Effexor, Trintellic, Alprazolan, Lamictal, Olanzapine, Rexulti, Topamax, and others, reports The New York Times. These are drugs often advertised on TV with graphic side effects warnings on the potential for psychotic episodes, suicidal thoughts or behavior, weight gain, and other unpleasant issues. There has also been an indication that these drugs interfere with developing reproductive systems.

As of last year, 8.5 percent of American children under 18, or 1 in 12, are taking psychiatric drugs. 1.2 percent pre-schoolers are taking these meds, and 12.9 percent of adolescents between the ages of 12 to 17. And these numbers are on the rise, with a 26 percent increase reported in the five year span between 2015-2020.

The increase in the number of adolescents taking these drugs is more than 100 percent since 2012. The National Center for Health Statistics reported that at the time: "5% of American 12- to 19-year-olds use antidepressants, and another 6% of the same age group use medication for ADHD—in total, about four million teenagers."

These drugs are particularly common among children who have experienced "childhood adversities." 16.3 percent of children with "two or more childhood adversities" have been prescribed these drugs, and most of those are boys.

"The fastest growth for antidepressants over the past six years is among 5- to 11-year-olds (10.1 percent annual growth). For ADHD drugs and antipsychotics, however, the fastest annual growth is, alarmingly, among pre-schoolers (12.7 percent and 7.9 percent, respectively)" Psychiatry Today reports.

The journal Pediatrics found in 2020 that 40.7 percent of people between the ages of 2 and 24 who were given drugs for ADHD were also given drugs for additional conditions, such as depression or anxiety.  And these drugs were prescribed not one at a time, but in tandem. The practice is called "polypharmacy."

About half of the drugs prescribed, the Times found, were not recommended by the manufacturer for use in children and teens.

The FDA has approved Prozac and Lexapro for use in teens, but many of these others are required to show a warning that there is an increase in the "risk of suicidality."

"The risk of suicidality for these drugs was identified in a combined analysis of short-term (up to 4 months) placebo-controlled trials of nine antidepressant drugs, including the selective serotonin reuptake inhibitors (SSRIs) and others, in children and adolescents with major depressive disorder (MDD), obsessive compulsive disorder (OCD), or other psychiatric disorders. A total of 24 trials involving over 4400 patients were included. The analysis showed a greater risk of suicidality during the first few months of treatment in those receiving antidepressants. The average risk of such events on drug was 4%, twice the placebo risk of 2%. No suicides occurred in these trials," the FDA said.

The data encouraged the FDA to add warnings labels, saying: "Based on these data, FDA has determined that the following points are appropriate for inclusion in the boxed warning:

"Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with MDD and other psychiatric disorders.

"Anyone considering the use of an antidepressant in a child or adolescent for any clinical use must balance the risk of increased suicidality with the clinical need.

"Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.

"Families and caregivers should be advised to closely observe the patient and to communicate with the prescriber.

"A statement regarding whether the particular drug is approved for any pediatric indication(s) and, if so, which one(s)."

Yet, the prescription of psychiatric medications for children and teens continues to expand. A clinical psychiatrist at Columbia University told the Times that doctors tend to overprescribe when they can't find another solution. "When they’re searching for something that makes the patient symptom-free, they create problems that can result in what is politely called pharmaceutical misadventure," Dr. Mark Olfson said.

Much of the start of this kind of over medicalization began with the emergence of new diagnoses that were then given pharmaceutical solutions. "Polypharmacy became even more common after 2013, when the clinical definition of A.D.H.D. was updated and broadened," the Times reports.

The increase in prescribing psychiatric medications for children and teens, especially in elaborate drug cocktails, is a trend that many find concerning, in large part because the impact is not known.

"These trends are of concern because very little is known about the effects of these drugs, taken alone or in combination, on the developing brain. Most of the prescribing is 'off-label,' meaning, essentially, unlicensed and with unproven efficacy and safety," reports Psychiatry Today.