Thursday, 27 November 2008

Medications and Mental Disorders in Young People

The recent Globe and Mail piece on mental health concerns pertaining to children and youth strikes many correct notes, but unfortunately also incorrectly hits a few important “major chords”, particularly pertaining to the use of medications to treat mental disorders in young people.

Contrary to much popular opinion, there is a rich and scientifically sound data set pertaining to the effective use of medications to treat specific mental disorders and also specific symptoms that are found in some mental disorders. Indeed, there has arguably been much more rigorous first order clinical trials research conducted in medications use than in any other treatment modality in this population.
For many mental disorders, the use of medications is an essential (albeit not sufficient intervention) that helps control symptoms and promotes recovery. Unfortunately, public understanding of the medication use issue in the treatment of mental disorders in young people falls far short of the scientific evidence that supports this intervention. It is not uncommon to read reports about the increase in medication prescriptions to treat mental disorders over the last few years, and usually this data is negatively portrayed. Frequently the media issue focuses on the presumed “over-use” of medications.
Now, we know that diagnosis and treatment of mental disorders in young people has been a concern for decades. Fundamental to this concern has been the finding that these disorders have been under-recognized and under treated. This sorry state of affairs has been slowly changing. Today more young people are being appropriately diagnosed and treated for their mental disorder. However, now when we find the statistics increasing for both diagnosis and effective treatment, there is criticism that this increase is somehow alarming and to be feared.

Did you know that the use of medications in young people to treat asthma and diabetes has increased more than the use of medications to treat depression over the last few years? Do we read sensationalized reports of “over-medication” for diabetes? No we do not – quite the opposite. Publicly we are concerned about the increasing rates of diabetes and we want to address this problem effectively and comprehensively. So we advocate for better diet, more exercise and earlier diagnosis and treatment with medicines that help control blood sugar.This is different than what happens when we publicly address the issue of treatment for mental illnesses. In their case we seem to criticize the use of treatments known to be effective. This is quite the difference in approach, so we need to begin to wonder why.

I am not saying that medications are always properly prescribed and properly used in the treatment of children and youths living with mental illnesses. That is clearly not the case.And the proper use of these medicines needs to be improved. There is a great need to provide better education to doctors and all other health providers about how to best and most properly use medications to treat mental disorders in young people. We also need more research to help address some of the issues that we have not yet fully understood and we need to develop more sophisticated research studies that compare and contrast the use of medications with other forms of treatment so that we can get the complexity of care needs better understood.

So, I wonder why. Could it be that we as a society still somehow hold the fantasy that mental disorders really do not affect young people and thus they do not need medical treatments?Could it be that we hold invalidated beliefs about what works in the treatment of mental disorders in young people – a sort of herbs and spices model that we abandoned for such childhood diseases as cancer and diabetes long ago? Could it be that we do not really know the correct information about appropriate or inappropriate medication use and instead of trying to find out are just happy being intellectually lazy? Could it be that our understanding of brain function and brain development is so uninformed that we assume that any kind of medication that affects brain function will have more negative than positive effects but that for some unknown reasons other interventions, which also affect brain function, are somehow uniquely spared such concerns? Or could it be that we still hold a very very very strong stigma against children and young people that are mentally ill – and as a result would deny them access to properly researched and properly provided treatments?

These are serious issues. I will address a number of the important issues around medication use in young people in the next few blogs – starting with this: what does it mean for a medication to be used “off label”? Keep your eye on this space! If you want more info check out our evidence-based medicine guide for patients.

~ Dr. Stan Kutcher

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