Children under the age of 18 and Prozac

Specialties Psychiatric

Published

I have read various literature regarding children under the age of 18 being prescribed anti depressants. Some of the literature suggests that there may be a higher suicide ideation in these kids. I am just looking for some input here.. any thoughts???

Thanks

I wasn't talking about having to be in a mental hospital, he felt that if they were in a regular hospital, it would be acceptable b/c they would be monitored by hospital staff.

Hmm...I'll cut some slack here because you are a student and probably didn't realize how that sounded.

"Mental Hospitals" (Behavioral Health Units/Psychiatric Units) ARE part of many "regular hospitals". And again, people need to QUALIFY to be admitted. Again, the only way right now someone can be admitted for DEPRESSION is if they are suicidal or have attempted suicide. Under the current system, they can not be admitted for the sole purpose of monitoring newly prescribed psychotropic medications unless there are serious comorbid factors. If they qualify to be admitted they ALSO need to have appropriate units to be admitted to. Someone that is being monitored for psychotropic med side effects better darn sure NOT be put on a med surg floor...their hospital stay would not be covered by insurance/medicare, etc.

They would need to be admitted to a specialty floor a/k/a Behavioral Health, for appropriate, specialized monitoring. However, before that could even happen, your professor would have to have a one man/woman lobby against the insurance companies to get them to change their rules so they would ever even consider covering someone that was admitted due to newly prescribed psychotropic meds with no other symptoms/problems.

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There are just too many deaths, or even worse, people killing other people after there is a history of recent medicine changes or a new prescription....I look closely at these stories...very rarely is a psychiatrist or a psychologist involved at all.

And the reason why oftentimes a psychiatrist or psychologist is not involved is that people have to wait 3-6 months to get in to see them. Rather than wait, I do support PCP's in prescribing antidepressants.

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Specializes in Looking for a career in NICU.

I fully understand the difference, but that still isn't what I am saying. I am not saying that you have to be ADMITTED to receive the meds...my professor said that if they were admitted FOR SOMETHING ELSE would be the only time a medical doctor should prescribe psychological drugs.

I'm well aware of what the legal criteria is..."A danger to yourself and others". There is a famous case of a man in New York City (this has been cited in many textbooks) who has a Masters degree and is living like a homeless person and thinks he is Santa Claus. His family tried unsuccessfully to have him involuntarily admitted to a mental healthcare facility through the court system and was not able to do so...because just because he thinks he is Santa Claus and just because he is living as a homeless person, doesn't make him "a danger to himself or others", so the case failed the legal criteria and the guy is still there. His "hang out" is Central Park...and I have actually seen the man myself.

Maybe I can give an example to clarify myself better: For example, sometimes when patients are in a regular hospital, let's say it's a cancer ward and someone has recently been diagnosed with a serious form of cancer. Of course, someone can be in the hospital for a considerable period of time from cancer, and become of a grim diagnosis, they can also become very depressed, which as you know, depression can have physiological implications and people can "lose their will to live" and this can have significant impact on care. IF THE MEDICAL DOCTOR choose to give anti-depressants to a patient such as that, in order to help their overall course of treatment, then yes, this would be entirely appropriate. Even though this may not be clinical depression per se, the patient may need "help" in feeling a little bit better to ease the edge of feelings of hopelessness.

Obviously, you cannot check every teenager who sits all day listening to Marilyn Manson and insists that the windows need to be painted black to keep the light out and has shut out all of their friends, into the hospital. However, too many doctors are prescribing anti-depressants to these kids, and they have NEVER been evaluated by a MENTAL health-care professional. The doctor may recommend counseling, but it needs to be beyond a recommendation, it needs to be required by law until it can be established that the patient has clinical depression which, if therapy fails to correct it, then a chemical imbalance can be assumed, and then medication would be the most appropriate course of treatment...like any other disease that requires medication. Depression is a disease of the brain and it's symptom is found in behavior.

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Specializes in Looking for a career in NICU.
And the reason why oftentimes a psychiatrist or psychologist is not involved is that people have to wait 3-6 months to get in to see them. Rather than wait, I do support PCP's in prescribing antidepressants.

I don't believe that is true in all geographical areas, and if someone feels that it is an emergency, they will work you in. Just like I have to wait 6 months to see by OB-GYN, but if I have a problem, they work me in..

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Specializes in Med-Surg, Wound Care.
Your child was prescribed Paxil, which is not labeled by the FDA for child/adolescent use. That is a huge red flag. Seems to me, at least with THIS specific drug, your doc could be held wholly responsible for prescribing an offlabel use which was detrimental to your child. I have NEVER seen an adolescent prescribed Paxil on my unit. Ever.

All of the antidepressants(except Prozac) are off label and they are prescribed by the thousands to children. This huge red flag did go off, and was explained to me as most drugs are off label for children, which they are. The two adolescent psychiatrists that my son saw BOTH had samples in their offices. Paxil is prescribed frequently for children. Good for your unit, but I'm sure that they are prescribing the other ssri/snri's which are also off label.

Bottom line is that anyone prescribed an antidepressant should be fully informed of the risks and adverse reactions to watch for. This is mandated in the FDA medication guide which is not being distributed. This is all I'm asking for.. fully informed parents who know what to watch for in their child. And if that behavior change occurs, a drug reaction should be the first thing looked at.. not adding another drug to cover the reaction.

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Specializes in Looking for a career in NICU.
All of the antidepressants(except Prozac) are off label and they are prescribed by the thousands to children. This huge red flag did go off, and was explained to me as most drugs are off label for children, which they are. The two adolescent psychiatrists that my son saw BOTH had samples in their offices. Paxil is prescribed frequently for children. Good for your unit, but I'm sure that they are prescribing the other ssri/snri's which are also off label.

Bottom line is that anyone prescribed an antidepressant should be fully informed of the risks and adverse reactions to watch for. This is mandated in the FDA medication guide which is not being distributed. This is all I'm asking for.. fully informed parents who know what to watch for in their child. And if that behavior change occurs, a drug reaction should be the first thing looked at.. not adding another drug to cover the reaction.

I couldn't agree with you more. I am so incredibly passionate about doctors "sticking with their specialty". Psychiatry is a specialty, it's a medical doctor who has received extensive training in mental health.

For a General Practitioner to "play psychiatrist", is like having someone rush into the ER needing emergency heart surgery and the only surgeon that is there is a neurosurgeon and asking him to do the job instead...after all, they are both surgeon's, right?

I've just seen too many cases make the news about kids that kill themselves and others due to new medications for "depression" or their general physician who has recently changed the drug. In very few of these cases are these kids in therapy. I personally feel the GP should be held fully accountable if he chooses to prescribe drugs outside of his specialty.

The study of Psychology is barely 100 years old, In the 1920's they still thought people that suffered from migraines needed to have the "demons let out" of their brain and those that suffered from convulsions needed an exorcism. That's not that long ago.

We still don't know what causes depression, there are theories, but they still don't know. That is why it needs to be left to the experts, and a GP ain't it.

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All of the antidepressants(except Prozac) are off label and they are prescribed by the thousands to children. This huge red flag did go off, and was explained to me as most drugs are off label for children, which they are. The two adolescent psychiatrists that my son saw BOTH had samples in their offices. Paxil is prescribed frequently for children. Good for your unit, but I'm sure that they are prescribing the other ssri/snri's which are also off label.

Bottom line is that anyone prescribed an antidepressant should be fully informed of the risks and adverse reactions to watch for. This is mandated in the FDA medication guide which is not being distributed. This is all I'm asking for.. fully informed parents who know what to watch for in their child. And if that behavior change occurs, a drug reaction should be the first thing looked at.. not adding another drug to cover the reaction.

Actually we are agreeing on most points here.

However, and it needs to be stated again, IF a provider is using offlabel meds to treat a condition for which it has not received FDA testing and approval, that provider is putting their license on the line, and they should have their paid up. It's truly that simple.

And regarding your reference to other ssri's/snri's....no, the psychiatrists I work with absolutely do not prescribe anything to children that is not specifically FDA cleared for them. Since I sign off the orders, I know.

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...too many doctors are prescribing anti-depressants to these kids, and they have NEVER been evaluated by a MENTAL health-care professional. The doctor may recommend counseling, but it needs to be beyond a recommendation, it needs to be required by law until it can be established that the patient has clinical depression which, if therapy fails to correct it, then a chemical imbalance can be assumed, and then medication would be the most appropriate course of treatment...like any other disease that requires medication. Depression is a disease of the brain and it's symptom is found in behavior.

What needs to be required by law and what is required by law are two entirely different things.

In a perfect world, there would be enough psychiatrists/psychologists to go around, managed care and insurance coverage would not be an issue and office hours would be available in the evening. But unfortunately it is just not reality. What do you do about kids of the 'working poor' in the US that make too much to qualify for state aid, but can't afford or are not offered private insurance? There are tons of them out there. And forget about getting a referral to a specialist unless you are at death's door, the system just doesn't work the way it should.

I would rather see a someone attempt to be helped through a PCP than to suffer in silence. Because I work with people that are suffering emotionally daily, I have developed this viewpoint. I think that until you're in the trenches, you cannot possibly fathom the pain these people endure.

Don't misunderstand. I think it's great to be idealistic, we were all students once upon a time. As I stated before, I'd like to see people able to consult with a psychiatrist, psychologist and have multiple types of therapy. Sadly, most are not able to follow through with this for the reasons stated above.

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Specializes in Med-Surg, Wound Care.

And regarding your reference to other ssri's/snri's....no, the psychiatrists I work with absolutely do not prescribe anything to children that is not specifically FDA cleared for them. Since I sign off the orders, I know.

Then they should be commended! Just curious.. do you know about the medication guide that the FDA put out on all ssri/snri's??

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I had not heard specifically about the medication guide that you speak of. However, I found it here:

http://www.fda.gov/cder/drug/antidepressants/MG_template.pdf

In reviewing this guide, we give the same information, just in a different format. Hope that answers your question.

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Specializes in Med-Surg, Wound Care.

Thanks! This document is "supposed " to go out with each prescription written.. in most cases the parents have never seen it.

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Specializes in Looking for a career in NICU.

The United Way offers counseling for free.

I am just wondering how many children have to kill themselves or kill family members before someone in the FDA wakes up and figures out that therapy is very necessary, and that medical doctors are really not the best folks to be writing these prescriptions without anyone else "checking in" to see how they are really doing.

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