When kids need meds
DRUGS TO combat severe mental illness are among the most powerful in the arsenal of medicine. But they have become controversial in Massachusetts because of the death in December of Rebecca Riley, a 4-year-old who had been diagnosed with bipolar mental illness. She overdosed on Clonidine and two other drugs. Her psychiatrist voluntarily suspended her practice. And Dr. Joseph Biederman, a child psychiatrist at Massachusetts General Hospital who has argued that bipolar disorder can afflict even very young children, has faced mounting criticism.
Despite this backlash, the drugs in question can work well even in young patients. The question is how to use them safely.
It is hardly obvious why a child as young as Rebecca was given so powerful a combination of drugs. Might family dynamics, rather than a chemical imbalance, have caused the behavioral problems that led to her diagnosis?
Yet the drugs can be helpful. A Boston man described to the Globe how his son, 11 years old and prone to uncontrollable violent outbursts at home, was saved from institutionalization by a drug regimen. It was administered by the MGH medical team that pioneered this therapy. The boy has gained some weight and is struggling in school, his father acknowledged, but "he's got a relatively normal life because of those doctors."
The development of powerful drugs has revolutionized the treatment of mental illness. It was inevitable that these treatments would be tried on young people. But children and adults can react differently to the same drugs. And while a few clinical trials have been done with children, researchers have not amassed the amount of data that supports use of the drugs in adults.
Because of Rebecca's death, the state is reviewing the cases of 8,343 children in the Medicaid program who are taking antipsychotic medications. Perhaps other forms of therapy might be more effective than drugs, and without side effects.
In an interview Wednesday, state Mental Health Commissioner Elizabeth Childs said that drugs have their place but can't be administered in a vacuum. Children with mental illnesses need to have their families involved in care; if the family cannot help, they need new support systems to help them cope with the disease. As of May, 125 young people were waiting in hospitals for the right place to go. The state is short of qualified foster families to take them in.
The 11-year-old boy received a spectrum of care before his family and doctors decided strong medication was the only way to control his illness. But these drugs should not be prescribed for children lightly. The Mental Health Department and the psychiatric profession need to keep watch so that these drugs do not become a quick and dangerous fix. 