-Caveat Lector-
http://www.vancouverprovince.com/newsite/news/001218/5033783.html
Babies on mood drugs
Tender age of patients shocks physicians
Ann Rees The Province
Babies still young enough to
be in diapers are being
prescribed powerful adult
tranquilizers.
A Province investigation
found about 20 B.C. infants
aged two and under last
year were prescribed either
a sedative called imipramine
or anti-depressant drugs
such as Prozac, Paxil and
Zoloft, a class of drugs
known as SSRIs
The five youngest were not
even a year old, which
shocked doctors.
"Oh my goodness!" said Dr.
Wendy Roberts,
pediatrician and director of
the Child Development
Centre at Toronto's
Hospital for Sick Children.
Dr. Marshall Korenblum,
chief psychiatrist at the
prestigious Hincks-Dellcrest
Centre for Children in
Toronto said: "I cannot see
any indication for putting a
pre-schooler on
anti-depressants."
The drugs have not been
tested for safety and
effectiveness in such young
children.
Dr. Jane Garland, head of
the mood disorders clinic at B.C. Children's Hospital in Vancouver, said
"systematic studies" have been done only on children six and up.
But despite the lack of research, Garland said the drugs are appropriate
in rare and extreme cases for children under three.
"I have seen kids, for example, with sleep-terror disorders or extreme
sleep disorders and anxiety problems who are younger than three who
occasionally have been put on those medications," she said.
"But that would be a treatment of last resort for under-threes. One
would have wanted to try everything else."
Garland is currently conducting a drug trial, paid for by the
manufacturer of the anti-depressant Zoloft, to study safety and
effectiveness in six- to 18-year-olds.
Meanwhile, there is widespread debate about whether popular
anti-depressants could cause long-term side-effects, especially in young
children.
At the extreme end of the debate is a book called Prozac Backlash, in
which Harvard psychiatrist Dr. Joseph Glenmullen documents serious
long-term effects of popular anti-depressants such as Prozac, Paxil and
Zoloft.
Glenmullen reports several cases of neurological disorders, such as
disfiguring facial and body tics, which he believes are indications of
brain damage.
Other prominent doctors have dismissed Glenmullen's concerns. But when
it comes to children there is no certainty either way.
"I think it's reasonable to be concerned," Julie Magno Zito, a
University of Maryland pharmacy professor, said in a recent magazine
interview. "We have no idea on how these drugs affect the developing
brain, the heart, the kidney, the liver."
What is certain is that the use of psychiatric drugs by young children
is on the increase.
Zito recently published a study in which she found a three-fold increase
in the prescription of psychotropic drugs in U.S. children aged two to
four between 1991 and 1995.
"It's a growth market," said Dr. Larry Diller, an American pediatrician
who is writing a book urging a more sensible approach to using drugs to
treat childhood psychiatric disorders.
Diller, who wrote the best selling book Running on Ritalin, believes
widespread acceptance of drugs to treat Attention Deficit Hyperactivity
Disorder has made doctors and parents less cautious about using other
psychiatric drugs to treat children.
"I think it is just basically the increasing acceptance of using
psychiatric drugs in children."
B.C. appears to be on the cutting edge of the trend.
The 20 babies and tots were among almost 70 pre-schoolers four and
younger who were prescribed sedatives and anti-depressants last year,
according to data obtained through Freedom of Information from B.C.'s
PharmaNet prescription record system.
The youngest anti-depressant patients were two baby girls and three baby
boys, all under a year old. The two girls received Paxil. One baby boy
was prescribed bupropion, a drug sold as Zyban and Wellbutrin, and the
other two received Surmontil and Effexor.
Three babies who turned one last year were also given Prozac, Paxil or
trazodone.
A dozen tots who turned two last year were also given anti-depressants.
Five of the two-year-olds were prescribed imipramine, which the
American Heart Association warns could cause death from cardiac arrest.
Toronto's Roberts said doctors at Sick Children's are very cautious
about using the sedative and never prescribe it for babies.
"Not at that age, never," she said. "There are major cardiac problems
with that."
In the past, the drug was commonly prescribed in school-aged children to
control bed-wetting.
But there is absolutely no excuse for using a drug to control
bed-wetting in a two-year-old, said Toronto psychiatrist Korenblum.
"They may not even be toilet-trained yet," he said.
Neither of the Toronto child specialists could explain why infants would
be prescribed anti-depressants or sedatives.
Roberts said anti-depressants such as Paxil, Prozac and Zoloft are used
to treat children old enough to speak but who have a rare form of mutism
associated with social anxiety.
"The incidence is very small," she said. "I wouldn't think there would
be 10 kids in B.C. with it."
The same anti-depressants are used to treat autism, but usually not
before age four or five.
"Zoloft has been very helpful at night for a percentage of (autistic)
kids because it has a sedating effect," Roberts said.
"For some of our kids it is a lifesaver because they sleep two hours a
night and the parents are just completely wiped out. It also helps the
excessive anxious behaviour."
Dr. Pratibha Reebye, infant psychiatrist at B.C.'s Children's Hospital,
does not prescribe anti-depressants to kids under three.
"But occasionally you may have a child who is three and a half years or
four years old who is clinically so depressed and having phobic
reactions, not sleeping, not settling down and you may want to try some
anti-depressants. But that would be a very rare."
Dr. Derryck Smith, chief psychiatrist at Children's Hospital does not
know why a baby would be prescribed an anti-depressant.
"There is no reason I could think of personally, but that is not to say
there isn't one," said Smith.
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