In the intervening years since that testimony, SSRIs and other behavioral medications have been widely adopted for use in children, treating the same behavioral issues that adults present, including depression, anxiety disorders, obsessive-compulsive behaviors and panic. With a decade in the rearview since that testimony, DOTmed asked Fassler to comment on the trend of prescribing psychiatric meds in children. "Teachers, pediatricians and parents are all getting better at recognizing the early signs and symptoms of mental illness in children and adolescents," he said. "As a result, we're definitely seeing an increase in the overall rate of diagnosis of child and adolescent psychiatric disorders. More and more young people are also being referred for treatment. We've also seen a significant increase in the use of psychiatric medications in pediatric populations.

"It's true that most of our studies concerning these medications are relatively short term, typically lasting several weeks to months. Very few studies have evaluated the safety or effectiveness of these medications when used to treat children and adolescents over a more extended period of time, which is often the norm in actual clinical practice."
B is for bipolar
According to Charles Barber, author of Comfortably Numb: How Psychiatry is Medicating a Nation, that dearth of research puts too many children at risk. "Medications to address ADHD can be remarkably effective for the children who really need them, but the drugs are highly overused. They are often used as the first-line of treatment without the appropriate probing of more "low tech," social factors that might be contributing to the problematic behavior, such as diet, parenting styles, and lack of consequences for inappropriate behavior," he says. "The last ten years have seen a startling rise in the use of mood stabilizers and antipsychotic drugs for children. This represents a sea change in the use of these medications, which used to be reserved almost entirely for adults. Indeed historically, such illnesses as bipolar disorder were thought not to apply to children at all."

As yet, there's no clear reason why more children are being diagnosed and treated for bipolar disorder. While there have been some studies suggesting a link between ADHD and the development of bipolar disorder, "It's very difficult to figure out what kind of disorder a child is going to eventually develop," Vitiello notes. "Oftentimes kids are just very impulsive and hyperactive and they present with a picture that can fall into the broad category of attention deficit disorder, but then what is the underlying problem? Is it mood disorder? It's true, they are hyperactive, they cannot pay attention, but the problem is the mood dysregulation. They have a problem in maintaining stability of mood that allows them to focus and to pay attention. And so more than just attention deficit disorder, it's really mood disorder that in some cases can develop then toward bipolar disorder. But of course, not for all of them."

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