Growing Up on a Ritalin-Prozac Cocktail

Growing Up on a Ritalin-Prozac Cocktail
Posted by FoM on April 18, 2000 at 15:22:29 PT
Is This What Ricky Needs? By Howard Markel, M.D.
Source: New York Times
Ricky is one of the most appealing teenagers in my practice. Bright, funny and a genuinely cool kid, Ricky suffers from the worst case of attention deficit disorder with hyperactivity that I have seen in 14 years as a pediatrician. He is also prone to serious bouts of depression, poor self-esteem, forays into alcohol and marijuana abuse, and, at unpredictable junctures, violent outbursts. 
A broken hand from punching out a brick wall, physical attacks on family members, frequent run-ins with the police, and even suicide attempts have all brought Ricky into my clinic for medical care and counseling. Yet in the six years that I have been Ricky's pediatrician, I have never seen him when he was not medicated with a staggering combination of Ritalin, Prozac and, at different times, far stronger psychotropic drugs under the supervision of a child psychiatrist. In Ricky's case, the medications for attention deficit disorder and depression have, at best, only partly ameliorated his problems. But at this point, it is impossible to be certain of the exact effects of this combination of drugs on his behavior. Ritalin, an amphetamine, has a paradoxical effect on children with the disorder. Instead of speeding these children up, it enables them to focus on learning tasks and even calms their hyperactivity. But the drug is not uniformly predictable and may cause several unwanted results ranging from insomnia and appetite suppression to behavioral outbursts. Prozac is thought to help alleviate depression by allowing serotonin, a neurochemical that modulates mood, to be absorbed from the synaptic spaces of neurons more slowly. But this drug, too, can have multiple untoward effects including insomnia, jumpiness, fatigue and irritability. When taken together, Ritalin and Prozac are usually well tolerated. But for some children, the combination creates mixed results. Ricky came to my practice as a 9-year-old with a history of taking these medications since before he began kindergarten, just like the children profiled in the highly publicized report in The Journal of the American Medical Association on the increasing rates of prescribing psychotropic drugs to American preschoolers. Even as a toddler, Ricky showed signs of excessive impulsivity. The long medical chart that followed Ricky to my clinic revealed that his parents had been concerned enough about his behavior to begin searching for professional help by the end of his third year. As a 4-year-old, and several times since, Ricky underwent a battery of neuropsychological tests that strongly suggested attention deficit disorder with hyperactivity and depression. And while such tests are hardly as exact a yardstick as those that measure blood sugar, they were done by highly regarded child psychologists and psychiatrists with whom I work on many difficult cases. The overwhelming consensus of medical and parental opinion has been to put Ricky on Ritalin and Prozac. The goal, of course, is to control or change behaviors that seriously interfere with the normal progression of childhood. Sometimes it is overworked pediatricians handing out drugs to get frenetic children out the door. In other cases, it is harried teachers demanding that difficult students be medicated into submission. But plenty of parents, like Ricky's, ask for powerful psychotropic drugs by brand name in hope of curing their children's poor school performance or behavior. What is so frustrating for all concerned is the wide gulf of uncertainty among doctors, regardless of their specialties, mental health professionals and parents over when to use psychotropic drugs and, just as important, when to stop using them. Psychotropic drugs can work wonders for a wide range of serious behavioral or psychological problems. Every children's health professional, myself included, is familiar with cases of children who were able to experience a more normal childhood and adolescence because they took these medications. Sadly, however, there are many other children for whom these drugs are bandages that only mask gaping psychic wounds, serious and poorly understood disorders of neurochemistry, and even counterproductive parenting techniques that give rise to complex and destructive behaviors. About the Author: Dr. Howard Markel is a fellow at the Center for Scholars and Writers of the New York Public Library and an associate professor of history and of pediatrics and communicable diseases at the University of Michigan. Like the proverbial snowball rolling down a hill, these problems can be compounded with each turn and revolution, and discovering what is at the center eludes even the most perceptive physician or caring parent. I see Ricky at least every month, and during times of crisis as much as daily. Working with this family for so long, I know he has good, attentive parents. I do not always agree with their decisions and they do not always agree with my medical opinions. For example, I have repeatedly pleaded with them at least to try to wean him off some of his medications. Each time I make the suggestion, Ricky's parents vociferously object, terrified at the mere mention of a son not buffered by psychotropic medications. "You just do not know what Ricky was like before we put him on these medicines," his mother says. I usually rejoin that Ricky is not doing so well while on them. I must confess, however, that it is far easier for me in the confines of the clinic to suggest withdrawing the medications than for his parents to act on that suggestion. I do not know what it is like to have a violent 5-foot-10 teenager in the house. Chronic disease is disruptive for all members of a family it touches, but a chronic disease that manifests itself with hitting others, or worse, is downright dangerous. I continue to work with Ricky and his family and have incorporated other approaches, including special school and counseling programs, into his treatment plan. I also like to think that the hours we have spent together rehearsing how he will react to challenging situations have helped matters, but I have no proof that any of these methods are really working. Ricky's parents and his psychiatrist, far more impressed than I by pharmacologic approaches, continue to hope that some new medication will soon be developed that better controls his attention deficit hyperactivity disorder depression and violent outbursts. Ricky's story reflects just a few of the many problems that result from prescribing these powerful medications to young children and their continued use well into early adulthood. It is a story replete with complicated diagnoses and, so far, without conclusion. We do not know if these psychotropic medications are helping or harming Ricky. We have long lost touch with the original psychopathology that brought about these interventions. And, frighteningly, we simply do not know if he will outgrow his more destructive impulses before any permanent harm results. In his more receptive moments, when Ricky and I are alone in the examination room simply talking to each another, I counsel him not merely to count to 10 before expressing anger or acting out but instead, to try counting to 1,000. Ricky always smiles at this advice, promises to try harder and bids me goodbye. But within a week, maybe two or three, I know I will receive a frantic call from Ricky's parents reporting his latest misadventure. Published: April 18, 2000Copyright 2000 The New York Times Company Introduction: Addiction as a Disease the Line to Addiction: How and When Does It Happen? Articles On Ritalin & Prozac:
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Comment #5 posted by freedom fighter on April 19, 2000 at 13:17:55 PT
my son and the ritalin
I only can remember what my son had to do in order to go to school.You see, I am a divorced father who had no say in it. Teachers   his school told the my ex-wife that if he does not take ritalin he cannot go to school. He finally told his mom that he did not want to do ritalin anymore, "It was just a hype." What kind of country we are living in?One day I asked my son about the DARE class wither if it is effective, he said that the kids that were in DARE class were on prozac,ritalin and also took LSD.. My son is doing okay now, he does not do ritalin. But he does do cannabis so I worry about him and his future. Peace
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Comment #4 posted by CongressmanSuet on April 19, 2000 at 10:14:25 PT:
FoM, my heart goes out for you...
and I now have a good understanding of how personal this WoDs is to you. You fight the good fight, and believe me, it is appreciated. Im not the only one who looks at the number of hits you get here per day, and I say, when someone can take personal tragedy and use it succesfully as an outlet that helps educate and advance the cause of reason, well, my hats off to you. Thanks FoM. And DDD, my dad was a MD, and in my rebellious youth, I was put on antidepressants, lithium, even phenothiazines at various times, all in the hope I would become less rebelious and less argumentative. The reasoning was any kid that was not blindly accepting of the current "dogma" was depressed, and needed medication. See, we didnt have ADD to be labeled with. So, this isnt a new problem, its just become more mainstream, as more and more parents become truant in their responsibilities to their kids. Remember, we live in a chemical society that treats EVERYTHING with a pharmaceutical. This is just a natural extension of that society. Hell, I had a veteranarian suggest my anxious Border Collie needed antidepressant therapy! Yet, have a nazi-narcowarrier drug dog smell a pinch of the most beneficial substance known to mankind in your vicinity and see what happens. This is such insanity.
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Comment #3 posted by dddd on April 19, 2000 at 08:35:54 PT
FoM,I appreciate the appreciation,and I hope you know I sincerely appreciate what you have done to allow these commentaries. I wanted to make one more point,and that is;When we were children,in the 40's,50's,or 60's,we all went through the tantrums and strange events as part of growing up.The same problems of raising children,and such,have been happening since time began. I must admit,that todays' world is a more strange and intense to grow up in,basically,growing up is the same.From infancy to adulthood,the process of growing up has always been fraught with eminent peril,and complications,but now there is an industry developed that recommends drugging kids to alleviate their perceived "problems",and to minimalize their annoyance of the usually well intentioned parents. It is really sickening,that at the same time we have all the "dont do drugs" rhetoric,saturating our children,these kids are simultaneously being medicated with massive quanities of pharmaceutical garbage that no one knows what the future effects will be. The normal experience of growing up is supposed to be strange and full of weird problems.But the snake oil drug companies have now made it seem like the best thing you can do for your child,is load them with these ghastly psycoactive drugs if they become cranky,or seem rebelious. I dont think the parents are the evil ones in this bizarre tragedy.I think it's the (legal,"good")drug industry that's to blame. And like I said before,this is one of the most infuriating hypocracies of this fake "War on Drugs",is the supposed concern for the "children",yet there is relatively little concern about the strange mood altering drug cocktails kids are given by "doctors". I'm glad I wasnt born recently,because my Mom would probably have been sucked into thinking these strange drugs were the right thing to do,and I would not be writing this now,because my intellect would have been altered and/or compromised by my mothers innocent and well intentioned medications,when some doctor told her I had some sort of three letter syndrome..."oh,we think he has DDH,or SAD,,or GHD. Quite frankly,I'm glad the first three letter drug I had was LSD!  love  dddd
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Comment #2 posted by FoM on April 19, 2000 at 05:19:22 PT
Thanks dddd
Hi dddd,I too am upset by this article. We are setting young children up for a life of drug abuse by using these powerful mind altering drugs on them. Young people need outlets to blow off steam. Keep a child busy in sports or an activity that they enjoy and drugs won't be necessary. It is easier to pop a pill then to dedicate your life to keeping your child drug free. My son only experimented with drugs when he made it to college and he really didn't like doing drugs but the sad thing is contracted HIV during his one year experiment with cocaine and he did things he was sorry he did under the infuence but it was too late.Thanks dddd for being apart of CannabisNews and all the others too I just wanted to say that to you right now!Peace, FoM!
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Comment #1 posted by dddd on April 18, 2000 at 21:13:06 PT
 Yet again,we have another excellent article which offers lush and fertile grounds for comment. Of all the blatant and obvious hypocracies of the War on (some)Drugs,this is one of my favorites. The masked ugly prominence of "legal" drugs is,to put it mildly,OUTLANDISH and PREPOSTUROUS!!!In the gruesome and disgusting world of "drugs",we have allowed the "children" to be both the excuse for ghastly intrusions on our rights,yet,it turns out that they are being exploited as the lucrative test monkeys for the megabucks pharmaceutical shiesters. I,for one,am outraged.When you hear people saying crap like,"we need to have marijuana go through the same trials that all drugs must go through to be considered for ,,etc.",,and we have children stoned out of their minds before they even have the intellect to know what they are being fed,really blasts my old ass out of the water! There is no "good part" in all of this,but if there was,it would be how obviously this exposes the sham that is"good/legal drug,,bad/illegal drug"dichotomy....dddd 
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