Transcript To Medicate or Not to Medicate?

To Medicate or Not to
Medicate?
The Ethics of Recommending
Medication for Minors
By:
Jennifer Bucceri
Rosmond Ginieczki
Tiffany LaBarbera
Marie Le
& Adria Stern
Fact or Fiction?
1.
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Prescribing medication for an off-label use is no
big deal?
FALSE
By providing medication for off-label uses, the
healthcare professionals concerned are
accepting risk and liability.
2. Psychotropic medications are prescribed for
kids as young as two.
• TRUE
Fact or Fiction? Continued
3.
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Schools have a vested interest in having
students diagnosed with ADHD?
TRUE
Black children are more likely than white
children to be diagnosed with ADHD?
FALSE
White non-Hispanic children are more than two
times as likely as Hispanic and black nonHispanic children to be diagnosed with ADHD.
They are up to four times as likely to take
Ritalin.
Why is medication used for ADHD ?
• ADHD is a biochemical problem, related to an
imbalance of the neurotransmitters in the brain.
• For ADHD people the prefrontal cortex is underactive and doesn’t prioritize and select or inhibit
input, resulting in a flood of data bits that keep
the mind and body unfocused.
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Stimulant medications allow the prefrontal
cortex to perform traffic direction more
efficiently.
• Although some stimulants have been used on
children as young as age 2, most are recommended
for age 6 or older.
What are the medications
for treating ADHD?
Stimulants
• Amphetamines (Adderall)
• Methylphenidate (Ritalin,
Concerta, Metadate)
• Dextroamphetamine
(Dexedrine, Dextrostat)
• Pemoline (Cylert - less
commonly prescribed
because can cause liver
damage)
• Non-stimulant- Stratterathe newest treatment. It
is a reuptake inhibitor that
acts on norepinephrine.
Because it is a nonstimulant, it may be less
objectionable to
some
families, but
they
still have
similar side
effects.
Antidepressants and antianxiety medications
• In some cases,
antidepressants or antianxiety medications may
be prescribed either in
addition to or instead of
stimulants.
ADHD Medication Side
Effects
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decreased appetite or weight loss
headaches
upset stomach, nausea or vomiting
insomnia or sleep difficulties
jitteriness, nervousness, or irritability
lethargy, dizziness, or drowsiness
• social withdrawal
What are SSRIs?
• SSRI stands for Selective Serotonin-reuptake
inhibitor
• Drug binds to postsynaptic serotonin receptors
• It blocks the ability of serotonin to activate the
postsynaptic receptors
• The blockage of serotonin receptors sends a
feedback signal to the presynaptic neuron
• The feedback signal increases the level of
serotonin, which is broken down in the synapse
resulting in elevated serotonin levels (Pinel, 2003)
Prozac
• Only Prozac has FDA approval for use
in children and adolescents with
depression
– However other SSRIs are routinely
prescribed to children
– Prozac is the most commonly prescribed
SSRI due in part to its number of side
effects
Common Side Effects of
SSRIs
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Nausea
Sexual problems
Diarrhea
Dizziness
Drowsiness
Gas
• Indigestion
• Insomnia
• Mouth dryness
(Cotton mouth)
• Sweating
Why is the use of medications
for ADHD and depression
controversial?
• Overuse
– Long-range effects on the developing brain are
not known.
– Many children are prescribed drugs by doctors
who do not specialize in behavioral issues and
are not fully trained to diagnose or treat these
disorders (Kuwana, 2000).
– Doctors may not try less invasive treatments,
such as behavioral interventions
• This is complicated by insurance which can limit the
number of doctor visits.
Why is the use of medications
for ADHD and depression
controversial? Continued
• Age of children
– Doctors are diagnosing and prescribing medications for
children as young as age 2, even though the controlled
studies on these medications were not done on preschool children.
• NIMH is planning a $6 million, 5 year study on the
use of Ritalin in children under the age of six. (Kuwana,
2000)
– It is unknown how these drugs affect developing brains
• Additional problems suggested from animal studies
(Kuwana, 2000)
– Understanding of normal child development and family
behavioral management skills might be a more
appropriate intervention for such young children.
Why is the use of medications
for ADHD and depression
controversial? Continued
• Misdiagnosis
– There is no specific test for ADHD or depression.
– Behaviors that are common to ADHD and depression may
be caused by a variety of other sources, such as:
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domestic violence
abuse (sexual, physical or emotional)
neglect
alcoholism in the family
inadequate parenting
ineffective behavior management
poor attachment to a stable caregiver
or a number of other medical conditions.
Pros
• ADHD medication can improve daily functioning
when carefully managed, individually tailored, and
combined with behavioral therapy.
• The increased availability of medications has destigmatized psychiatric disorders and freed
families and communities to seek medication
intervention for troubled kids.
• The variety and increase of medications in the
90s has served the needs of untreated children.
• Antidepressants may lift children out of
emotional danger and self-destruction.
•
The neurological or biochemical roots of
disorders may best be regulated through
medication.
Cons
• For some young people, the risks of suicidal
behaviors caused by antidepressants may be
especially high.
• Ritalin may be prescribed to control behavior that
may not be accurately diagnosed as ADHD.
• There is a lack of research on the use of ADHD
medications and antidepressants on young
children.
• Young children on psychotropic medications may
not know how to accurately report side effects.
• Risk of overuse of medication as a fast fix.
Ethical Issues
Law and Order episode, Mania
A child killed two of his classmates while on the
anti-depression medication Apteral
The Right to Refuse
Except for legally authorized "involuntary"
treatment, patients who are legally competent
to make medical decisions and who are judged
by health care providers to have decisionmaking capacity have the legal and moral right
to refuse any or all treatment. This is true
even if the patient chooses to make a "bad
decision" that may result in serious disability
or even death.
ACA Code of Ethics
• A.2.
Non discrimination:
Counselors do not condone or engage in discrimination based
on age, culture, disability, ethnic group, gender, race,
religion, sexual orientation, marital status, or socioeconomic
status.
APA Ethics Codes
• Unfair Discrimination:
In their work-related activities, psychologists do not
engage in unfair discrimination based on age, gender, gender
identity, race, ethnicity, culture, national origin, religion,
sexual orientation, disability, socioeconomic status, or any
basis proscribed by law.
• Respect for People’s Rights and Dignity:
Psychologists respect the dignity and worth of all
people, and the rights of individuals to privacy,
confidentiality, and self-determination.
School and Ritalin
• Ritalin is a stimulant that is used to treat children
with ADHD in schools
• Over-prescribing by public school administrators
where they are relying on pharmaceuticals for
“difficult children”.
• Parents are being forced against their will.
• Challenge to parents rights to make choices.
-no longer free access to public schools
-CPS involved
• Parents overall concern about medication.
-long-term effects
-personality change
APA’s stance on children
and medication
• Proper diagnosis by an expert.
• Make sure health professionals know the
difference between normal health development
and childhood disorders.
• Psycho-stimulant medication alone is either
inappropriate or inadequate.
• An integrated collaboration of mental health
professionals.
-issues of confidentiality
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References
American Psychological Association. (2004). What Parents Should Know About Treatment of Behavioral and
Emotional Disorders in Preschool Children. Retrieved November 23, 2004 from
http://www.apa.org/pubinfo/kidsmed.html.
Depression in Childhood and Adolescence. (2003). Retrieved November 21, 2004 from
http://my.webmd.com/hw/depression/ty4655.asp
DeNoon, Daniel. (2002). Child Mental-Health Woes Multiply. Retrieved November 29, 2004 from
http://my.webmd.com/content/Article/57/66040.htm?pagenumber=1
Diller, L.H.(2000) Just Say Yes to Ritalin! Parents are being pressured by schools to medicate their kids-or
else. Retrieved November 23, 2004 from http://www.freerepublic.com
Fowler, R.D. (2002) ADD/HD- Are Children Being Overmedicated? Retrieval October 19, 2004 from
http://www.apa.org/ppo/issues/padhdtest902.html
Kottler, J. (2005). Introduction to Therapeutic Counseling- Voices from the Field (5th ed.). Pacific Grove,
CA: Wadsworth Publishing.
Kuwana, E. (2000). Increasing Use of Stimulants and Antidepressants In Children Sounds an Alarm.
Retrieved November 20, 2004 from http://faculty.washington.edu/chudler/ritalin.html
Kuwana, E. (2000). New Guidelines for Diagnosing ADHD. Retrieved November 20, 2004 from
http://faculty.washington.edu/chudler/adhdpro.html
Mahler, J.(2004) The Antidepressant Dilemma. Retrieved November 23, 2004 from http://www.nytimes.com
National Institute of Mental Health. (2004). Treatment of Children with Mental Disorders. A booklet with
answers to frequently asked questions about the treatment of mental disorders in children. Retrieved
November 23, 2004 from http://www.nimh.nih.gov/publicat/childqa.cfm.
Pinel, J.P.J. (2003). Biopsychology (5th ed.). Boston: Pearson Education, Inc.
Turkington, C. & Kaplan,E.F. (2001). Selective Serotonin Reuptake Inhibitors (SSRIs). Retrieved November
23, 2004 from http://my.webmd.com/content/Article/87/99352.htm?pagenumber=1
U.S. Food and Drug Administration. (2004). FDA Proposed Medication Guide: About Using Antidepressants in
Children or Teenagers. Retrieved November 23, 2004 from
http://www.fda.gov/cder/drug/antidepressants/SSRIMedicationGuide.htm.
Zwillich, Todd. (2004). FDA Orders Strict Anti-depressant Warnings. Retrieved November 21, 2004 from
http://my.webmd.com/content/Article/95/103293.htm?pagenumber=1