Sunday, September 26, 2010

The Drug Bandwagon

Introduction
Ok, this is probably going to be a controversial post so I'll get a few things out of the way before I begin.
  1. Just a reminder that I am not a doctor - no medical advice from me should ever be taken seriously - go see a professional before you take any medication.

  2. My stance on medication: I'm not anti-medication but I am anti-harm. It's my belief that the only reason a child should be on medication is if it is doing them more good than harm.
As I write this, my youngest child has just been diagnosed with ... well, nothing in particular. Our pediatric psychologist surprised us by simply saying that since it was obvious that he had emotional issues, he should go on Risperdal.

I'll admit to being quite stunned.

I had expected a recommendation of behavioural therapy of some kind - not a drug-based "quick fix". I'd heard some horror stories about the drug but then, being a balanced person, I knew that every drug, particularly those used in children, have horror stories about them.

Testing
Most drugs tend to have effects with longer term use rather than short term. This usually means that provided that you don't get any initial bad effects, it's reasonably safe to use it for a short test period.

I've said before that it's a good idea to preface any test on your children with a test on yourself. It won't prove anything in particular but your genetic material is always going to be a closer match for your child than any test subject. It will also help you to know how the drug tastes, what it feels like and how quickly it reacts.

When looking at the effects of behavioral drugs in your children, there are a few important questions you need to ask (beyond the obvious questions about side-effects).

You need to find out;
  1. How long the drug will take to get into your child's system?
  2. How long it will stay there?
  3. How long before the drug is having an influence on your child?
  4. What symptoms to look for when it is present
  5. What symptoms to look for when it is wearing off
  6. Does the drug need to build up over time? (and if so, what happens if you don't give it on weekends?)
You need to set a definite test period which includes trigger points. After all, how can you measure behavioral change if you're tip-toeing around your child all day long? You also need to set a definite end-date. Don't test medications for months, one or two weeks is perfectly sufficient for most. In the case of some, like Ritalin, you should expect to see results in a couple of days.

In our case, the doctor recommended that we try Risperdal first at .25mg, then at .5 and finally, if there was still no effect, at 1mg. We're currently testing at 1mg having had our son on each dosage for two days. We have seen absolutely no change - and for that, I'm grateful.

You see, Risperdal has some terrible and well-documented side effects. It was only approved for use against irritability in children with autism in 2006. That's a tad recent for me.

If the Risperdal had been effective, then I'd have had to weigh up the pros and cons of using it in the long term. In this case, it would have been a very, very difficult decision.

9 comments:

NiroZ said...

I'm not sure I agree with many of your points, but you have good reason to be suspicious. Various studies have found very weak, if any, improvement from giving anti-psychotics to children, and yes, in children especially the side effects are quite harsh.

Although I must point out that usually you need to take these drugs for a period of time (1 week for Risperdal I believe) before you see the real effect.

Foursons said...

I haven't given my son any drugs for behavioral problems other than homeopathic ones. I want to use those as long as they are working before we dive into prescriptions.

StatMama said...

I am anti-drug, and not afraid to say it. The main reasons are that (1) the pharmaceutical indistry puts profit before people and (2) too many doctors are looking for a quick fix instead of a real one. The first question anyone should ask is, "Can this be accomplished without medication?" If not, then it should be given careful consideration.

Stacey,momof 2 said...

My son was on risperdol from the winter of his kindergarten year to the end of the school year last year. He is currently in 2nd grade and doing very well.. We had put him on the risperdol to help him take the edge and the volience off of his meltdowns-- I don't know that the drug helped-- but I know that his meltdowns didn't seem to last as long and they weren't as explosive. For us it was a good choice, but I am also glad to see that Shane can manage without the meds... he is doing fine now-- and that could be him growing up-- or maybe the medication did help change his behaviors! I think that,sometimes-- meds can make a positive change.

Rachel Cohen-Rottenberg said...

Another question to ask when considering medication is "Will this drug cause dependency and be difficult to withdraw from?" Some drugs you cannot stop taking cold turkey without running the risk of significant harm. And sometimes the tapering off process is very rocky.

And don't just read the warning labels that the pharmaceutical companies put on the drugs. Do your own homework and find out how the drug has affected other people. In other words: be suspicious. I'm not against people taking medication or giving it to their children. I've just learned through hard experience to ask lots of questions and do lots of research before going down that road.

A very good book to read about the overuse of drugs in both children and adults is "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America." Although the research covers only the US, I think that the book is a good cautionary tale for people outside the US as well.

On another note: Gavin, I enjoy your blog so much that I just gave you an award! Come over to my blog for details.

Caitlin Wray said...

I believe there are appropriate times to give meds to kids, but I have very little confidence that we are getting it right the majority of the time.

I think doctors are prescribing heavy duty anti-psychotics to young children at an alarming rate, and as a first-option, rather than a last one.

I know there are parents who have chosen to use them, and I do not judge their choices, but rather wish that doctors would be more educated in proposing alternatives and being more cautious with these serious pharmaceuticals where kids are concerned.

The problem I have with Respiridol, is that it's an anti-phychotic, and it's being prescribed to small children who have not been diagnosed with a psychosis. We would never consider giving a diabetes medication to a child who doesn't have diabetes, so why are doctors so freely prescribing anti-psychotics?

I just think it's time to take stock of how we are mass-medicating the children of America overall.

Caitlin
www.welcome-to-normal.com

Gavin Bollard said...

Well, we concluded our tests and today my youngest is off the Risperdol - and has been behaving very well so far.

I think that we can conclude that Risperdol at various dosage levels had no "positive" effect.

I don't doubt that it could have a positive effect on the right child and at the right dosage but at this stage, my child isn't "the right child".

We had a great fit with my other son and Ritalin/Concerta and that was helped by our unbiased view towards the use of medications.

I had two reasons for posting this story;

1. Because I was surprised that drugs were recommended before any other form of treatment was considered.

2. Because I thought it might help other parents to get some rules around testing medications.

Had Risperdol proven effective, it wouldn't have been the end of the story. We would have had to investigate the serious side-effects and decide upon a course of action.

I'm glad it didn't come to that.

(oh and BTW Rachel, thanks for the comment - we do need to research the effects of coming off drugs thoroughly before longer term use).

Lori said...

Our 6 year old son was formerly diagnosed with Aspergers this past month, although we have known for quite sometime that he was on the spectrum (mommy and daddy intuition). We first realized that something was a little different about him around the age of 3.....fast forward to last December when we were several months into Kindergarten. His anger was so explosive...he was so aggressive toward me....he was so destructive....he threatened to kill me everyday.

We struggled through long meltdowns and finally in the beginning of September we were able to get into a psychiatrist and she gave us Risperadol. Our lives have been forever changed. He is just like a different little boy. He still struggles and has much smaller melt downs but he is so much better. After reading this article, I must admit I became very afraid of this medicine that has helped up so much. Thank you for making me want to keep a closer eye everything about it.

Aram Simsar said...

I am not a fan of medicating children but I am a ISS school suspension modern and have seen that some medications are effective.

On the subject of risperdal I am shocked that they upped the dossage by .25 mg every two days. Honestly, you should see a new mental health professional. I am on the spectrum (diagnosed at 25) and am prescribed risperdal. It took 8 days for my initial .25 mg dosage to take an effect but when it did it was the equivalent of taking a straight jacket off that I had been wearing for 25 years. The positive effects have been enormous.

All in all I am not sure if I would want my child on Risperdal unless they had considerable emotional problems. The side effects on you boys are pretty scary. How ever abillify or parafidal might be worth looking into.