Off-label prescribing (2 min -- Public Source)

And the problems with this practice are many

1. There is a push to "do something" and for some problems like behavioral problems associated with trauma all there may be to "do something" is give a pill. It's quick, easy to do, there is often a placebo effect, however, pills don't stop trauma!

2. This is how psychiatry for kids became 10 minute med checks with often no counseling.  In our resource poor areas there aren't enough counsellors if there are any available to see kids at all. But even if there were for complexly traumatized kids, they may not be able to talk. I remember after my sister and I were removed, I was taken to a counselor and I couldn't talk. It was thought, I was told that I was being uncooperative but that wasn't true. I could not talk about what had been done to me. Just thinking about it was re-traumatizing.

3. Many therapists, and I believe this is changing, don't know how severely the mind can be hurt in some of these complexly traumatized kids so developing the repore needed can take awhile but just like Paper Tigers showed, the kids will open up once they know they can trust you and you are safe. I did open up. I was scared what I had to tell would frighten others. It frightened me. So it takes a very strong person.

4. Still many psychiatrists at least in my state don't take trauma seriously as a cause. This may be changing but not very well and I'm not at all certain the curriculum at UMich has changed sufficiently to go beyond seeing kids as a label to treat- often with drugs. For payment, the psychiatrist must give a DSM label, but if we are dealing with complexly traumatized children, do these labels help or harm?  Labels lead to cookbook treatments often with psychotropic medications. The best the labels can do now is diagnose with PtSD but I don't see the kind of trauma I experienced at the hands of my parents over all of my developmental years as PTSD. This was developmental trauma and much more severe than PTSD.  It couldn't be treated with a drug. 

5. These pills have very severe side effects that actually can shorten the life span. They can also make kids severely obese which is not good for a bullied kid who already has a fragile sense of self. Kids really aren't given the opportunity to consent to such a "poisoning" of their bodies and there have been few very short trials of these drugs on developing kids. GP's often are handed the task of managing these drugs but worse...it really gives the message to a traumatized kid that there is something wrong with them, that they are flawed and broken. Trauma can break a kid but I think a better message it that just like a bullet causes damage to the body or a car accident does, so does growing up unloved.   The responses-- anger, panic, dissociation are normal processes that occur w/o support from an adult to such horror being done to a child.

6. I have met many adult psychiatrists unwilling to manage kids on these strong meds. Why am I being asked to when there is no evidence of efficacy and I don't believe in them and I have no training in them? I would much rather we use safer means that can help like MBSR, yoga, animal assisted therapy, healthy diet, exercise, nature, enlist kids in sports, band, theater, community service activities where they can develop self esteem and social- emotional skills they were never tought?

7. These drugs are being used to numb emotion... Alcohol/heroin or other narcotics numb feelings better so what are we trying to say ... Subtly? Antipsychotics are an okay way to get numb... They are legal. They are prescription BUT a problem is highly traumatized youth (at least many) seek to be numb... Is a good message to give them "Here's your drug. It will take away your pain?" I don't think so.


ONE OTHER THOUGHT, LETS stop using the terminology "mental health"!!! Let's use brain health! The brain's connectivity and epigenome are changed by trauma. The brain is an organ in the body we all need to function - walk, breath, and talk.  Insurance companies and drug companies want us (Peds) to manage these drugs for psychiatrists but not pay for the visit (1/3 or more of what I see is directly related to trauma) so we're dealing with brain health, like renal or musculoskeletal health. We are not treating mental health--- I agree with Dr. Block 100%!!!

Just a few thoughts..

This video accompanies the story, PA juvenile offenders given psychiatric drugs at high rates. It is the first of three stories that are part of an investigative look at troubled kids and the powerful drugs they're given.