Why screening teens for mental illness is a bad idea

by John Horgan

Mental illness can afflict children, just as cancer and other diseases do. Many young people quietly struggle with depression and other disorders, which may provoke them to commit suicide, the third most common cause of death among teenagers. So from one perspective, programs like TeenScreen – which was designed by a group at Columbia University and is now employed by schools and community centers in 43 states – make perfect sense. Students fill out a free, computerized form that asks, among other questions: In the past three months, has there been a time when nothing was fun for you and you just weren\’t interested in anything? When you had problems with your schoolwork or grades because you felt sad or depressed? And so on. Kids deemed at risk of a mental disorder are referred to a mental-health provider.

I fear that, given the recent trend toward prescribing powerful, profitable and potentially harmful psychiatric medications to children in the U.S., TeenScreen and similar programs may end up hurting more children than they help. Here\’s some background information, most of which comes from Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in American (Crown 2010), a book by the journalist Robert Whitaker.

*Several decades ago, children were rarely diagnosed with mental illness. Today, leading psychiatrists estimate that more than 10 percent of all children suffer from mental illnesses—from relatively mild ones, like attention-deficit disorder, to severe depression and full blown psychosis. The number of children so mentally disabled that their families are eligible for government assistance has swelled from 16,200 in 1987 to 561,569 in 2007, a 35-fold increase.

*3.5 million American children are now taking Ritalin and similar medications for attention-deficit hyperactivity disorder (ADHD), up from only 150,000 or so in the late 1970s. That comes to about one out of every 23 children from four to 17 years old. American children consume three times as many ADHD medications as the rest of the world\’s children combined. One study cited by Whitaker, which was funded by the National Institute of Mental Health, concluded that drug treatment of ADHD \”was a significant marker not of beneficial outcome, but of deterioration.\”

*Since the popular selective serotonin reuptake inhibitor (SSRI) Prozac was introduced in the late 1980s, the number of children treated with SSRIs and other antidepressants has soared. One 2002 study estimate that one in 40 children 18 years old or younger takes antidepressants. Whitaker cites numerous studies showing that antidepressants, while they can provide short-term relief for some children, over the long run are at best ineffective and at worst harmful. Children treated with antidepressants experience side effects ranging from anxiety and insomnia to full-blown mania and psychosis.

*The most startling trend in pediatric psychiatry is the surge in diagnoses of bipolar disorder, which just a few decades ago was viewed as almost exclusively an adult ailment. Since 1995, the number of children diagnosed with bipolar disorder has multiplied more than 40-fold and to roughly 800,000. Whitaker presents persuasive evidence that this epidemic may be driven, at least in part, by increased prescriptions for stimulants for ADHD and antidepressants. Stimulants and antidepressants can trigger bouts of mania followed by sluggishness in children, who are then re-diagnosed with bipolar disorder.

*Children diagnosed as bipolar are treated with drugs–notably antipsychotics normally prescribed for adult schizophrenics—that have severe physiological as well as mental side effects, including apathy, obesity, diabetes and involuntary tremors. More than half a million children—including infants less than two years old!–are now ingesting antipsychotics. This trend has been aggressively promoted by manufacturers of antipsychotics, which have become the most lucrative class of drugs in the world.

TeenScreen, you will surely not be surprised to learn, has ties to the pharmaceutical industry. The program was designed by David Shaffer, a professor of child psychiatry at Columbia, who according to one watchdog group has served as a paid consultant for GlaxoSmithKline and other manufacturers of psychiatric drugs. Mental illness is devastating, for children as well as adults, and drugs, when used wisely and sparingly, can help. But clearly our current approach to treating disturbed young people is broken.

John Horgan directs the Stevens Center for Science Writings, which is part of the College of Arts & Letters. This column is adapted from one published in Scientific American online.