Dr. Henry Paul, MD

Psychiatrist, Author and Educator

Tag Archives: NYC child psychiatrist

ARE TOO MANY CHILDREN TAKING PSYCHIATRIC MEDICATIONS OFF-LABEL AND WHAT DOES THAT MEAN?

January 9th, 2014

Using drugs “off-label” for treating all kinds of conditions from cancer to ADHD has become so common that almost every drug at some point is prescribed off-label. “Off-label” means the medication is being used in a manner not specified in the FDA’s approved packaging label, or insert. Off-label prescribing isn’t necessarily bad. It can be beneficial.

In child and adolescent psychiatry, the majority of the drug prescribing is done off-label. Few medications are approved for young people, but making these valuable medications unavailable because drug companies have not tested them for all conditions and populations would cause a lot of prolonged suffering and even deaths. This is the case for hundreds of drugs, not just psychotropics. Studies have been coming out showing the helpfulness of psychotropic medication in young people and hopefully science and research will continue to catch up with clinical reality.

All in all, there are about ninety common psychotropic medications in common use today. The highest rate of approved drugs for use in children is in the area of stimulants used for ADHD. In that category, 100 percent of the drugs are approved for young people. In the antidepressant category, there are about thirty compounds altogether, seven of which are approved for use in children. In the antipsychotic category (most of these drugs are used for behavior control), there are fewer than twenty compounds with seven approved for children. There are no officially approved drugs for the treatment of anxiety in children and teens, and for mood stabilization (bipolar children) six medications are approved, mainly for teenagers only.

So, yes, child and adolescent psychiatrists routinely prescribe off-label, but we know that what we are prescribing works. Although there have been outcries against any off-label drug use because of possible dangers, the other side of the argument is that millions of people would be hurt if medication were withheld. When it comes to children, the outcry is even louder since the vulnerability is assumed to be greater with a younger and more physically and mentally immature population. But despite the many Internet tales of children being harmed by off-label prescribing, there are few reports in professional journals of its particular danger.

Presently about one million antidepressants prescriptions are written yearly in the United States for young people. This number has quadrupled in the last several years. In general, antidepressants are used off-label in treating children except for the following:

  • Prozac approved for depression in children eight years old and over for depression;
  • Anafranil approved for children ten years old and older but for Obsessive Compulsive Disorder only;
  • Lexapro approved for twelve to seventeen year olds for depression;
  • Luxox approved for eight year olds for Obsessive Compulsive Disorder only;
  • Sinequan approved for twelve year olds for depression;
  • Tofranil approved for six years old and over for bedwetting only;
  • Zoloft approved for six year olds for Obsessive Compulsive Disorder only.

Many people do not realize that the FDA regulates drug approval, not drug prescribing, and doctors are free to prescribe a drug for any reason they think is medically appropriate. For this reason, few patients are aware they are receiving a drug off-label since doctors are not required to tell a patient that a drug is being used that way. If you are concerned about a drug that is being prescribed for your child, by all means, ask the doctor about it.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

HOW TO CHOOSE A THERAPIST FOR YOUR CHILD

December 4th, 2013

Once you realize that your child needs professional help the next step is finding that help. There are various types of therapy that are generally recommended for specific psychiatric disorders. At first glance, those therapies cover a bewildering range not only of the conditions they are designed to treat but of the philosophies and techniques they employ to treat them. What criteria does a parent use to choose?

Help is relatively easy to find; through your doctor, your child’s school, your local hospital or medical clinic, your religious organization or the local mental health organization in your municipality. Ideally every child or teen should receive a broad based clinical mental health evaluation. This entails the family and child being interviewed. A child/teenage psychiatrist (one who has done a residency or fellowship in child/adolescent psychiatry) is the most broadly trained of all the child mental professionals and can spot the need for possible medication right away. They can also provide psychotherapy if needed. Many locales do not have a psychiatrist, and in that case other mental health professionals can perform the evaluation and therapy as well. Licensed psychologists, social workers, psychiatric nurse specialists and mental health counselors all work in this area. The important thing to remember is that they need to have had special training and experience in working with young people. Do the research before you choose.

The next thing to consider is recommendations from others who have sought help from the individual. Did it help? Was he/she available when needed?

Lastly, trust your gut. After meeting with the therapist ask yourself how comfortable you and your child are. What was the atmosphere? Was he/she flexible regarding times? Ask about his/her understanding of the problem. How long should the treatment last?  What will you look for as far as progress is concerned?  Ask all you can if medication is prescribed– side effects, how to take it, what symptoms are being targeted and how to go off it.

Sometimes just one visit can be clarifying – the therapist may have so much knowledge of your child’s minor problem that direction can be given on the spot, and that may be all the therapeutic advice you need. Maybe just the parents need some education and counseling. For more serious issues, longer-term therapy for the child/teen might be needed. The family is usually included especially for pre-teens. Ask about fees and insurance, too.

 

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

MOLLY

November 26th, 2013

MOLLY is the name of a new drug which has been flooding the party scene and especially been marketed to teenagers.  It is made mostly in China and is very easy to get over the internet.  It has become popular at electronic music parties just like ecstasy was for many years.  Actually, it was considered pure ecstasy at first, but now you usually have no idea what you are taking when you take MOLLY.  It is a combination of synthetic drugs-over 250 compounds has been found already.  The combinations vary, and there is no way of knowing what you are taking from batch to batch.  It is usually sold as a capsule or powder.

Like club drugs of the past it is taken with the idea of becoming euphoric.  It does accomplish that sometimes but also has side effects, which can be quite dangerous.  It stimulates the nervous system which can result in rapid heart rates, high blood pressure, seizures, sweating and sometimes panic to the degree of psychotic breakdowns.  Young people have been having breakdowns, becoming violent and out of control.  Deep depression often follows use of MOLLY.  This drug has also caused death.

We have always been aware of the dangerous effects of all sorts of drugs, but MOLLY use seems even more sinister because what is being ingested is unknown.  Thus, diagnosis and treatment is more difficult, and the danger is much greater.

STAY AWAY FROM MOLLY!!

 

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.