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640: Young Brains

Around 2004, the American Psychological Association founded a working group to take a look a the use of psychoactive medications for children. Their report was issued in 2006, and highlighted, among other things, quote:

The unique issues in child and adolescent psychopharmacology must be considered when prescribing and monitoring medication effects at home and at school. The acceptability of the risk–benefit profile for any intervention involves value judgments as to the cost of harm-related and psychiatric-related adverse events. Recent safety concerns about antidepressants in the pediatric population illustrate several of the ethical issues related to clinical research and the dissemination of findings. For many other psychotropic agents, issues of safety have not been explored, particularly for long-term usage.

In other words, it’s tough to ethically test this kind of medication on kids — but the drugs are getting utilized with kids anyway — to varying levels, but in a multitude of countries.

A 2008 report found, quote:

The annual prevalence of any psychotropic medication in youth was significantly greater in the US (6.7%) than in the Netherlands (2.9%) and in Germany (2.0%). Antidepressant and stimulant prevalence were 3 or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5–2.2 times greater.

As Ellen Hendrickson wrote in Scientific American, quote:

Childhood mental illness (and resulting medication) is equally overblown and under-recognized.  Approximately 21% of American kids – that’s 1 in 5 – will battle a diagnosable mental illness before they reach the age of 17, whether or not they actually get treatment.  A 2012 review from Stanford researchers analyzed over 50 studies that used neuroimaging – that is, MRI, fMRI, magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), and anything else that takes before-and-after pictures of the brain – to examine the brains of kids with a variety of mental illnesses: anorexia, ADHD, autism, bipolar disorder, depression, OCD, and schizophrenia.  They found that overall, medication does indeed affect brain structure and function to a degree detectable by imaging.

But probably not in the way you expect. Usually, when we think “brain changes” we think it means something bad, like damage or stunting. But it’s important to remember that untreated mental illness can also harm brain development. Early medication can help prevent the illness from getting worse or becoming neurally entrenched.  Let’s look at the anorexia group, for example. Before medication and therapy, teenagers with untreated anorexia displayed different brain activation than a control group, but after 7 months of treatment, the differences disappeared.