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Why Screening Teens for Mental Illness Is a Terrible Idea

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teen sitting on floor with head in handsMental 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—designed by a group at Columbia University and now operating in 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? Have you had problems with your schoolwork or grades because you felt sad or depressed? And so on. Kids deemed at risk for psychological problems are referred to a mental health provider.

"Support for screening teens is increasing along with recognition of the role mental health checkups can play in improving mental health," Wall Street Journal health columnist Laura Landro remarked in a story on TeenScreen. Although her report is largely positive, Landro does mention that school screening programs "aren't without controversy. Some groups oppose them, arguing that they interfere with issues that should be the domain of the family and lead to over-prescription of psychiatric medications."

Indeed. Given the recent trend toward prescribing powerful, profitable and potentially harmful psychiatric medications to children in the U.S., I fear that 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 America (Crown, 2010), a book by the journalist Robert Whitaker that I have mentioned previously.

*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 attention-deficit hyperactivity disorder (ADHD) to full-blown psychosis. In 2008 the General Accounting Office estimated that one in 16 children is "seriously mentally ill." 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. During this same period the number of children requiring government assistance for all other ailments—from cancer to retardation—declined from 728,110 to 559,448.

*3.5 million American children are now taking Ritalin and similar medications for 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 long-term drug treatment of ADHD was associated with increased rather than decreased symptoms.

*Since the selective serotonin reuptake inhibitor (SSRI) Prozac was introduced in the late 1980s, the number of children treated with SSRIs and other antidepressants has soared. A 2002 study estimates that one in 40 children 18 years old or younger takes antidepressants. Whitaker cites numerous studies indicating that whereas antidepressants can provide short-term relief for some children, over the long run are at best ineffective and at worst harmful. Children treated with antidepressants may 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 disease. Since 1995 the number of children diagnosed with bipolar disorder has multiplied more than 40-fold to roughly 800,000. Whitaker presents persuasive evidence that this epidemic may be driven, at least in part, by increased consumption of stimulants (for ADHD) and antidepressants. These medications 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 obesity, diabetes and involuntary tremors. More than half a million children (including infants less than two years old!) are now ingesting antipsychotics. This trend, The New York Times reported last year, has been aggressively promoted by manufacturers of antipsychotics, which have become the most lucrative class of drugs in the world.

The promoters of TeenScreen, you will surely not be surprised to learn, have 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 (which is not, I should add, affiliated with Scientology), has served as a paid consultant for GlaxoSmithKline and other manufacturers of psychiatric drugs. The executive director of TeenScreen, Laurie Flynn, previously headed the National Alliance on Mental Illness, a group that lobbies for improved care for mental illness. Both under Flynn's leadership and since she left, NAMI has been criticized for its close ties to manufacturers of psychiatric drugs. According to a 2009 investigation by The New York Times, NAMI receives about three quarters of its donations from drug companies.

TeenScreen is subtle compared with other psychiatric-intervention programs. Some psychiatrists have advocated medicating young people who are deemed to be "at risk" of schizophrenia—because they exhibit signs of mental instability and/or have schizophrenic relatives. Several trials of this "early intervention" approach have produced inconclusive results, and a proposed trial in Australia was canceled recently after critics complained that the risks far outweighed any potential benefits.

The Australian plan, for an estimated cost of $400 million, would have treated adolescents with the antipsychotic drug Seroquel, according to an Australian newspaper. The drug's manufacturer, AstraZeneca, recently paid $647 million to settle a U.S. lawsuit that claimed the firm failed to properly disclose evidence linking Seroquel to diabetes. Previous studies have shown that the false-positive rate of predicting schizophrenia exceeds 80 percent. I hope that the cancellation of the Australian program portends a backlash against the overmedication of young people worldwide.

Mental illness is devastating for children as well as adults, and medication, when used wisely and sparingly, can help. But clearly our current approach to treating disturbed young people is broken. Let me give Whitaker the last word: "Twenty years ago, our society began regularly prescribing psychiatric drugs to children and adolescents, and now one out of every 15 Americans enters adulthood with a 'serious mental illness.' That is proof of the most tragic sort that our drug-based paradigm of care is doing a great deal more harm than good."

Photo courtesy Wikimedia Commons

The views expressed are those of the author and are not necessarily those of Scientific American.

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