MILLIONS OF KIDS GET MOOD MEDICATION

STEVEN GOLDSMITH

Seattle Post-Intelligencer

Foster children may be leading the psychotropic bandwagon, but they're right in tune with their pill-popping generation.

Medicine treats growing millions of American children for depression and hyperactivity, despite public confusion over whether that heralds new hope or a stunted future.

National consumption of methylphenidate - better known as Ritalin - has risen 600 percent in the past six years. The stimulant, used to treat hyperactivity and attention disorders, flows through the bloodstreams of more than 2.4 million children, according to the U.S. Drug Enforcement Administration.

Another million-plus children are taking various drugs for depression.

What drives this rise in medications, said University of Pennsylvania psychiatry professor Elizabeth Weller, is that they work. Weller said she often prescribes drugs that almost instantly help children who never seem to get any better from being dragged to one counseling session after another.

``I feel like years ago this kid should have been getting medication, along with counseling,'' she said.

Other professionals believe the opposite is true, that mood-altering medicines can suppress a child's natural rambunctiousness and even block the chance for a cure.

Dr. Sharon Collins, a pediatrician in Cedar Rapids, Iowa, said she has found non-chemical means to help children whose stimulants or anti-depressants are doing no good. She coaches families in how to deal with disruptions and traumas in children's lives. ``I ask the parent: `What are you doing to give the child the attention and help they need?''' Collins said.

Between those opposing camps is a spectrum of opinion on which drugs are the most safe and effective, who should take them, and when they should be prescribed.

Psychotropic drugs, which affect the chemical serotonin in the brain, should be thought of much like ordinary medicines, said Dr. Harold Koplewicz, author of a recent book on childhood depression.

``When a kid has strep throat, we know how many units of penicillin to give,'' Koplewicz said. ``I'm suggesting that if a kid is not producing enough serotonin in his brain, he deserves a fair shot.''

Left unmedicated, Koplewicz said, children with such illnesses probably will drop out of school and ``medicate themselves'' with illegal drugs and alcohol.

How psychotropic drugs work is not fully understood.

Stimulants such as Ritalin boost children's attention spans in roughly the same way that a cup of coffee makes adults feel more focused and alert, Koplewicz said.

Anti-depressants such as Prozac and anti-psychotics such as Thorazine adjust the flow of serotonin and its sister chemicals in the brain, called neurotransmitters, which improve or stabilize mood swings. Some medicines block serotonin from being metabolized or absorbed, so more is available, while others block its release.

Few psychotropic drugs have undergone widespread, controlled tests in children, in part because of ethical constraints on volunteering a child to be a guinea pig. Lacking those trials, the Food and Drug Administration has declined to approve thousands of medicines as safe and effective for children even though, according to the American Pharmaceutical Association, that doesn't mean they're necessarily dangerous or ineffective.

Doctors are left to rely on sometimes conflicting research reports and their own experience.

Children are not just little adults, researchers say. Dr. Peter Jensen, chief of Child and Adolescent Disorders Research at the National Institute of Mental Health, said pre-adolescents respond to psychotropics in distinctive ways.

For example, the tricyclic anti-depressants implicated in the death of Domico Presnell in a Seattle foster home are more likely to increase blood pressure, accelerate heartbeat and cause withdrawal symptoms in children than in adults, Jensen said.

While tricyclics and stimulants (such as Ritalin and Dexedrine) both are used to treat attention deficit disorder, the American Academy of Pediatrics considers tricyclics a ``second choice'' if stimulants don't work.

That is partly because all the tricyclics are more prone to fatal overdoses and require ``careful monitoring of therapeutic efficacy and of vital signs and (electrocardiogram),'' according to the ``American Psychiatric Association Textbook of Psychiatry.''

The need for careful monitoring is one reason experts say drug treatment is risky for foster children, who may lack consistent, long-term adult supervision to track their medical history and side effects.

Even with full-time parental supervision, the drugs can sometimes kill. One tricyclic linked to the deaths of five youngsters is desipramine, which claimed 15-year-old Julie Miller of Issaquah as a victim in 1990. She was taking it for an eating disorder.

Jensen said a national campaign is under way to learn more about how drugs affect children. Beginning this year, researchers will survey about 14,000 youngsters, ages 4 to 17, and monitor them for a minimum of two years.

``We know very little,'' Jensen said, ``about the safety and efficacy of a number of these medications.''

A Glossary of terms

Anti-convulsants: A group of drugs prescribed to treat or prevent seizures; includes carbamazepine and clonazepam.

Anti-depressants, tricyclic: A group of medicines used to treat mental depression; includes amitriptyline, clomipramine, desipramine and imipramine.

Anti-depressants, SSRIs: Selective serotonin reuptake inhibitors. A group of medicines that affect the absorption of the brain chemical serotonin; includes fluoxetine and sertraline.

Anti-psychotics: A group of drugs used to treat psychoses, such as schizophrenia and manic-depressive illness, anxiety states and severe behavior problems; includes carbamazepine, thioridazine and thiothixene.

Anxiolytics: Drugs that relieve tension or anxiety.

Attention deficit hyperactivity disorder (ADHD): A behavioral disorder characterized by overactivity, restlessness, distractibility, short attention span and difficulties in learning and perceptual motor function.

Depression: A mental disorder commonly associated with slowed thinking, decreased pleasure, decreased purposeful physical activity, guilt and hopelessness, and disorders of eating and sleeping.

Psychotropics: Group of drugs intended to affect or alter thought processes, mood or behavior; includes anti-psychotic, anti-depressant and anxiolytic medications and behavior medications.

Sedatives: Drugs that reduce excitement or anxiety.

Stimulants: Group of drugs that stimulate the nerves of the brain and spinal cord; includes amphetamine, caffeine, cocaine and methylphenidate.