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Medications Can Fan Children's Emotional Flames

Apr 8, 2003 | Tampa Tribune Lee thrashed in her father's arms, a raging 60-pound girl. She had been agitated all day, jumping around and threatening to kill herself.

When she stuck her fingers into the electrical outlet, saying she was going to electrocute herself, her parents decided they had to get her to the hospital. Maybe someone there could help her, they thought.

But her admission to a crisis center under Florida's Baker Act was only one step in a two- month journey through emotional bedlam.

Lee, 9, had been diagnosed a year earlier with bipolar disorder and prescribed psychiatric medication, including Seroquel and Risperdal. About September, when she developed an obsessive fear of germs, the psychiatrist suggested Paxil, used for anxiety and depression.

Within weeks, Lee's mother noticed a surge in her aggression. She told the doctor, but he said it was an acceptable side effect and she would be fine. If he had taken her more seriously, Lee's mother says, her daughter might have been spared four wrenching trips to crisis units.

The family has seen the worst of the Baker Act system, Lee's father says.

In roughly a fourth of Baker Act cases involving children, there are references to psychiatric drugs, a study by The Tampa Tribune shows.

The analysis involved nearly 600 sheriff's reports in Hillsborough and Pinellas counties and was part of a five-month Tribune investigation into the rising number of child Baker Act incidents statewide.

In at least 10 percent of the cases, the child had refused to take a prescribed psychiatric drug, often because of unpleasant side effects. Several other reports listed a recent medication change as a factor in the crisis.

Prescribing In The Blind

For years, parents and mental health experts have debated the use of medications to calm disruptive children.

Many say the drugs ease the symptoms of brain dysfunctions such as attention deficit disorder and bipolar disorder.

Others, however, say insurance systems that won't pay the cost of proper diagnoses and family counseling force parents to give their children potentially dangerous medications, which they may not need.

The debate flared anew in January when a medical journal, Archives of Pediatrics and Adolescent Medicine, reported the number of children taking psychiatric drugs nationwide has at least doubled in the past decade, rising to more than 6 percent.

Local pharmacist Bob Bobo has noticed the jump. Better diagnosis of children's problems is causing some of the increase, Bobo says, but he also has heard alarming stories from parents.

``They're telling me teachers won't let their kids back in class until they're on a drug,'' says Bobo, of Davis Islands Pharmacy. ``It's scary. It's like they just want to sedate them.''

Many of the drugs in the national study, among them Seroquel and Risperdal, were created for psychotic adults. That disturbs the study's lead author, Julie Magno Zito, a University of Maryland associate professor of pharmacy. There is very little research on how these compounds affect the young.

Nevertheless, psychiatrists are prescribing them to uncounted children in office visits and during Baker Act stays in crisis centers. The drugs, in turn, sometimes cause new problems that lead to more Baker Act commitments.

Such was Lee's case, her parents say.

Tripping On A Diagnosis

When Lee's symptoms began years ago, her parents say, they tried it all. Lee's mother was home with Lee and her two siblings, and she spent her free time researching child disorders and how to handle them.

Nothing worked. When the psychiatrist recommended medication, the parents didn't question it.

``We felt like she was a guinea pig'' because he tried one drug after another, says Lee's father, who works for the state. ``But it seems like that's the only way of finding out what works.''

Bipolar disorder can be confounding in children. It is characterized by severe mood swings. But children can cycle through the extremes so fast they are continuously irritated and anxious and often appear to have other disorders. Some researchers say bipolar disorder coexists with others.

Some of these maladies, such as obsessive-compulsive disorder, improve when patients take Paxil. But with bipolar disorder, the drug can trigger mania.

Lee's parents believe that is what happened to her.

Despite her psychiatrist's assurances that she would adjust to Paxil, her hostility and aggression grew, they say. She stomped around, kicking at walls, saying repeatedly she wanted to kill herself.

In a frenzy one afternoon, she grabbed a knife and threatened her younger sister. Her parents took her to Community Hospital of New Port Richey, and she was sent to a crisis center at Morton Plant Hospital in Clearwater.

One problem, a unit doctor said, was Paxil. The dose was too low. So the hospital increased it and, after four days, released Lee. On the way home with her parents, she threw a fit.

The Rules Cause Delay

At rest, Lee is a frail-looking girl with plaintive blue eyes. But she can turn ferocious in an instant.

Soon she was back at Morton Plant, where she was treated and sent home a second time only to unravel within hours, threatening that night to electrocute herself.

This time, the parents called a crisis center in New Port Richey, The Harbor Behavioral Health Care Institute. They were assured there was an open bed, but they arrived to learn they had to wait for a social worker to come in to write the Baker Act order.

Because disturbed children often are most aggressive toward family members, attendants separated Lee from her parents. Dressed in pajamas, she sat in the waiting area with an unkempt older man and later with a teenager in handcuffs.

Attendants could see Lee through a window, but reaching her would have required them to run around a counter, down a short hallway and through a door.

Her parents waited, sick with apprehension. Then, after the counselor arrived and signed the Baker Act form, they learned another patient had arrived and the 10-bed unit was full.

The staff offered to send Lee back to Morton Plant. Her parents said no, worried that she would end up home again in three or four days with the same problems.

(Morton Plant officials say they can't comment on Lee's case but are bound by the Baker Act to discharge patients when they cease to be dangerous to themselves and others. Each discharge, they say, is approved by a board-certified psychiatrist.)

Workers found an opening at a crisis center in Tampa, run by Mental Health Care Inc.

The Crises Continue

The Tampa center found reason to keep Lee for five days, and therapists took that time to work with the family. But that ended at discharge.

And although the doctor agreed to change Lee's medication, she was prescribed Zoloft, a relative of Paxil. On her fourth day home, Lee tried to run away.

Lee's father took her to work with him the next day. That usually calmed her, but this time she became more agitated.

He got her into the family van to take her to the hospital. She jumped out.

Emergency workers cornered her behind the office and tied her to a gurney. She screamed and thrashed the whole way to the Community Hospital emergency room and screamed throughout the afternoon as nurses tried to sedate her. They finally succeeded by giving her a shot of Thorazine.

The family refused a transfer to Morton Plant. The crisis units in New Port Richey and Tampa were full. But there was a bed at a crisis center run by Coastal Behavioral Health Care in Sarasota. That turned out to be the break Lee needed.

A doctor there took a special interest in Lee. He kept her for 10 days, stopping the antidepressants. Lee responded.

Insurers Prefer Drugs

Lee's case is extreme, but thousands of parents feel the same confusion and frustration over giving their children psychiatric drugs.

Massachusetts psychiatrist Michael Jellinek, responding to the University of Maryland study, says the findings point to a weakness in public and private insurance health plans: They would rather pay for drugs than for costly and time- consuming counseling.

Another Pasco County mother, Debbie, believes her son was a victim of this bias. She has called police twice to send her 9-year-old son, Richard, to crisis centers under the Baker Act. She is convinced that in one case, when he was screaming he wanted to be back in her stomach, he was reacting to a new medication.

Diagnosed with attention deficit hyperactivity disorder and oppositional defiant disorder, Richard throws violent tantrums when denied what he wants.

Once-a-month counseling through the crisis center in New Port Richey didn't improve his behavior.

The medication keeps Richard under control most of the time, she says. ``It makes him like a zombie, but it's not changing him. It's not teaching him to be a better person. And what happens when the drugs don't work any more?''

Zito, of the University of Maryland, asks the same sort of questions. Rates of psychosis aren't rising, she says, but more children are being given the powerful drugs.

``We need a serious research agenda to reassure us that the medications are being used appropriately'' when the patient is a child, Zito says.

The experiences of Lee and Richard show that drugs prescribed inappropriately may be pushing children into crisis units.

Lee has been home for more than three months now.

She still gets irritable and lashes out but not as violently as before.

``She's in a much better place, mentally,'' her father says. ``She has some peace and stability, which was all we wanted in the first place.''

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