Until recently, no studies have systematically examined the rate of psychotic symptoms caused by routine treatment with stimulant drugs such as Concerta, methylphenidate (Ritalin) and amphetamine (Dexedrine, Adderall). Doctors who prescribe stimulant drugs often seem oblivious to the fact that they can cause psychoses, including manic-like and schizophrenic-like disorders. Without providing a scientific basis, the literature often cites rates of 1% or less for stimulant-induced psychoses (reviewed in Breggin, 1998, 1999). Recently on television I debated a well-known expert in child psychiatry who took the position that prescribed stimulants "never" cause psychoses in children.

The rate of psychotic symptoms that first appear during stimulant treatment has recently been investigated in a 5-year retrospectives study of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) (Cherland and Fitzpatrick,1999). Among 192 children diagnosed with ADHD at the Canadian clinic, 98 had been placed on stimulant drugs, mostly methylphenidate. Psychotic symptoms developed in more than 9% of the children treated with methylphenidate. According to Cherland and Fitzpatrick, "The symptoms ceased as soon as the medication was removed" (p. 812). No psychotic symptoms were reported among the children with ADHD who did not receive stimulants. The psychotic symptoms caused by methylphenidate included hallucinations and paranoia. The authors conclude that, due to poor reporting, the rate of stimulant-induced psychosis and psychotic symptoms was probably much higher.

In my practice of psychiatry, I am frequently consulted about children who are taking three, four, and sometimes five psychiatric drugs, including medications that are FDA-approved only for the treatment of psychotic adults. The drug treatment typically began when the children developed conflicts with adults at home or at school. In retrospect, the conflicts could easily have been resolved by interventions such as family counseling or individualized educational approaches. Usually under pressure from a school, the parents instead acquiesced to put their child on stimulants prescribed by psychiatrists, family physicians, or pediatricians.

When these children developed depression, delusions, hallucinations, paranoid fears and other drug-induced reactions while taking stimulants, their physicians mistakenly concluded that the children suffered from "clinical depression," "schizophrenia" or "bipolar disorder" that has been "unmasked" by the medications. Instead of removing the child from the stimulants, these doctors mistakenly prescribed additional drugs, such as antidepressants, mood stabilizers, and neuroleptics. Children who were put on stimulants for "inattention" or "hyperactivity" ended up taking multiple adult psychiatric drugs that caused severe adverse effects, including psychoses and tardive dyskinesia.

It is time to recognize that the supposedly increasing rates of "schizophrenia," "depression," and "bipolar disorder" in children in North America are often the direct result of treatment with psychiatric drugs. They should be classified as adverse drug reactions, not as primary psychiatric disorders. Doctors need to become more expert at identifying these adverse drug reactions in children and more aware of how and why to taper children from psychiatric medications (Breggin and Cohen, 1999).

When parents are willing to take a fresh approach to disciplining and caring for their children, or when the children's school situation can be improved, it is usually possible to taper them off of all psychiatric medications. The parents are then relieved and gratified to see their children increasingly improve with the removal of each drug.

What's the answer to this widespread, unwarranted use of medication in the treatment of children? As long as we respond to the signals of conflict and distress in our children by subduing them with drugs, we will not address their genuine needs. As parents, teachers, therapists, and physicians we need to retake responsibility for our children (Breggin, 2000). We must reclaim them from the drug companies and their advocates in the medical profession. At the same time, we must address the needs of our children on an individual and societal level. On the individual level, children need more of our time and energy. Nothing can replace the personal relationships that children have with us as their parents, teachers, counselors, or doctors. On a societal level, our children need improved family life, better schools, and more caring communities.

Bibliography

Breggin, P. (1998). Talking Back to Ritalin. Monroe, Maine: Common Courage Press.

Breggin, P. (1999). Psychostimulants in the treatment of children diagnosed with ADHD: Risks and mechanism of action. International Journal of Risk and Safety in Medicine, 12, 3-35

Breggin, P. (2000). Reclaiming Our Children. Cambridge, Massachusetts: Perseus Books.

Breggin, P. and Cohen, D. (1999). Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications. Cambridge, Massachusetts: Perseus Books.

Cherland, E. and Fitzpatrick, R. (1999, October). Psychotic side effects of Psychostimulants: A 5-year review. Canadian Journal of Psychiatry, 44, 811-813.

(reprinted from Vol. 2, Issue 3, Ethical Human Sciences and Services, in press)