Boston Globe

By Dave Gram, Associated Press

MONTPELIER, Vt. –State government spent nearly $10 million providing psychiatric drugs to more than 6,000 children in a six-month period last year, in a mental health system that an advocacy group on Wednesday labeled “out of control.”

“Our contention is that no one is paying attention to a system that is out of control, costly and potentially harmful to some children and adolescents in Vermont,” Ken Libertoff, executive director of the Vermont Association for Mental Health, told reporters.

“Drugs have greatly replaced clinical interventions and counseling in the world of children’s mental health and we need to change this environment in Vermont,” said Libertoff, who got his figures on cost and children’s participation from a state report.

Both Mental Health Commissioner Michael Hartman and Joshua Slen, director of the state Office of Health Access, agreed that the use of psychiatric prescription drugs with Vermonters under 18 is a cause for concern.

“This is an area that does need to be looked at, that society needs to be paying attention to,” Slen said.

But Hartman disputed Libertoff’s assertion that, “Many if not most of these medications have never been approved by the Food and Drug Administration for use in the treatment of children and adolescents.”

Hartman pointed to a list kept by a federal agency, the National Institute of Mental Health, identifying 25 commonly used medications and the ages at which the Food and Drug Administration had determined children may begin taking them.

Among them: Children with attention-deficit/hyperactivity disorder may begin taking the stimulants Adderall at 3, Concerta or Ritalin at 6. Depression and anxiety may be treated with Zoloft at 6 or Luvox at 8. The anti-psychotic drug Haldol can be given at 2 and the mood stabilizer Depakote can be given at 3.

Libertoff drew support for his view that the use of psychiatric drugs in children needs careful study from Lt. Gov. Brian Dubie, Senate President Pro Tem Peter Shumlin, and Kathy Holsopple, executive director of the Vermont Federation of Families for Children’s Mental Health.

All acknowledged that medications can be helpful in the treatment of mental health and behavioral challenges in some children as well as adults. Hartman cited a statistic on adolescent suicide on this score.

The national suicide rate for 10- to 19-year-olds was 2.2 per 100,000 in 2003, he said. But after “black box” warnings were placed on some antidepressant drugs about them causing suicidal thoughts in young people, prescriptions of those drugs dropped, and the teen suicide rate jumped by 18.2 percent — to 2.6 per 100,000 — the next year, Hartman said.

Libertoff said there had been “staggering” growth in the use of the drugs with young people in recent years. He said part of the reason was heavy promotion by drug companies, citing statistics from the attorney general’s office that pharmaceutical manufacturers gave at least $2.17 million in fees, travel expenses and direct payments to Vermont doctors and other health providers in 2006.

Slen said later that some drugs were being used for diagnoses that hadn’t been identified 10 or 20 years ago, so that it was difficult to measure year-to-year growth for many of the medications.

Libertoff vowed his association will work with lawmakers next year for legislation directing state agencies to get a better handle on the use of psychiatric drugs by children.

“To be sure, the current lack of public scrutiny and review is not in the best interest of Vermont children,” he said.