Drugs for Kids: It's Time to Stop Medicating and Start Practicing

While Michael Jonathan Grinfeld's article "Psychiatric Drugs for Kids: How Many Is Too Many?" (Psychiatric Times, October 2006, page 1) was interesting, I must comment to the various defenders of community standards for prescribing psychotropic drugs for minors-"You doth protest too much."

In many jurisdictions, children and adolescents are currently being treated with "cocktails" of various psychotropic medications, the vast majority of which have never been empirically tested or validated in the age group in which they are being prescribed. Stating otherwise is being disingenuous. Medications are prescribed so often that one frequently cannot discern which symptoms are clinically derived and which are iatrogenic.

We are in dire straits: Psychiatrists in the country have been relegated (by HMOs) to the role of "pump jockey"--checking the "fluid levels," "topping off the gas," "changing the oil," etc. And in the 15-minute sessions that we are allotted-as mandated by HMOs-one can forget about psychotherapeutic interventions. That heavy lifting is left to other mental health disciplines, while psychiatrists are asked (by HMOs) to diagnose and prescribe medication, much of which is to the detriment of patients (as well as to psychiatrists as expert professionals and self-respecting adults). It is high time that psychiatrists take back their expertise and implement their professional skills again in therapeutic alliance with patients, in evidence-based psychotherapies, and in their prescribing practices.

Saul Levine, MD
San Diego, Calif

Dr Levine is chairman in the department of psychiatry at Rady Children's Hospital in San Diego and professor of psychiatry and director in the division of child and adolescent psychiatry at the University of California, San Diego.