So now we hear that a Harvard psychiatrist apparently hid millions of dollars in payments from pharmaceutical companies, all while promoting the use of powerful antipsychotic drugs for children. This comes at a time when the big increase in prescriptions in bipolar disorder for children is ever more controversial. Given all this, how can parents decide whether medication is the right choice for their child?
Dismayed by this latest news, I called Robert Hendren, president of the American Academy of Child and Adolescent Psychiatry, who points out that while there's plenty of controversy in child psychiatry about how to diagnose bipolar disorder, Joseph Biederman, the child psychiatrist at the center of the scandal, is not the only person contributing to the knowledge base. "We do think that we have good information," Hendren says. "We do see children and adolescents with bipolar disorder, and we do find that these medications work better than placebo."
But if the news of academic conflicts of interest has you feeling a bit more skeptical, here are three tactics to track down the most reliable evidence available:
- When a medication is recommended for your child, do your own research. The fastest way to get up to speed: Log on to the National Library of Medicine's PubMed database of medical journal articles, and search for the name of the drug, along with "children" and "review". Review studies evaluate the work of dozens of scientists on a given topic and summarize the current practices and controversies. Also consider taking a look at the practice parameters from the AACAP, which are advice to doctors developed by a committee of M.D.s. They tend to be conservative. (Here's the 2007 practice parameter on treating bipolar disorder.)
- It's OK to tell the doctor you want to go home and think about it. All drugs come with side effects and risks, and because many drugs have been tested only briefly in children, clear data on the risks and benefits isn't always available. Now is the time to think about your child and weigh his or her needs against the best evidence available as to risks and benefits of the medication.
- Think of the medication as a trial purchase, not a lifetime commitment. Before starting your child on a new drug, set a future appointment when you'll meet with the doctor and decide if it's working. You know your child better than anyone, and you'll know if it's producing clear benefits in mood or behavior.
"Parents have control over this process," Hendren says. "They get to be the judge."