However, according to the American Academy of Child & Adolescent Psychiatry (AACAP), there are just over 74 million children in the U.S. under 18 years old, but only just over 10,000 child and adolescent psychiatrists (CAPs). This would result in only 14 CAPs per 100,000 children. This demonstrates how very few children can actually have access to a CAP who could diagnose conditions and find the best solution for each.4
Because there are few mental health professionals (or none in some areas), teens may instead be given psychiatric medications to manage their condition. While symptoms may be alleviated for some, this doesn’t target the root problem itself.
How Does Polypharmacy Affect Teens?
Today’s teens may receive prescriptions for many psychotropic medications, especially selective serotonin reuptake inhibitors (SSRIs) prescribed for depression and related disorders and central nervous system stimulants like Ritalin and other drugs to treat ADD and ADHD. These psychotropic medications exert an effect on the brain by artificially manipulating levels of important brain chemicals known as neurotransmitters. These neurotransmitters are responsible for relaying chemical signals that balance the brain’s pleasure and reward systems, among many others.
Unfortunately, disrupting neurotransmitters may have the opposite effect as what the prescribing physician intended, worsening mental health symptoms. Worse, if one psychotropic doesn’t work for an individual, practitioners may rush to switch or combine medications, which can lead to some significant physical and mental health complications in anyone – but especially in teens.
It’s important to note that many common psychotropic medications originated as remedies for other issues but are prescribed off-label for use in addressing depression, anxiety, and other mental health issues. Not only were these medications never intended for use as antidepressants or antianxiety medications, but they were also developed with adults in mind. Adolescent brains are still developing, which means they do not function as mini-adults, but as the adolescents they are.
The combination of several strong medications at once can result in many negative consequences in adolescents, which may include:
- Drowsiness
- Insomnia
- Weight gain
- Kidney damage
- Nausea
- Mood swings and mood disorders
- Suicidal thoughts
When taken long term, multiple psychotropic medications can cause the above symptoms as well as lasting symptoms like brain fog, brain zaps, fatigue, tardive dyskinesia (repetitive, involuntary movements), and more.
Worse, psychotropic polypharmacy can lead to these other negative effects 5:
- Worsening side effects
- Cumulative chemical toxicity
- Diminished effectiveness of individual medications
- Increased potential for medication errors by patients and providers
- Adverse medication interactions
- Potential over- and under-dosing of each medication
- Mismanagement of drug-induced reactions
- Patient noncompliance and abrupt disuse of the medications, causing further risks
One Teen, Ten Medications
In a story published on August 27, 2022, 6 The New York Times highlighted a teenager named Renae Smith, who was found to be taking ten different psychotropic medications to manage her depression and anxiety. The quest for a solution had begun in the fourth grade, when her family began looking for treatment options for her mental health condition, later diagnosed as ADHD.
By 2021, she was on several different medications that were designed to target mental health conditions. These included Prozac, Focalin, Topamax, Rexulti, and more. Despite these attempts to address her mental health condition – and likely because of the complex mix of psychotropic medications in her system at once – Renae continued to struggle with her depression.
Unfortunately, this is what her practitioners were trained to do, as they didn’t have any specific training for helping those with mental health conditions. However, the disruption in brain chemistry caused by the medications served to mask the true issue.
In April of 2022, Renae had a cancerous tumor in her thyroid removed. While her story shows the negative effects of psychotropic polypharmacy, Smith’s surgery was a success for both her physical and mental health. She credited the surgery as a way to begin self-reflection and reduce the number of medications she was taking. She also found a new psychiatrist who could meet with her on a regular basis and who was willing to explore alternatives for psychotropics.
How Did We Get Here?
The thought of a growing teenager taking ten medications for a mental health condition may sound shocking, but as studies confirm,, the practice is becoming more and more common.11 Renae Smith was prescribed several different medications for her ADHD and depression, but there was never an effort on the part of the medical community to identify the source of her depression symptoms. For example, when she was in eighth grade, she mentioned to her school’s guidance counselor that her family was struggling with finances, and she feared she wouldn’t be able to get into a large university. However, rather than target the root of the problem with coping skills, therapies, and holistic wellness practices like art and movement therapies, physicians prescribed medications.
The rise of psychotropic polypharmacy is concerning because it requires physicians and parents to subscribe to some common myths regarding children and pharmaceuticals. The first is that children are simply smaller adults and can effectively take a reduced dose of a medication to achieve the same results. The second is similar in that it involves the assumption that mental health concerns exist the same way among adults as they do in children.
Others assume that children experiencing mental health symptoms inevitably have a chemical imbalance that must be fixed, as they have no real reason to feel depressed or anxious. Finally, prescribers and parents often believe that medications are a quicker, more effective route to treating mental health symptoms. Unfortunately, all these assumptions are unsubstantiated and can ultimately lead to teens being prescribed multiple medications at once as providers attempt to land on a quick and easy solution.7
