Antidepressants for Children...Unsafe? A Better Question Might Be: Why Are So Many Children Depressed?

It seems strange to me that, in all the recent flap about the safety of antidepressants for children, no one is asking why it is that so many kids seem to need them now. Though no one knows for sure, it's likely that the answers have to do with social change. Start with divorce. That "Leave It to Beaver" family, where it’s the first and only marriage for both parents, dad is the sole breadwinner and mom stays home to care for the children, is now down to about five percent of the total population. The divorce rate is currently about 49 percent. It seems to have leveled off at that point after rising for the last twenty years, but shows no sign of declining. Of children today, about 45 percent will go through a parental divorce. More than twice as many children of divorce compared to those from intact families will see a mental health professional during their lifetimes. And the effects of divorce on the divorcing parents aren't that great either; though some tend to jump into divorce as impulsively as they jumped into marriage, they usually find that they're poorer, more stressed, and guiltier after the divorce. Despite these findings, divorce is increasingly accepted as normal.

Mass culture may play a role here in our dissatisfaction with our spouses: In lab studies, both men and women who are bombarded with images of highly attractive members of the opposite sex report decreased commitment and love for their current partner. But what do we get each day from television, movies, and magazines? It certainly isn't a celebration of the way everyday people look.

Suburban living has its own deleterious effects on the family. Suburban sprawl leaves everyone dependent on automobile travel, adds to obesity and health problems, and leads to isolation. Over the past 40 years, the percentage of Americans who report frequent visiting with neighbors has dropped steadily so that today it's fewer than 20 percent of us. Parents don’t have neighbors or grandparents to help them with parenting. When it used to be that the whole community was involved in child rearing, now there is no community. The task falls solely on parents and professionals, who seem to be more and more at odds. If a neighbor takes it on herself to reprimand a child for misbehavior on the street, she fears a lawsuit. School administrators are being driven crazy by the need to be sensitive to gender discrimination, bullying, violence, and the possibility of mass murder, at the same time as being expected to show continuous improvement in standardized test scores, all without any budget increase. Parents and children alike are overwhelmed by mass culture, without a support system to reinforce any alternatives.

We can see how our children are suffering. We drop them off at daycare, pick them up from the babysitter, and feel like we have almost no time for them. Their little lives have to be programmed with a Palm Pilot. Mom and dad don't get to spend time with the kids; they spend all their free time on the phone arranging activities for the kids. Worst of all, children today grow up in a world of fear. In kindergarten they are taught about stranger danger; in fourth grade they are taught about the dangers of drugs; in junior high, the subject is AIDS. And now we all have terrorism to worry about. Have you noticed that you don't see children playing outside any more? Increasingly, children are inside, in the air conditioning, playing alone. Part of it is our paranoia about child abduction; most of it has to do with TV and videogames as the electronic babysitter.

At my office, and in the schools and daycare centers, we see the effect on kids. Something's going haywire with them. A third of the boys are on Ritalin, a third of the girls on Prozac. Kids go to school literally unable to sit still and attend; their brains aren't wired up correctly. Television is partly to blame: according to the American Academy of Pediatrics, each hour per day of television watching increases a child's risk of ADHD by nine percent. These disaffected and disconnected kids are especially vulnerable to drugs. According to the Department of Health and Human Services, there are about 2.6 million new marijuana users per year, the vast majority of them teens; and 25 percent of all high school students got drunk in the two weeks immediately preceding the DHHS survey. The DARE anti-drug education program doesn't work, according to the GAO, but it continues to get funded because it's politically popular. Affluent teens have higher rates of anxiety disorder and substance abuse than inner-city kids. The incidence of depression among children is on the rise: ten percent of all kids will have a major depressive episode before age twelve; the age of initial onset is getting younger and the severity of the first episode is getting worse. The suicide rate among adolescents has been rising at a frightening pace, and no one knows why. In the past twenty-five years, while the general incidence of suicide has decreased, the rate for those between fifteen and nineteen has quadrupled. Sixty percent of adolescents know someone who has made an attempt.

And as the rest of the globe becomes Westernized, each country in turn sees the rate of depression increase, and the age of the first episode get younger and younger.

These are uncomfortable facts. If the way we live is making our children depressed, what do we do about it? Are we supposed to turn back the clock and return to the 50s? Obviously, we can't, and obviously, I don't have the answers. But why is no one asking the questions?

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