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By Rob Waters

June 17, 1999 | Jimmy Spence was in fourth grade when his strange new behavior started: He began jerking his head and limbs uncontrollably and making strange blowing sounds with his mouth. During lunch at his school in Milford, Conn., his arm would suddenly jump and smack into someone next to him. Jimmy would hang his head in embarrassment as the kids around him laughed.

Partly to control these tics, a psychiatrist prescribed an antidepressant, Wellbutrin, which Jimmy began taking twice a day. Ironically, the tics were most likely a side effect of another medication Jimmy had started taking three years earlier, when he was 6: Ritalin, the stimulant taken by millions of American kids who are considered hyperactive.

Looking back, it's hard to say exactly when Jimmy's problems began. When he was 3, his mother and father separated. He felt suddenly lonely, and thought he didn't fit in with his parents' new partners. Entering school didn't help; in class he was restless, unable to concentrate or stay in his seat. His teacher urged Jimmy's mother to seek professional help and when she did, the psychologist diagnosed Jimmy with attention deficit hyperactivity disorder (ADHD) and suggested Ritalin. Within a week, Jimmy was taking two pills a day.

Jimmy disliked the medications. The Ritalin left him with wild mood swings when it wore off in the afternoon. And he dreaded the sense that everyone at school knew about his problems. "The kids were always making fun of me," he remembers. "It would be like, 'That kid's stupid, he's on Ritalin.'" Jimmy begged his mother to stop the Ritalin, and at one point, she agreed. But school officials told her that if she didn't keep Jimmy on medication he would not be allowed to attend school for more than half a day. Nancy, a single mother, gave in.

Later, when the Wellbutrin was added to Jimmy's daily regimen, it had little effect. The twitching continued, one time jerking his head so forcefully that the school nurse feared he would snap his neck. Jimmy went to therapists, psychiatrists, even a neurologist, but never saw anyone long enough to form a connection. He was variously diagnosed with ADHD, bipolar disorder and a mood disorder. Another doctor took him off Ritalin and put him on a different stimulant, Cylert, while continuing the antidepressant. Still the tics continued.

By the fall of 1996 Jimmy, then 11, was in a funk. He hated going to school in the morning, and came home nearly every day to hide in his bedroom and cry. "I felt like nobody liked me, everything was just like -- like downpours," he says. One afternoon, his mother went into his room and found a note scrawled on the wall. "Somebody help me, I want to die," it said. She called the psychiatrist Jimmy saw occasionally, who switched him from Wellbutrin to Zoloft, an antidepressant similar to Prozac. But within a week, Jimmy degenerated. He ran in the street, ignoring traffic, threw lit matches around the house and imagined conversations that never occurred.

Alarmed, his mother grappled with questions she'd been asking herself for years. Were these medications really helping her son? Should she continue to make him take them, or challenge the school and medical authorities who seemed so confident of their course?

Click here to find support for parents with children suffering from depression.

A decade after it vaulted into our consciousness, America's love affair with Prozac (and other new antidepressants) has worked its way down the age ladder. Last year, more than 2.5 million prescriptions for antidepressants were written for children and adolescents, according to IMS Health, a research firm that tracks prescription drug sales. That's a jump of nearly 60 percent since 1993 -- despite the fact that most of these drugs have not been approved by the Food and Drug Administration for use with children, and that no one knows what the long-term effects might be on developing brains. Prozac and its chemical cousins, the so-called serotonin selective re-uptake inhibitors (or SSRIs), have led the charge: SSRI prescriptions for kids nearly tripled in the last five years.

Many children have no doubt been helped by these drugs. But it also seems clear that powerful medications are being given far too easily to some children, fueled by a variety of forces, from managed care to overworked parents. In a culture addicted to drugs, but reluctant to address children's pain unless they start shooting up schools, it's become easier and cheaper to deal with troubled kids by medicating them than by providing the personal attention of a sympathetic professional.

These days, antidepressants are being prescribed not just by psychiatrists but by pediatricians and family doctors. In a survey released last month by researchers at the University of North Carolina, nearly three of four pediatricians and family practitioners in North Carolina said they had prescribed antidepressants to children or adolescents; nearly a third had recently (within the past six months) prescribed the medications to kids between 6 and 12. And, more alarming, only 8 percent of the doctors said they were adequately trained in the management of childhood depression; just 16 percent said they were comfortable treating depressed kids.

In an unpublished study from 1996-97, researchers with Kaiser Permanente, the nation's largest HMO, found that more than 65 percent of children under 15 who were seen for depression in Kaiser clinics in Portland, Ore., were prescribed antidepressants by their pediatrician or family doctor. But perhaps the most shocking research finding is this: In Michigan, in 1996, investigators looking through records of state Medicaid patients found 157 children aged 3 or younger who had been given any of 22 different psychotropic medications for attention deficit disorder.

To Peter Jensen, the associate director of child and adolescent research with the National Institute of Mental Health, the idea of pediatricians dispensing antidepressants is troubling. "The average pediatric visit is now 13 minutes," Jensen says. "The kind of evaluation that's necessary to tell whether a child is clinically depressed goes beyond what a pediatrician in an office practice has the time or training to do."

Next page | Is managed care pushing kids onto antidepressants?