It's not just Americans. All over the world, more and more children and teens are taking psychiatric drugs.

The good: Doctors and parents are getting much better at recognizing — and treating — mental illnesses in children.

The bad: Drugs have different effects in children and teens than they do in adults. Yet few psychiatric drugs have been thoroughly tested in children to see whether they really work — and whether they really are safe.

The ugly: There's a shortage of qualified child psychiatrists and psychologists. This makes psychiatric drugs easier and cheaper to provide than nondrug treatments.

"We believe the use of psychotropic medications (search) in children is a global public health issue," write University of London researchers Ian C.K. Wong, Macey L. Murray, and colleagues at the Center for Pediatric Pharmacy Research at the University of London. Their two reports appear in the current issue of Archives of Disease in Childhood.

In their first report, the researchers examined data from nine countries, including the U.S. Every one – Argentina, Brazil, Canada, France, Germany, Mexico, Spain, the U.K., and the U.S. — had an increase in pediatric prescriptions for psychiatric drugs between 2000 and 2002. The increase ranged from 13 percent in Germany to 68 percent in the U.K.

In their second report, the researchers document increased use of antidepressant medications in British children and teens.

"People shouldn't assume that this increase is bad. Children are being diagnosed earlier with depression and other psychiatric illnesses," Murray tells WebMD. "There is concern in using these drugs in children purely because we don't know what the long-term outcome is. We don't know if it will affect growth or intelligence later in life. But they are being treated early. And that has to be a good thing."

'Children Are Not Small Adults'

Treatments for some psychiatric disorders are very well tested in children, says Gregory Hanna, MD, director of the section of child and adolescent psychiatry at the University of Michigan. For example, it's well known that stimulant drugs are a huge benefit to children with attention deficit disorder (ADD). On the other hand, there's relatively little research on how other psychiatric drugs affect children and teens.

"There is a real disparity in what we know about how medications affect children and adolescents with different psychiatric disorders," Hanna tells WebMD. "There's abundant information about use of psychostimulants [for ADD]. We have some information about the use of medications for anxiety disorders such as obsessive-compulsive disorder (search) in this population. We have much less information about the use of antidepressants for child and adolescent depression."

The concern, Murray says, is that children's brains aren't the same as adult brains. Or as the researchers note in their article, "Children are not small adults."

"Children's brains aren't fully developed and don't fully develop until after adolescence," Murray says. "So giving these drugs when they haven't been fully tested in children gives you some concern because you don't know how their brain is going to react. So you could be affecting development in a child."

Murray and colleagues note that the U.S. FDA dangles a carrot in front of drug manufacturers, offering to extend drug patents if they pay for pediatric studies. She urges parents to lobby governments for even more research on psychiatric drugs in children.

Also calling for more research is Robert Findling, MD, director of child and adolescent psychiatry at University Hospital in Cleveland. Findling leads the American Academy of Child and Adolescent Psychiatry's working group on research.

"The whole context of missed major depression in children is very serious," Findling told WebMD in an April 2004 interview. "These are not just grouchy youngsters — many of these kids have potentially devastating illnesses. It is very important to address these questions in a meticulous, scientific fashion."

By Daniel J. DeNoon, reviewed by Michael W. Smith, MD

SOURCES: Murray, M. Archives of Disease in Childhood, 2004; vol 89: pp 1098-1102. Wong, I. Archives of Disease in Childhood, 2004; vol 89: pp 1131-1132. Macey L. Murray, Center for Pediatric Pharmacy Research, University of London. Gregory Hanna, MD, associate professor and director, section of child and adolescent psychiatry, University of Michigan. Robert Findling, MD, director of child and adolescent psychiatry, University Hospital, Cleveland; chairman, American Academy of Child and Adolescent Psychiatry working group on research.