In the meantime, patients and their families often ride a carousel of diagnoses and medications. Valerie Hesse, 42, a first-grade teacher living near Greenville, S.C., brought her daughter Celeste to a children's clinic after the 6-year-old got suspended from school for spells of aggression mixed with trance-like states. Doctors diagnosed her with ADHD and prescribed the stimulant Ritalin -- which made Celeste even more aggressive. She was then switched to another stimulant, with the same effect; and then to Paxil, for depression. Celeste "went into orbit" on Paxil, her mother says.
It appears now that both Celeste and 5-year-old Andrea Robinson have a bipolar syndrome (they have responded well to mood-stabilizing drugs, such as lithium); and it is well known that antidepressants such as Prozac and Paxil can prompt intense manias in adults with bipolar disorder, when given without mood stabilizing drugs.
For The Record
Los Angeles Times Thursday July 03, 2003 Home Edition Main News Part A Page 2 National Desk 1 inches; 42 words Type of Material: Correction
Children's mental health -- An article in Monday's Health section about psychiatry and young children incorrectly stated that Celeste Hesse, a 6-year-old in South Carolina, was suspended from school because of behavior problems. She was not suspended, but disciplined by the school.
For The Record
Los Angeles Times Monday July 07, 2003 Home Edition Health Part F Page 8 Features Desk 1 inches; 42 words Type of Material: Correction
Children's mental health -- An article last Monday about psychiatry and young children reported incorrectly that Celeste Hesse, a 6-year-old in South Carolina, was suspended from her school because of behavior problems. She was not suspended, but was disciplined by the school.
"These are things I wish doctors had told us before prescribing the drugs," said Andrea's mother, Tammy. "I now believe that bipolar is something that should be ruled out at the very beginning, before treating for depression and all these other things."
Researchers are just beginning to understand and define what constitutes major depression in young children, however. In a five-year trial including 174 preschoolers, Dr. Joan Luby and a team of investigators at Washington University in St. Louis compared children with persistent low moods to those who are mentally untroubled, or who have ADHD. They report that depression in this age group looks in some ways like the adult variety: Kids become listless; they lose interest even in playing; the joy runs out of life.
But Luby said her research also suggests that the current criteria for diagnosing major depression are appropriate only for adults and adolescents, not preschoolers. And without good diagnostic criteria, no one can tell how common this earliest form of depression is, how often it leads to adolescent or adult problems, or whether drugs or counseling helps. It's little wonder that while some doctors swear by antidepressants, Luby and others are leery, and still others mix counseling with medication.
This catch-as-catch-can approach cries out for some central forum where psychiatrists and families can readily keep up with what is clearly a frontier science, said Dr. Gregory Fritz, medical director of Bradley Hospital, a children's psychiatric clinic in Providence, R.I. "Right now, we've got a situation in which there are very active pharmaceutical companies producing more and more drugs, and more ads, and there's pressure from the public to get quick results based on scattered reports, or anecdotal information -- it's a nightmare," he said. "We ought to have a more centralized series of protocols for these illnesses in young kids so we can pull all this information together."
It will not happen soon enough for the Robinsons. During her nearly two years of needless medication, Andrea Robinson went for months without riding her purple five-speed. "It's her favorite thing to do," said Tammy Robinson. "I know something's very wrong if she's not out riding that bike."