The Medication Generation Grows Up
  • This is the story of your friends, family, coworkers - and millions of other young people.

  • Imagine spending a third, half, two-thirds of your life taking medications that are designed to alter the processes in your brain. Psychotropic drugs impact your emotions, your behavior, sometimes even your personality and your identity. Wouldn't you want to know how they affected you?

  • That's what millions of young people are wondering as they enter adulthood and contend with the legacy of psychiatric medications. But because there are almost no studies tracking medication use from childhood to adulthood, some of their most basic questions about how drugs affect the developing brain are going unanswered.

  • Until a few decades ago, both doctors and parents were likely to chalk up kids' problems to shyness, "kids being kids," or adolescent angst. But beginning in the late 1980s and early 1990s, they began to see symptoms of psychiatric disorders that needed treatment.

  • At the same time doctors were diagnosing more cases of emotional and behavioral problems in kids, there were more tools to treat them. With new drugs coming on the market and new research showing the benefits of early intervention, more kids got drug treatment at younger ages. Prescriptions tripled between the late 1980s and the mid-1990s-and continued to increase from there.

  • Doctors also began diagnosing more kids with Attention Deficit/Hyperactivity Disorder - and writing more prescriptions for Ritalin. Critics said that schools, strapped for time and resources, were just looking for a pharmaceutical shortcut to deal with rambunctious and inattentive students.

  • But taking meds wasn't necessarily a quick fix or a magic passport to achievement. Many kids still struggled in school - and sometimes, because psychiatric problems were seen as a private, medical matter, they struggled silently.

  • Sometimes, kids wanted to do better in school and lobbied for medication. Other times, they hoped it would help them control their behavior or their emotions so they could get along better with peers or family.

  • But for others, it was difficult to accept help. Would taking medication erase their personality, teenagers wondered. Would it hurt them, smaller children worried. Did it mean they had done something bad and were being punished? Did it indicate they had some fatal flaw that needed fixing?

  • Many kids viewed medication as something adults were trying to force on them. These kids resisted, especially if they didn't think there was anything wrong with them in the first place.

  • Parents, doctors, therapists and other adults could go a long way toward alleviating kids' concerns if they took the time to explain why medication was necessary in the first place. But many assumed it was obvious why kids needed meds, or that they would figure it out soon enough.

  • Adults listening to kids' concerns is equally important. In the case of psychiatric meds, a pill isn't just a pill. Kids can attach all kinds of meanings to medication, and can have plenty of legitimate concerns.

  • Ironically, just as more and more kids were taking medications that posed new challenges for them, they were also keeping quiet about those drugs in public with their peers, unsure what to say, or how to say it.

  • With peers, the medications could help clear up the symptoms that made some kids feel different. But those same pills could also serve as one more reminder that there was something wrong, especially if kids had to take them multiple times a day, during school or extracurriculars.

  • It's hard enough for adults to explain psychiatric symptoms and how drugs affect those symptoms, not to mention ordinary emotions, behavior, and sense of self. How do you do that when you're still trying to figure out how to act and who you are?

  • After months or years taking medications, it's tempting to assume that if you feel better, you are better. Or, that if one medication doesn't work after a few weeks, there's no use continuing. Doctors consider teens refusing to take their medications so common that they practically expect it as part of treating this age group.

  • Just because kids don't have their identities figured out doesn't mean the personas they have crafted aren't important to them. Especially when medications threaten their social roles, or cause side effects - like weight gain - that shook their sense of themselves, many adolescents or young adults decide to ditch their meds.

  • Starting in the 1990s doctors began to diagnose more cases of childhood bipolar disorder, as well as other conditions involving aggressive behavior that they increasingly treated with the new atypical antipsychotic drugs coming on the market. It could be hard to distinguish a kid's reasonable urge to resist a drug he detested from an antisocial or aggressive opposition to authority.

  • People with psychiatric problems are several times more likely to have a substance use disorder than the general population, and psychiatric meds can also interact badly with drugs and alcohol, making normal or innocent experimentation a more dangerous proposition for kids who take such meds. Parents and doctors, therefore, have a hard call when judging medicated young people's substance use.

  • Colleges have been overwhelmed in the last 15 years with a huge influx of kids arriving on campus with histories of medication use. The schools say in previous eras many would never have made it to college. Overall, one in four students took psychiatric medication in 2009, compared to fewer than one in 10 in 1994, and the numbers have increased since then.

  • College holds out the promise of a fresh start, but it can also be a rocky, stressful transition, and some kids, overly optimistic, failed to do much more than bring along a few extra months' worth of pills. With doctors and parents sometimes thousands of miles away, students have few safeguards if something goes wrong.

  • If a breakdown or relapse comes years after you've begun taking meds, it can be hard not to feel like you're moving backwards. For some it begins to feel like they've tried every drug out there - and like they're running out of options.

  • A relapse can also portend a worsening illness, perhaps adding a new, and scarier, diagnosis and serving as a reminder that, however much you'd hoped to be rid of meds, you might well be stuck with them, at least for the time being.

  • How do you decide if you've moved beyond the troubles you had when you were 8, or 14 or 18? People do change, and so do their disorders. We want to think we can mature beyond the problems that caused us to take medication in the first place. But after so many years, going off meds can be a scary proposition, too.

  • Some young people outgrow the problems they had as children, but others struggle with the transition from pediatric to adult care, starting afresh in new cities, with new doctors, new insurance plans or no insurance whatsoever, sometimes with new drugs and new symptoms

  • Young people who grew up with their parents overseeing every aspect of their medication treatment can face a tough transition to independence. Sometimes, just wrestling control of their treatment from parents is tough. For others, making decisions about what to do if meds stop working, cause side effects or present other problems feels overwhelming.

  • As young people with histories of medication enter long-term, serious romantic relationships, they have to contend with the question of how to navigate a relationship with a loved one at the same time that they are juggling ongoing relationships with medication - and then how to get their significant others to understand what they're going through.

  • What do young adults struggling with ongoing emotional and behavioral issues owe their employers in terms of productivity and disclosure about the meds they take? Laws protect medical privacy, but certain side effects - drowsiness, cognitive problems - might make disclosure seem like a wise option.

  • For young adults with ADHD and attention problems, does revealing the fact that they take stimulants like Ritalin or Adderall invite the bosses and coworkers to think that the meds provide an unfair advantage?

  • As members of "the medication generation" have children of their own, it remains to be seen how their experiences with medication will influence their decisions if and when their own kids require intervention for psychiatric problems.

  • In all likelihood, their own experiences taking medications will shape their views and attitudes as they make treatment decisions for their own children.

A journalist asks what it has meant for herself and her peers ~ the first generation to have been widely prescribed the new psychopharmaceuticals ~ to grow up with lots of meds and lots of questions