Watch the TV segment at the link above, or read the transcript below for information on this topic.
WCAX: Welcome back everyone. Some children need medicine to care for their psychiatric disorders, but do all of those kids really need those meds, or are the drugs being over prescribed? Child psychiatrist, I said this wrong twice today, Child Psychiatrist, David Rettew, you know him well, he joins us now for our regular segment, Peace of Mind. I appreciate your being here.
Dr. Rettew: Nice to be back, Keith.
WCAX: And you provided us some good information, so I wanna start with that right away, and we’re gonna start with some figures you sent along, regarding the use of psychiatric meds by Vermont, six to 12-year-olds insured by Medicaid, folks at home seeing this graphic up on their screen. What is this graphic showing us?
Dr. Rettew: Well, what it’s showing that from the years of 2012 to 2016, it’s looking like fewer kids as a percentage are taking multiple different classes of medicine, so fewer kids taking ADHD medicines, fewer kids taking antidepressants, and fewer kids taking antipsychotic medications. The overall drop is about 40% between 2012 and 2016.
WCAX: So somebody who’s looking at these figures, what should they take away from them? What does this say to you?
Dr. Rettew: Well, I think you start with the first numbers in 2012, and you can look at that and say hmm, that seems kinda high, if you have 20% of Medicaid-insured youth taking ADHD medications, that may be a high number, and so bringing it down a little bit I think, is showing a more balanced approach to treatment.
WCAX: So folks at home we’re gonna say well, my child’s not on Medicaid, not everybody is on Medicaid. Do you suspect that these numbers are reflected across the population, do you have thoughts there?
Dr. Rettew: Well, we don’t know for sure for Vermont, but when other states have done this, the rates are probably lower for people who have private insurance, compared to Medicaid.
WCAX: Why is that?
Dr. Rettew: Well, it just could be for a couple of different reasons, one, just having a lower income can be a really big stress on families, and sometimes when people do struggle with different things from depression to schizophrenia, to ADHD, it can have an impact on being able to get and keep a job.
WCAX: Alright, so we shared some stats for kids six to 12, what I wanna do now is kind of look at identical information for older folks in our community, those young people ages 13 to 17 years old, what are we seeing here?
Dr. Rettew: Well, the trend is fairly similar, so you’re starting with pretty high rates of kids taking different medications, and they came down quite a bit from 2012 and 2014, and then it looks like things stabilized somewhat between 2014 and 2016, so overall a very similar picture.
WCAX: Anything surprising you in this data as we look as these graphs?
Dr. Rettew: Well I think the amount that it dropped was surprising. I don’t think too many people expected that, we’re still not really quite sure why it dropped that much, but it was steeper than most people have expected, and I think the rates in the beginning, being as high as they are, were also a little surprising.
WCAX: So, as we pull in all of this information across age groups, your professional opinion, are we over prescribing, under prescribing, what’s your take?
Dr. Rettew: I don’t think that that’s a mutually exclusive category. I think that there’s plenty of instances where we may be over prescribing, but two recent research studies have shown that the majority of people who do suffer from psychiatric illness, actually get no treatment of any kind, and even a fewer percentage of those actually get medications. So to me it’s both, and we shouldn’t be just arguing on one side of that equation.
WCAX: Talk to me about what you think is driving the drop that we’ve seen across age categories here.
Dr. Rettew: Well some of the factors may be more boring, so one thing was a lot more people got Medicaid around 2014, and that made the demographic differences may have something to do with that. But I think there is a bit of a change in culture, and I think that there is a little bit more balance that’s now coming, and trying to treat people who struggle with emotional and behavioral problems, not just with medications, but with a whole variety of non-pharmacological approaches too as well. I think that message is coming across, and it’s being reflected in these numbers.
WCAX: Talk to the mom or dad at home, who’s listening to this segment tonight, and may think either A, my child is on medication and shouldn’t be, or my child isn’t on medication, and I think that he or she should be.
Dr. Rettew: Yeah, well for one, people don’t have to take medications for life, and so it may be that if somebody could’ve used the medication for a while, but they may or may not need it after a while, a lot of my patients, after they’ve been doing well, you know we ask that question, that’s an important question, do you still need to take the medication or not? And sometimes we will attempt to pull back. Other times I think people really need to know what are the potential benefits, as well as some of the potential risks for taking these medications, especially in the long term.
WCAX: Psychiatrist David Rettew, I appreciate your joining us tonight on The :30.