Generation Rx

In the fall of 1996, Nancy Spence, a New Milford receptionist, went into her son's bedroom after work and found a note scrawled on the wall. "Somebody help me, I want to die," it said.

Her son Brian was then 11 and in the fifth grade. He had been taking Ritalin against his will and under pressure from school officials since he was 6, and a combination of stimulants and antidepressants since he was 8. He'd been seen by a psychologist; by a psychiatrist and a family therapist; by a neurologist paid for by his school district; and by another psychiatrist in private practice. No mental health professional had seen him for more than a few visits, and nobody had formed much of a relationship with him.

They had variously diagnosed Brian with Attention-Deficit Hyperactivity Disorder, or ADHD, an unspecified mood disorder and Bipolar Disorder. They had tried putting him on Ritalin, extended-release Ritalin, Dexedrine, Ritalin plus the anti-depressant Wellbutrin and Wellbutrin plus the stimulant Cylert.

All of the drugs and drug combinations had produced side effects -- physical, psychological and social. In second grade, he had been teased at school for his noontime trips to the nurse's office for Ritalin, and he had also developed subtle tics, shaking his hands and jerking his shoulders and other parts of his body. In third grade, he'd started exploding in rage at home in the afternoons as the Ritalin wore off. On Dexedrine, tried as a substitute for Ritalin, he sleepwalked through the day like a zombie, his mother recalls.

At the time that he scrawled the note on his bedroom wall, Brian was still taking Wellbutrin, an antidepressant for adults. Its potential side effects, according to the Physician's Desk Reference, or PDR, include agitation, insomnia and an increased tendency toward seizures. It has never been approved by the Food and Drug Administration as a safe and effective treatment for any childhood psychological condition. He was also still on Cylert, a central nervous system stimulant approved by the FDA as a treatment for childhood ADHD even though the PDR notes that it is associated with some childhood deaths from liver failure and can stimulate tics and Tourette's syndrome.

On this drug regimen, Brian's tics had become much more pronounced. His head and shoulders jerked uncontrollably, and his mouth would make strange blowing sounds. Once, during lunch in the school cafeteria, his arm jumped up and smacked into someone next to him, and he hung his head in embarrassment as the kids around him laughed. He dreaded going to school and nearly every day, when he came home, he hid in his bedroom and cried.

"I felt like nobody liked me," Brian, now 14, remembers as he sits with his mother at their kitchen table in the waning light of a cold autumn afternoon. "Everything was just like -- like downpours."

He had pleaded for years to be allowed to stop taking the drugs, he says, partly because they had disturbed his still-developing sense of who he was. "They made me feel a lot different," he says, groping for words, " -- like, who I am and the way I felt inside."

After discovering her son's scrawled note, Nancy Spence took Brian back to a private psychiatrist he'd seen a couple of times before. She replaced the Wellbutrin with the adult antidepressant Zoloft, a Selective Serotonin Reuptake Inhibitor, or SSRI, that has also never received FDA approval for use with depressed children. Within a week, Nancy recalls, her son became crazed. He ran into the street ignoring traffic, threw lit matches around the house and imagined conversations that never occurred.

It was then, Nancy Spence says, that she finally faced questions that had worried her for years. Were these medications really helping her son? Should she continue to make him take them, or listen to his pleas and challenge the school and medical authorities who seemed so confident of their course?