In America, medication is becoming almost as much a staple of childhood as Disney and McDonald’s. Kids pack their pills for school or college along with their lunch money. Some are taking drugs for depression and anxiety, others for attention deficit hyperactivity disorder (ADHD). The right drugs at the right time can save young people from profound distress and enable them to concentrate in class. But some adolescents, critics say, are given medication to mask the ordinary emotional turmoil of growing up; there is a risk that they will never learn to live without it.
According to America’s Centers for Disease Control, 11% of four- to 17-year-olds in the US have been diagnosed with ADHD, a label for those who are disruptive in class and unable to concentrate; just over 6% are taking medication. But the official figure hides huge variation across regions and class. Numbers are very high in the white, middle-class east coast population, says Ilina Singh, professor of neuroscience and society at Oxford University, while there is under-diagnosis in poor white populations and among ethnic minorities.
“In the middle-class, educated group in New York, you probably are seeing kids who are just under more academic pressure,” she says. “Parents will begin to look at psychiatric diagnosis and treatment with drugs as one option for making children perform better. You have parents saying, ‘My child must be on Ritalin because all the other children in the class are.’”
In the UK, meanwhile, about 3% of children are diagnosed with ADHD; just 1% are on medication. American children can go through six or seven different drugs quite early in their lives; in the UK, children are usually sent for cognitive behaviour therapy first, in line with guidance from the National Institute for Health and Care Excellence.
Medication for ADHD has long provoked controversy. But in recent years, the big upturn in the US has been in prescribing for depression and anxiety. It is now generally accepted, says David Healy, professor of psychiatry at Bangor University, that 20%-25% of students at most universities in the US are on medication, often on multiple prescriptions. There, he says, taking your meds is often seen as proof that a young person is dealing with their problems. “But you are not going to learn coping skills if you are taking pills,” he adds.
He believes the UK may follow where the US leads. Once, it was unusual for British children to be put on medication; mental health teams would expect to work with a family over issues such as divorce. But increasingly, Healy says, young people turning 18, who transition into the adult mental health services where he works, arrive with a diagnosis of ADHD, autistic spectrum disorder or even bipolar – and will argue that they should carry on taking the pills they have been given by the children’s services. “We used to have a world in which it was accepted that kids in their teens were confused,” he says. “It’s an extraordinary change compared with even five years ago. This is the new norm.”
Edward at 16
Medication: Fluvoxamine 300mg a day for the past nine months
I’ve always seen a psychotherapist. Then, a couple of years ago, when I was in drama class, I started twitching on stage. I tried acupuncture and hypnosis, but that was very high-maintenance. Medication wasn’t an option until the disorder became physically painful and socially crippling. I was constantly checking that I hadn’t lost something, turning my head around. Then my body needed to feel the muscle tension of looking backwards in order to feel at ease.
I started on a low dosage, and I initiated the whole thing. School was not involved, my parents were not involved. I’ve always been a perfectionist, focused on very little things, but the medicine helps relax those compulsions. I’m really thankful for it.
Edward at 19
Condition: OCD and anxiety
Medication: Fluvoxamine 200mg a day; guanfacine 1mg a day
I’m taking pills for anxiety and repetitive behaviours. I realised I didn’t know much about the medication, so I read up; one is apparently prescribed for Tourette’s, but also ADHD and anxiety – it’s sort of a one-size-fits-all.
I’m studying in England now, so my doctor prescribed a dose that was higher than I actually take. I just brought a bunch with me, and had my mother send more. Here, medication seems less common, but it might simply be less discussed. People in the UK like downers, such as ketamine, so I guess Adderall is not their drug of choice.
I’m sure the medicine does terrible things to my liver, but the benefits outweigh the negatives. I’m probably a product of my generation, but I like quick fixes.
Madison at 16
Medication: Focalin XR 20mg; Focalin XR 5mg; both for two years
I did really badly in some tests. I got angry and gave random answers, and didn’t finish. So I got tested, which took four days and led to a 300-page report. That got me time and a half for tests, the same as five or six other people in my class of 30.
My usual dosage is 15mg, and at exam time I might take 35mg. But I don’t like the side-effects: depression, and a kind of OCD, sometimes headaches, or nausea. In the summer, I like to stop, so I don’t have the side-effects and I don’t have to take antidepressants.
My mum takes it, too, because she helps my father with his business. My father is a workaholic; he should really be on medication, too.
Madison at 19
Medication: Focalin XR 25mg a day; Focalin XR 5mg a day as needed
Since I started at art school, my workload has been consistently high – I might have five hours of homework a night – so my dosage has gone up.
When I don’t take them now, it’s OK – I’m not a zombie and can interact, but I am almost more hyper. I am learning to sit down and concentrate when it comes to things I love or get excited about, but it doesn’t last as long as a natural attention span should.
I am continuing to be responsible. I make sure I eat before I take it, so I don’t get headaches. In college, many people see it as a smart pill and use it to get work done. They don’t understand the harm it does to your brain and heart. I feel it limits my creativity, though I have learned to think efficiently on it, even when it comes to my art.
Madison at 22
Medication: Focalin XR 5mg a day
I’m really OCD when it comes to my work: either something has to be made well or it has to be finished, and that’s a hard decision for me.
A lot of my friends who were on medication have stopped, to see if they are dependent on it, but some people abuse it to be productive. When they come to me around finals time, I’m like, “I’m sorry, there is no generic version of my pill, they are $90 a month, so, no, I’m not giving them to you!” And I’m not going to support that.
I can take my pill and not feel blocked any more. I have a huge problem with younger kids taking it, because a) it could be a phase, or b) they are not the ones who are able to control it – their parents make them take it. It works for me, because I’m educated about it. Obviously, I don’t want to be 30 and taking it. But as long as I’m in school and have these deadlines and pressure, for sure.
Michelle at 17
Medication: BuSpar 100mg, one a day; Zoloft 200mg, one a day, both for the past year
I started taking medicine when I was 14. I had been going to therapy for a few years, and it wasn’t enough. My father is a doctor, so he was very concerned about excesses in behavioural medication, but after three years of therapy, I had to take the meds. And I’m thankful – I’m significantly better. At first, I tried Cytomel combined with Zoloft, but I had terrible side-effects: they gave me cold sweats and I couldn’t sleep. BuSpar and Zoloft are working fine.
Michelle at 20
Condition: anxiety and depression
Medication: Ativan 20mg as needed; Cymbalta 60mg a day; Seroquel 50mg a day; Paxil 40mg a day
My condition has become more complex, but at the same time more manageable. I have major depression with symptoms of psychosis; I have episodes where I’m hallucinating, stuff like that. As you get older, all the hormonal pieces of the equation go away and it becomes more about the actual medical problem. I’m much more committed to my recovery. I’m taking my medicine; I have two therapists.
In college, people are open about their problems. Some try to utilise it for their work: “I’m disturbed and I make art!” I have to deal with people judging my work and not spiral into a depressive episode because someone doesn’t like my pictures. But I’m getting more confident, and starting to get some work.
Michelle at 23
Medication: Cymbalta 20mg a day; Seroquel 50mg a day; Paxil 15mg a day
I’m taking three medications, but pretty much the lowest recommended dose of each; I think I’ve worked out the emotional adjustment part, and now it’s just the chemical part.
I have more control over my schedule now I’m not in college. Also, in the professional world, I think people have fewer qualms when it comes to speaking about their issues. You have your hyperactivity issues, you have your depression issues, you have your anxiety problems – we all have issues, and that helps us stigmatise it less.
Most of my pills sell for about $100, and my insurance covers maybe half of it, so I have to pay $40 per bottle per month. My doctor doesn’t accept my insurance, so I have to pay him and my therapist. That gives me more incentive not to get too comfortable in my dosage. If I can be on a small dosage, or none at all, that would be great. All the signs are pointing to a functional, peaceful life.
Mike at 17
Medication: Adderall XR 20mg, in the morning; Adderall 10mg in the evening
When I was a kid, I would be a complete disruption, not letting anybody around me do their homework. I was the class clown. When I was 12, I was “diagnosed” by another parent. We went to the doctor, who had me tested; I’ve been on medication since then. There weren’t many kids who were taking it then; now, a good third of the school are.
I feel the medication constrains my creativity, so I don’t use it for music, but for school it really helps. My group of friends are more into a rock band lifestyle and don’t take so much medication. I think it is more common for people doing classical music, who need to practise a lot.
I was in therapy until about a year and a half ago. Now, if there is a special problem, my mother will make me go, to balance things out.
Mike at 20
Medication: the same as at 17
I went from a 250-student high school to a 4,000-student college, which was a shock. And in college, everyone is doing some kind of drug. Less than 10% of it is prescribed medication, but 50-60% of kids take drugs. I’d say that for every sale of pills, there are two sales of marijuana. I never heard of people getting in trouble for selling or buying the meds, but they do for marijuana or drinking.
Blue pills [Adderall] will sell for $2-$3 a pill, and orange pills [Adderall XR] for $10-$12, because they are slower release. Marijuana helps me work on my music; meds just make me feel like cleaning everything up. I even clean my mother’s room. When I have to do just one thing, I’ll take the blue pill rather than the orange pill.
Mike at 23
Medication: 10mg Adderall, when needed
I’ve been taking Adderall on and off for nine years. I’ve kind of turned to coffee now, and that’s been working out really well – I’ve been getting just as much done. My doctor thinks it’s great. The priority of all doctors, really, should be to move their patients off medication.
I’m studying psychology, and I want to go into clinical psychiatry so I can help people in the same position I was in. I want to be able to help people like my mother, people who have a psychosis. After so many years of talking to people who are prescribed the wrong medicine, I feel like I’m able to judge that very well. There is a paradox to it: I believe that medication is absolutely necessary, but necessary to start you on a journey towards ridding yourself of medication.
I don’t see myself taking medicine in five years’ time. More coffee, less Adderall.
Jessica at 14
Medication: Adderall 20mg a day, for the past two years
I’m not sure I like my medication. I see a little change, but not as much as I think I should. It makes me lose my appetite, and then I’m kind of spacey, because I didn’t eat. Some girls use it to lose weight, and some people snort it to get high. I try taking it every day but sometimes I’ll forget or I just don’t want to. Last summer, I didn’t take any.
Jessica at 17
Condition: ADHD and anxiety
Medication: Adderall XR 25mg a day; Adderall 40mg when needed; Ativan 5mg a day, for the past six months
Adderall definitely helps with homework. I’m supposed to take it every day, but I take it only when I need to. I also take an instant-release pill around 1pm, before school lets out; otherwise, I couldn’t do my homework, because the effects of Adderall wear off in the afternoon. Sometimes I’ll take it to do homework, and end up just calling somebody and having a long conversation, or cleaning my room. I’ll get sidetracked and procrastinate, but I’m really focused on what I’m procrastinating about.
I started getting a lot of bad panic attacks, mostly school-related, so they put me on Zoloft. They gave me Lorazepam for when I have a bad one; it’s a benzo[diazepine], so it turns off some of your brain receptors. I’m also interested in cannabis as a medicine, especially CBD [cannabidiol] oil, which is not psychoactive. It doesn’t have all the side-effects, the jaw chattering, jitteriness and weird gagging that Zoloft gave me.
For a while, I was trying to start a learning disability club at school, but I couldn’t get the numbers. I feel that people don’t want to own up to it. But it’s a double standard, because at exam time, everybody is trying to find Adderall. And they’ll go to the kids who they know have learning disabilities – now you’re my friend.
In terms of college, I’m trying to go to a school with not too much academic pressure, because that’s what gives me panic attacks. I don’t want to be put on antidepressants. As for the ADHD, I haven’t found another option.
Nick at 19
Medication: Concerta 27mg a day, for past two years; Ritalin 15mg a day, for the past six years
Sixth grade was just a disaster. It was fast-paced, with reading and tests, simply too much. So my mother switched me to the Montessori school, where all the kids had their own gifts and disorders, so I fitted in perfectly. I’m sure a lot of people there were taking some kind of medication. My mother thought it might be helpful, so we tried Albuterol and Adderall. Then we got to Ritalin.
It helps if I take it and then do something physical for 20 minutes, to get the blood circulating, so that when it kicks in I can hit the ground running. Doing parkour and just going through the woods is a great way to clear my head. I think it’s a good exercise just to learn how to focus, to be more in control.
Nick at 22
Medication: Focalin XR 10mg when needed
I still take medication, but less frequently than when I was in school. Now I’m on a better schedule and more organised. If I don’t get enough sleep and have to be at work at 8am (I’m a personal trainer), I’ll use Focalin to keep me up and keep me alert.
Another bonus of stimulants is that they curb my hunger, so if I don’t bring lunch with me, I can take a pill, skip a meal and it doesn’t kill me. Yesterday, I ate an apple before I worked out, because I know it’ll give me enough energy and carbs for what I need to do. If I take a Focalin an hour before that, my workout is perfect.
• All interviews by Baptiste Lignel, whose book about behavioural medication in the US, Pop Pills, will be published by Dewi Lewis next year; poppills.org.