In a comprehensive review, the American Psychological Association urged in August that for childhood mental disorders, “in most cases,” nondrug treatment “be considered first,” including techniques that focus on parents’ skills, as well as enlisting teachers’ help.
Some researchers and doctors are looking again at how inconsistent, overly permissive or uncertain child-rearing styles might worsen children’s problems, and how certain therapies might help resolve those problems, in combination with drug therapy or without drugs.
It has almost become standard practice for all adults to turn to medications before attempting some type of behavioral interventions for students or children. We need to look at some of these interventions first.
Showing posts with label antidepressant drugs. Show all posts
Showing posts with label antidepressant drugs. Show all posts
Wednesday, February 21, 2007
Wednesday, February 07, 2007
Kids' Suicides Rise, CDC Report Finds
Something isn't going well - and I'm not sure why
Kids' Suicides Rise, CDC Report Finds
Associated Press - February 05, 2007
CHICAGO - New government figures show a surprising increase in youth suicides after a decade of decline, and some mental health experts think a drop in use of antidepressant drugs may be to blame.
Suicides climbed 18 percent from 2003 to 2004 for Americans under age 20, from 1,737 to 1,985 deaths. Most suicides occurred in older teens, according to the data - the most current to date from the federal Centers for Disease Control and Prevention.
By contrast, the suicide rate among 15- to 19-year-olds fell in previous years, from about 11 per 100,000 in 1990 to 7.3 per 100,000 in 2003.
Suicides were the only cause of death that increased for children through age 19 from 2003-04, according to a CDC report released Monday.
"This is very disturbing news," said Dr. David Fassler, a University of Vermont psychiatry professor.
He noted that the increase coincided with regulatory action by the U.S. Food and Drug Administration that led to a black box warning on prescription packages cautioning that antidepressants could cause suicidal behavior in children.
Fassler testified at FDA hearings on antidepressants during 2003 and 2004 and urged caution about implementing black box warnings. The agency ordered the warnings in October 2004 and they began to appear on drug labels about six months later.
Psychologist David Shern, president of Mental Health America, called the new data "a disturbing reversal of progress."
Other research has linked certain antidepressants with decreasing suicide rates, Shern said, adding, "We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants in fact have caused an increase in youth suicide."
The advocacy group receives funding from makers of antidepressants, government agencies and private donations.
The suicide data are in a report on vital statistics published in February's Pediatrics.
Antidepressant use among children decreased during the same time period. Data from Verispan show 3 million antidepressant prescriptions were written for kids through age 12 in 2004, down 6.8 percent from 2003. Among 13- to 19-year-olds, the number dropped less than 1 percent to 8.11 million in 2004. Steeper declines in both age groups occurred in 2005, according to the prescription tracking firm.
The suicide data are preliminary and don't show whether suicides might have been concentrated in one region or among one gender or ethnic group, said the CDC's Dr. Alexander Crosby.
"It's something that we want to look a little bit closer into," Crosby said. "It's probably too early to say" if declining use of antidepressants had anything to do with it, he said,
The CDC is expected to issue a more thorough report on the data in a month or two.
The data are concerning, but it's too soon to know if they're anything more than a statistical blip, said Dr. John March, a Duke University psychiatry professor. He led landmark National Institute of Mental Health research linking antidepressant use with an increased risk for suicidal behavior, but also showing that getting psychotherapy at the same time canceled out that risk.
Some mental health experts believe suicide prevention programs and effective use of treatment including drugs and therapy contributed to the decline in suicides that occurred in the 1990s.
Funding cuts for school-based suicide prevention programs might have contributed to the apparent rise noted in the new CDC report, said Emory University psychologist Nadine Kaslow. But the rise might not indicate a nationwide trend and needs to be investigated, she said.
"It's definitely concerning" but will need to be followed to see whether increases occurred in subsequent years, Kaslow said.
Kids' Suicides Rise, CDC Report Finds
Associated Press - February 05, 2007
CHICAGO - New government figures show a surprising increase in youth suicides after a decade of decline, and some mental health experts think a drop in use of antidepressant drugs may be to blame.
Suicides climbed 18 percent from 2003 to 2004 for Americans under age 20, from 1,737 to 1,985 deaths. Most suicides occurred in older teens, according to the data - the most current to date from the federal Centers for Disease Control and Prevention.
By contrast, the suicide rate among 15- to 19-year-olds fell in previous years, from about 11 per 100,000 in 1990 to 7.3 per 100,000 in 2003.
Suicides were the only cause of death that increased for children through age 19 from 2003-04, according to a CDC report released Monday.
"This is very disturbing news," said Dr. David Fassler, a University of Vermont psychiatry professor.
He noted that the increase coincided with regulatory action by the U.S. Food and Drug Administration that led to a black box warning on prescription packages cautioning that antidepressants could cause suicidal behavior in children.
Fassler testified at FDA hearings on antidepressants during 2003 and 2004 and urged caution about implementing black box warnings. The agency ordered the warnings in October 2004 and they began to appear on drug labels about six months later.
Psychologist David Shern, president of Mental Health America, called the new data "a disturbing reversal of progress."
Other research has linked certain antidepressants with decreasing suicide rates, Shern said, adding, "We must therefore wonder if the FDA's actions and the subsequent decrease in access to these antidepressants in fact have caused an increase in youth suicide."
The advocacy group receives funding from makers of antidepressants, government agencies and private donations.
The suicide data are in a report on vital statistics published in February's Pediatrics.
Antidepressant use among children decreased during the same time period. Data from Verispan show 3 million antidepressant prescriptions were written for kids through age 12 in 2004, down 6.8 percent from 2003. Among 13- to 19-year-olds, the number dropped less than 1 percent to 8.11 million in 2004. Steeper declines in both age groups occurred in 2005, according to the prescription tracking firm.
The suicide data are preliminary and don't show whether suicides might have been concentrated in one region or among one gender or ethnic group, said the CDC's Dr. Alexander Crosby.
"It's something that we want to look a little bit closer into," Crosby said. "It's probably too early to say" if declining use of antidepressants had anything to do with it, he said,
The CDC is expected to issue a more thorough report on the data in a month or two.
The data are concerning, but it's too soon to know if they're anything more than a statistical blip, said Dr. John March, a Duke University psychiatry professor. He led landmark National Institute of Mental Health research linking antidepressant use with an increased risk for suicidal behavior, but also showing that getting psychotherapy at the same time canceled out that risk.
Some mental health experts believe suicide prevention programs and effective use of treatment including drugs and therapy contributed to the decline in suicides that occurred in the 1990s.
Funding cuts for school-based suicide prevention programs might have contributed to the apparent rise noted in the new CDC report, said Emory University psychologist Nadine Kaslow. But the rise might not indicate a nationwide trend and needs to be investigated, she said.
"It's definitely concerning" but will need to be followed to see whether increases occurred in subsequent years, Kaslow said.
Monday, December 19, 2005
Adolescent suicide and antidepressants
Although this article does nor get to the bottom of the issue, it is an interesting intro into the nature of adolescent anti-depressant usage and suicide. In general, what I have seen is that the nature of most medications is not well-researched in children (except with Ritalin), and more studies are needed in this area. So the area is ripe for armchair discussion. I would be curious to hear what any or all of you have to say on the issue....
What happens outside a tightly-controlled study is harder to know. Indeed, any chance that a teen may take his or her life is reason for concern. Suicides accounted for nearly 32,000 American deaths in 2002, with most of them occurring in teens between 18 and 19 years of age. Dr. David Shaffer, the director of child and adolescent psychology at Columbia University and a leading expert on suicidal behavior, discusses these risks and puts the recent controversy over antidepressants into perspective.
How common is it for adolescents to have suicidal thoughts? They are very, very common. Suicidal thoughts occur in around 20 percent of all high school-aged kids. One in five high school kids have thought about suicide within the last year.
Have the thoughts or attempts of suicide gone down in recent years? The rate of attempts doesn't appear to have gone down. The rate of ideation [suicidal thoughts] that's being tracked has gone down from about 25 percent two years ago to about 19 percent today
These lower rates have happened while more and more teens are taking antidepressants. Is it possible that the antidepressants are decreasing the risk of suicide? I think it's highly likely. There have only been two previous periods in the last 105 years when suicide rates have gone down and both were during World War I and World War II. They were probably related to alcohol, because alcohol tends to drive the suicide rate. If you look at the 1990-2004 alcohol use rates, there has been no decline in alcohol use at all. So there are other possible explanations and I think we've all looked at them, and nothing strikes one as very convincing.
What about the possibility that antidepressants may increase the risk of suicide? The really big argument that antidepressants are not causing a lot of suicides comes from autopsy studies. There are two places, one in New York and one in Salt Lake City, where they've been doing toxicology on youth suicides, and they're just not finding any trace of SSRIs [antidepressants, like Prozac] there. So my best guess is that non-treatment is more likely to lead to suicide than the reverse. However, that's not to say that antidepressants don't influence your behavior in a way that might make you talk much more about suicide, and it may also make you more aggressive and hostile.
Why has there been such a concern about antidepressants? Most suicidal thoughts are kept inside, with even more attempts never revealed to anyone. When you're on an SSRI, you become less inhibited, and kids who have been totally silent and really uncommunicative within a few doses may be over-talkative and disclosing a lot. You are more likely to disclose your thoughts after taking an antidepressant. That doesn't necessarily mean to say the antidepressant is working; it's just one of the nonspecific effects.
Is there no risk of suicide from taking these drugs? There are some kids who become quite hostile and aggressive when they take antidepressants. If you become aggressive and hostile, it's possible that you will get into trouble.
Do the benefits outweigh the risk? I think the risk of not treating depression is much, much greater than the possible effects of treatment. But I think because you can get side effects, you can't just hand out a starter pack and say, "Try these and come back in a month."
How do you prevent this kind of reaction in teens who take antidepressants? You tell the parents about the risk, and you start the patients on a very low dose. If you're not going to see the patient for a week or for two weeks, then you make sure that there are telephone contacts. And so you telephone the parent to ask what changes they've noticed, if any. And you give them a list of some of the things to look out for, like losing your temper, having difficulty sleeping or talking about suicide.
What happens outside a tightly-controlled study is harder to know. Indeed, any chance that a teen may take his or her life is reason for concern. Suicides accounted for nearly 32,000 American deaths in 2002, with most of them occurring in teens between 18 and 19 years of age. Dr. David Shaffer, the director of child and adolescent psychology at Columbia University and a leading expert on suicidal behavior, discusses these risks and puts the recent controversy over antidepressants into perspective.
How common is it for adolescents to have suicidal thoughts? They are very, very common. Suicidal thoughts occur in around 20 percent of all high school-aged kids. One in five high school kids have thought about suicide within the last year.
Have the thoughts or attempts of suicide gone down in recent years? The rate of attempts doesn't appear to have gone down. The rate of ideation [suicidal thoughts] that's being tracked has gone down from about 25 percent two years ago to about 19 percent today
These lower rates have happened while more and more teens are taking antidepressants. Is it possible that the antidepressants are decreasing the risk of suicide? I think it's highly likely. There have only been two previous periods in the last 105 years when suicide rates have gone down and both were during World War I and World War II. They were probably related to alcohol, because alcohol tends to drive the suicide rate. If you look at the 1990-2004 alcohol use rates, there has been no decline in alcohol use at all. So there are other possible explanations and I think we've all looked at them, and nothing strikes one as very convincing.
What about the possibility that antidepressants may increase the risk of suicide? The really big argument that antidepressants are not causing a lot of suicides comes from autopsy studies. There are two places, one in New York and one in Salt Lake City, where they've been doing toxicology on youth suicides, and they're just not finding any trace of SSRIs [antidepressants, like Prozac] there. So my best guess is that non-treatment is more likely to lead to suicide than the reverse. However, that's not to say that antidepressants don't influence your behavior in a way that might make you talk much more about suicide, and it may also make you more aggressive and hostile.
Why has there been such a concern about antidepressants? Most suicidal thoughts are kept inside, with even more attempts never revealed to anyone. When you're on an SSRI, you become less inhibited, and kids who have been totally silent and really uncommunicative within a few doses may be over-talkative and disclosing a lot. You are more likely to disclose your thoughts after taking an antidepressant. That doesn't necessarily mean to say the antidepressant is working; it's just one of the nonspecific effects.
Is there no risk of suicide from taking these drugs? There are some kids who become quite hostile and aggressive when they take antidepressants. If you become aggressive and hostile, it's possible that you will get into trouble.
Do the benefits outweigh the risk? I think the risk of not treating depression is much, much greater than the possible effects of treatment. But I think because you can get side effects, you can't just hand out a starter pack and say, "Try these and come back in a month."
How do you prevent this kind of reaction in teens who take antidepressants? You tell the parents about the risk, and you start the patients on a very low dose. If you're not going to see the patient for a week or for two weeks, then you make sure that there are telephone contacts. And so you telephone the parent to ask what changes they've noticed, if any. And you give them a list of some of the things to look out for, like losing your temper, having difficulty sleeping or talking about suicide.
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