Young people spend too long on antidepressants without examining whether they still need them, a Duke psychiatrist argued in a recent New York Times post.
The psychiatrist, Doris Iarovici, is almost certainly right that more young adults are taking these meds for longer these days than in the past. The problem is that we don’t have a very good idea of how many – or for how long. As a result, it’s hard to know how much concern is justified.
How closely does a writer’s work mimic her life experiences? It’s a perennial question made all the more irresistible as it pertains to Lena Dunham, the 26-year-old creator of one of TV’s most talked-about shows, and her recently-revealed history of Obsessive-Compulsive Disorder.
In the first season of HBO’s Girls, Dunham stirred up debate by, among other things, repeatedly revealing her less-than-perfect body while playing the show’s main character, Hannah Horvath. What got people talking as the second season progressed, though, was how serious the show seemed to be getting, especially with its depiction of Hannah coping with a resurgence of her OCD symptoms.
Critics, fans, mental illness activists and patients have largely praised the Girls’ depiction of OCD, which they’ve hailed as convincing and nuanced, but agonizing to watch. One hollywood.com writer and self-described former OCD patient called it “some of the darkest, most difficult material with which Girls has wrestled to date,” lauding the show for avoiding the temptation to turn OCD into a mere joke.
The fact that Dunham revealed in a March cover story for Rolling Stone that she’s struggled with OCD since childhood – and taken medication for it on and off – gave the topic more buzz. (I discussed what she revealed-and what she didn’t-here).
In a HBO behind-the-scenes look at one of the episodes, Dunham disclosed a little more about the connection between her experience and the show’s representation of Hannah’s OCD – though she didn’t go into specifics.
For those looking for a more direct comparison, here’s a look about what Dunham has said about her own experiences with OCD symptoms and treatment – and how they compare to Hannah’s.
Part of the cringe-inducing delight of watching Girls is hearing Hannah say things and do things she knows she shouldn’t. And part of what’s refreshing about Dunham herself are her irreverent, indecorous comments and self-revelations, whether on Twitter, New Yorker essays, or interviews.
So I was especially curious to hear what Dunham had to say about her obsessive-compulsive disorder and medication use in a just-released Rolling Stone cover story. Especially since it was titled Girl on Top: How Lena Dunham Turned a Life of Anxiety, Bad Sex, and Countless Psychiatric Meds into the Funniest Show on TV.
We keep asking ourselves “how?” and “why?” And, with authorities still trying to piece together evidence, the public has to make do with limited – and often incorrect – information.
First came reports that the shooter, Adam Lanza, might have Asperger’s. To my knowledge, no authoritative source has yet confirmed Lanza had a formal diagnosis of that or any other emotional, behavioral or developmental condition.
But that lack of evidence – as well as expert consensus that Asperger’s was extremely unlike to have triggered a shooting rampage – didn’t stop an army of commentators from weighing in.
Now, comes the speculation about whether Lanza might have a history of taking mood or behavior-altering medication.
Don’t get me wrong, here. I’m not blaming journalists, bloggers, pundits, Twitter users, and the general public from wondering if Lanza might be taking psychiatric meds.
In fact, it’s one of the first questions that came to my mind – even before I heard the reports of his possible Asperger’s.
I’ve argued before that declaring American kids and teens to be “overmedicated” is something of a cop-out.
How can people say what constitutes overmedication when they can’t – or won’t – specify what would constitute an acceptable number or percentage of kids taking psychiatric meds?
Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems.
A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all – key measurements of youth medication use.
Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.
Ever have a hard time remembering to take your meds regularly? Now try tallying up all the psychiatric meds you’ve ever taken, their dosages and side effects. It’s harder than you might assume – especially as time goes on.
When I was interviewing my peers for my book about growing up taking psychiatric meds, I started with what I thought was a basic question: Can you give me your medication history – which meds you’ve taken in the past, and for how long?
I was shocked at how many people couldn’t answer the question with any confidence.
Many children with autism spectrum disorders (ASD) take psychotropic medications to treat associated symptoms of their conditions, such as irritability and anxiety. Usage has increased in recent years, and some recent studies have questioned the evidence base supporting the drugs’ effectiveness in young people with ASD.
A new study, published in a supplement to the November issue of Pediatrics, suggests that coexisting psychiatric conditions and problem behaviors might account for much of that prescribing.
The study, which examined children and teens ages 2 and 17 with autism spectrum disorders, found that 80 percent of children with a comorbid psychiatric condition were taking medication, compared to just 15 percent without any psychiatric comorbidity.
Depending on the condition in question, those with a comorbid disorder were between 5 and 17 times more likely to be taking a psychotropic medication as those without the additional disorder.
The study included 2853 children enrolled in a registry run by the Autism Treatment Network, a consortium of 17 academic medical centers in the United States and Canada that is associated with the advocacy group Autism Speaks.
The registry used DSM-IV-TR criteria and the Autism Diagnostic Observation Schedule to diagnose autistic disorder, Asperger syndrome, or pervasive developmental disorder not otherwise specified. It relied on parent reports for information about comorbid psychiatric diagnoses and medication use.
Some metaanalyses have questioned the effectiveness of treating ASD with psychiatric medications, though they have not always taken psychiatric comorbidity into account. Comorbidity is very common in autism spectrum disorders, with studies finding that between 70% and 95% percent qualify for at least one additional psychiatric diagnosis. Other researchers, however, have said these high rates partly reflect overlapping symptoms and problems with diagnostic criteria.
The Pediatrics study didn’t collect information about why the children and teens had been prescribed medication – that is, whether the meds were to treat the comorbid condition, symptoms of the ASD, or both.
However, it found that current psychotropic use was also correlated with high scores on the Child Behavior Checklist, a measure of overall problem behavior. That …
In reality, though, many people taking psych meds drink anyway. They have various reasons: not wanting to curtail their fun, not putting much stock in the warnings, or simply thinking it’s easier to take a proffered drink than explain why they’re turning it down.
Doctors oftentimes don’t bother to talk to patients about potential dangers. Or they tell patients not to drink, but don’t explain why. To make matters worse, because of a lack of studies on the subject, patients inclined to do their own research will have a hard time just how risky it is to drink while taking various kinds of psychiatric medications (I’ve written elsewhere about this troubling lack of evidence).
A widely publicized study that came out last month in the journal Neurology underscores the problem. The findings, which pooled data from 16 studies, showed that people taking SSRI antidepressants like Zoloft or Celexa were 40 percent more likely to suffer a type of stroke caused by bleeding in the brain and 50 percent more likely to suffer any bleeding in the skull.
With the explosion of mobile apps and websites such as PatientsLikeMe, which help people chart symptoms, medications and side effects, we’ve entered a new era of unprecedented medical self-monitoring.
Is this a good thing when it comes to psychiatric medications and mental health?
To recognize World Suicide Prevention Day, I wanted to post again about the topic of medications, suicide and young people.
First, the sad statistics: Worldwide, suicide is the second-leading cause of death among young people ages 15 to 19. In the United States, according to the CDC, suicide was the third-leading cause of death in 2009 for people ages 10-14, 15-19 and 20-24. It was the second-leading cause of death for people ages 25 to 34.
The vast majority of people who commit suicide have a mental illness. But for nearly a decade doctors and researchers have been debating whether certain classes of medications used to treat mental illness increase or decrease the risk of suicide – as well as suicidal thoughts and behaviors – in young people.
In 2004, the FDA placed a black-box warning on all antidepressants, warning that they increase the risk of suicidal thinking and behavior (called “suicidality”) in children and teens.
An FDA analysis had found that one type of antidepressants in particular, the SSRIs, which include Prozac, Zoloft, Paxil, Lexapro and others, doubled the risk of suicidality in young people from 2% to 4%. But it found no completed suicides in the studies it looked at, which included some 2,200 children.
In 2005, the European medications regulatory authority urged European countries to put strong warnings about using either SSRI antidepressants, or SNRI antidepressants, such as Effexor and Cymbalta, for children or teens. The warning was based on the drugs’ potential to induce suicidality and hostile or aggressive behavior.
Also in 2005, the UK’s National Health Service issued guidelines urging doctors to avoid prescribing antidepressants to kids under 18 unless other therapies for depression didn’t work.
In 2007, the FDA expanded its black box warning on antidepressants to include all young people under age 25. The risk is greatest in the first month or two of treatment, the FDA warned.
After the U.S. and European warnings went into effect, prescribing of antidepressants to children and teens decreased. At the same time, some …