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.
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.
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 …
For years, researchers and health policy experts have been charging that psychiatric medications aren’t adequately tested in children – and a new study gives some powerful ammunition to that critique.
The study, from Pediatrics, looked at clinical drug trials between 2006 and 2011, involving five conditions that cause the greatest “disease burden” for children, as measured by a rating that counts the total years of healthy life lost to disability.
In high-income countries like the United States, three of the five conditions with the highest disease burden among kids were psychiatric disorders: depression, bipolar disorder and schizophrenia.
But of the drug studies to treat those conditions, disproportionately few involved children.
The lack of trials is troubling because children and adults don’t necessarily respond to medication in the same way. With psychiatric drugs, that’s a potential problem both for physical reasons – and for psychological and developmental ones.
It’s a simple question, and one I’ve been getting asked a lot lately as I’ve been interviewed about my new book, Dosed: The Medication Generation Grows Up, about coming of age on psychiatric drugs.
And I’ve been embarrassed to hem and haw and not to have a single, easy answer.
Because here’s the thing: There are a lot of piecemeal stats from a lot of different sources, but they vary wildly, and there’s no single, unassailable source.
A new, important study published in the prestigious Archives of General Psychiatry found that antidepressants decrease the risk of suicidal thoughts and behavior in adults and have no effect on the risk in children.
This is big news, since in 2004 the FDA slapped a black box warning on antidepressants, cautioning that they could cause suicidal tendencies in people under 18. In 2007, the agency extended that warning to young adults under age 25.
I’ve read the study and news accounts about it, including PsychCentral’s, but I’m still left with a lingering question. Perhaps some astute readers who know more about statistics than I can weigh in.
Based on the studies findings, can we conclude that there is really no association between antidepressant use and the risk of suicidal thoughts and behaviors in kids? Or did the kids who grew more suicidal while taking antidepressants and the kids who got less suicidal taking the medications just cancel each other out?
When the federal government released an important compendium of mental health data this week, the headlines proclaimed that 1 in 5 Americans over 18 had a diagnosable mental illness in the past year, and 1 in 20 had a “serious mental illness.”
But what does “serious mental illness” mean, anyway, and what are its connotations and implications when it comes to treatment? It’s a question worth asking, because it’s used differently in different contexts.
I’ve argued before that deeming kids overmedicated without saying what constitutes properly medicated doesn’t make a lot of sense. Still, at least we have some idea of approximately what percentage of kids in the United States – and, to a lesser extent, in other countries – take various kinds of psychiatric meds. What we don’t know is how long the kids continue to take these medications.
This is a frustrating knowledge gap if, like me, you’re interested in the long-term “psychosocial” effects of taking meds – that is, how the experience shapes kids’ outlooks and identities.