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.
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 …
Today Iām featuring the story of Allie, a 21-year-old college senior in Wisconsin who was ultimately diagnosed with bipolar disorder. Allie kept her unhappiness a secret and didn’t begin taking medication when she was old enough to ask for it without her parents finding out.
Allie’s story is interesting, because it shows how kids can suffer from severe depression from a very young age. It also shows how in a culture where psychiatric drugs seem ubiquitous kids can come to focus on medication as a source of salvation.
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.
A little while back, I asked readers to share their experiences with medication. CJ, who first took medication at age 12 and is now 21, was kind enough to write in. At 12, CJ had self-harmed and was suicidal, which was the initial impetus for drug treatment.
Some medications have helped with those tendencies, some only exacerbated them – a controversial topic I’ve addressed in previous posts.
Eight years later, mood swings and sleep continue to be problematic, and antidepressant and antipsychotic medications that help with these issues are ones CJ considers to work. Forgetting the drugs for even a day has alarming results, and CJ sees medication as necessary for living a “normal” life.
Despite reservations about lifelong medication treatment, CJ fears that doctors will think the medications have cured the disorders and stop drug therapy, triggering a frightening breakdown. Another lingering worry – and one I found particularly poignant – concerns meeting someone and falling in love, only to have the person leave upon finding out about CJ’s diagnoses and medications. Even with a team of doctors, therapists and other mental health professionals and a cocktail of medications, this young person sees a long road ahead to recovery and many obstacles ahead.
If you would like to share any aspect of your experience taking medication from a young age, please feel free to email me at kaitlin.b.barnett [@] gmail.com. And now, in CJ’s words:
I stayed up late the last few nights reading Jeffrey Eugenides’ The Marriage Plot, engrossed in large part by the subplot involving Leonard Bankhead, who suffers from bipolar disorder and what might be called a typically complicated relationship with both his manic phases and his medication.
The book is set in the early 1980s, which gives Leonard few viable options for pharmaceutical treatment. Now doctors often prescribe anticonvulsants such as Tegretol and Depakote, and atypical antipsychotics, but back then lithium was more or less the only choice.
Leonard began to experience depressions early in high school but wasn’t diagnosed or treated until his freshman year of college, when he began taking a low dose of lithium apparently without incident.
But as college graduation nears, he begins to chafe at the idea of taking the medication at all, which sets him on a terrible merry-go-round of breakdowns, high doses to get him back on track, side effects from the high doses and then rebellions against the side effects, followed by more breakdowns.
This reader’s story about her experience with medication seems especially timely, given the recent analysis of studies analyzing suicidal ideation and antidepressants. She says she experienced such suicidal thoughts in the initial weeks of treatment, but that the thoughts passed.
For patients, especially young people, who do experience this kind of suicidal ideation after beginning an antidepressant, it is usually early in the course of treatment. The reader, who didn’t want to use her name, doesn’t elaborate on her response to this suicidal ideation, or whether a doctor told her to expect it.
However, if she’d be willing to take questions in the comments section, I, for one, would be very curious to hear more about how she interpreted these thoughts, whether they scared her, whether she was able to brush them off because she knew they were “drug-induced,” etc.
I’d also like to hear why she was so resistant to taking meds in the first place and whether there was going on in her life that was particularly stressful and that she thinks helped set off her depression at that particular time.
Her initial resistance is interesting to me, because it seemed to surface again during the time she she either forgot to take her medications or decided to go off it and concluded that she “deserved” her misery. From interviews I’ve conducted and research I’ve done, that seems a very common attitude in others, especially in depressives. I don’t think it’s necessarily unique to being young, but I would be curious to hear readers’ thoughts about why this mindset is so persistent.
Incidentally, on the topic of suicidal ideation, I’d like to point readers to a very thoughtful critique of the Archives of General Psychiatry study by Dr. David Healy, a psychopharmacologist and one of the most prominent and earliest crusaders seeking to draw attention to the link between antidepressants and suicidal behaviors and thoughts. I’m not sure I understand everything he says in the column, but it’s an interesting read, nonetheless.
And now, the reader’s account of her experience with meds, in her own words. I invite further personal stories about medication, in any format you like and on any aspect of your experience – don’t feel bound by the prompts I gave. Email me at kaitlin.b.barnett [at] gmail.com. Try to include your diagnoses and what medications you took.
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?
This reader’s story presents an interesting perspective, because he took antidepressants 30 years ago, before many of the current psychotropics were on the market, before psychiatric drugs were as commonly prescribed as they are now and, especially, before they were prescribed as often to children and teens.
It’s also interesting because he was hospitalized fairly soon after his symptoms showed up. He’s agreed to take questions in the comments section.
Again, I invite readers to share any aspect of their experience taking medication by emailing me at kaitlin.b.barnett [at] gmail.com. You don’t have to respond to my prompts – you can discuss any aspects of taking medication as it pertains to growing up, childhood, adolescence, forming an identity, etc.
1) How did you start taking medication in the first place? At the time, did you think you needed medication?
At age 17, I woke up one morning with my face wet, and my pillow soaked. I was very confused, but focused on getting ready for school, and didn’t give it any thought. Into the bathroom, get ready, and tears start coursing down my face. I wasn’t thinking anything upsetting, wasn’t feeling upset. I realized I had cried in my sleep….apparently a lot, based on how wet my pillow was.