Keeping Medications Secret – A Way to Curb Abuse?

By Kaitlin Bell Barnett

A recent article in USA Today about the challenges of dealing with ADHD at college suggested students keep their conditions – and their prescriptions – secret from their peers.

The reason? Abuse of stimulant medications like Adderall and Ritalin is rampant on college campuses, where the medications are used as “study drugs” and also to provide a boost of energy during long nights of drinking and partying.

As a result, students with such prescriptions can find themselves under intense pressure to share or sell their pills.

But when students keep their meds a secret from peers, does anyone actually benefit?

Continue reading… »



Youth Suicide and Medications – What’s the Link?

By Kaitlin Bell Barnett

Youth Suicide and Medications - What's the Link?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 studies showed suicide rates in young people increasing, though they couldn’t show a direct link between less prescribing and more suicides.

Other studies, including one published in the prestigious Archives of General Psychiatry this year, showed that that antidepressants don’t increase suicidality in youth.

And a major federally-funded study of adolescent depression treatment found that both Prozac and a combination of Prozac and cognitive-behavioral therapy, or CBT, actually reduced suicidal thinking in teens with moderate to severe depression who started out the study with these thoughts. (The combination treatment reduced suicidality more than Prozac alone).

Then, in 2009 the FDA began requiring drug manufacturers to include a warning about increased risk of suicidal thinking and behavior for 11 anticonvulsant drugs, which are often used as mood stabilizers for bipolar disorder.

This is just a small sampling of the vast amount of information and debate on this topic. There are no easy answers.

As is always the case in medicine, it’s a question of balancing benefits and risks. Many doctors and researchers have argued that for certain mental illnesses – notably severe depression, bipolar disorder, and schizophrenia – the risk of suicide is greater without treatment than with medication.

But other mental illnesses that have lower rates of suicide can still cause serious, and protracted suffering.

I believe it would be a shame if all the hype discourages parents and doctors from giving antidepressants and mood stabilizers to young people whose suffering is severe and persistent.

That said, I would echo treatment guidelines urging that doctors carefully monitor young people taking these drugs, especially in the first weeks of treatment.

Parents should watch for changes in their children’s moods and behavior, too. And they shouldn’t be afraid to ask kids straight-out if they are suicidal, as many are ashamed or frightened to volunteer the information.

Please feel free to weigh in on this debate – especially if you have a personal experience you’d like to share.

Have you or someone you know experienced suicidal thoughts you attribute to meds? Did all the suicide warnings scare you or make you think twice about treatment? Or is the controversy overblown in light of the suicide risk posed by untreated mental illness?

 

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Image courtesy of The Black Dog Institute



Waiting Until You’re “Old Enough” for Antidepressants

By Kaitlin Bell Barnett

What’s it like to suffer from severe depression for as long as you can remember – and to be too scared to ask for help until age 18?

Today I’m 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.

Continue reading… »



A Hierarchy of Medications?

By Kaitlin Bell Barnett

People who take psychiatric medications long-term are no strangers to stigma, or the threat of it. We perennially face, for example, the question of whether it’s worth risking others’ judgment and the potential negative repercussions of disclosing our conditions — and the fact that we take medication for them.

But you can commit to taking medications long-term and still perpetuate or further the stigma associated with meds. And I don’t just mean that in the sense of keeping your medication regimen secret. Most of us do so in another way altogether that we’re largely unaware of.

The fact is, most people have some kind of internal barometer when it comes to medications – which ones they are willing to take, and which ones they’re not.

Continue reading… »



Medicating Class Cut-Ups But Overlooking the Rest

By Kaitlin Bell Barnett
iternalizing kids-cropped

This weekend a mother published a New York Times column about how her son came to be diagnosed with ADHD and became a member of the ballooning “Ritalin Generation.”

“Just a little medication,” the teacher told the boy’s mother, “could really turn things around” for the boy, who was having trouble focusing on class worksheets and lining up quietly for transitions between classes.

When the mother firmly responded that she and her husband weren’t going to medicate their son, the teacher backtracked, sounding mock-horrified.

She wasn’t explicitly suggesting medication, she said. The law prohibited such a thing. She just didn’t want him to fall through the cracks – and thus was was merely suggesting the boy’s parents have him evaluated by a psychologist.

The boy was evaluated, and sure enough, he ended up on Ritalin for a short-time, though he quit it on his own a year later, matured out of his former inattentiveness, and eventually ended up a well-adjusted, school-loving honor-roll student – and medication-free.

Such stories are commonly invoked as cautionary tales about the alleged over-diagnosis of ADHD and other behavior disorders and over-prescribing of drugs like Ritalin to keep children’s behavior in check. Teachers recommending meds for disruptive students often feature prominently. In fact, the debate over school involvement in medicating disruptive children showed up as early as the early 1970s.

Continue reading… »



The Hidden Costs of Medication

By Kaitlin Bell Barnett

Psychiatric medications have a lot of potential hidden costs.

We don’t know, for example, how taking them from a young age affects long-term brain and psychological development in kids. They have myriad of side effects, some serious, like diabetes, high cholesterol, neurological impairment and birth defects when taken in pregnancy. They carry stigma, both from others and self-imposed.

But I’m not talking metaphorically about costs here. I’m talking straight-up financial outlays. Taking psychiatric medications can really add up, even for those who have health insurance, and even when they can take generic instead of brand-name drugs.

One big reason is the so-called “medication merry-go-round.”

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Taking Meds, Being Judged

By Kaitlin Bell Barnett

Collegiate CocktailWith all the attention on the misuse of psychiatric drugs, I think it’s worth taking a look at how the increased scrutiny affects people who have a diagnosis and a legitimate prescription.

I don’t mean to suggest that just because someone has been diagnosed and a doctor has seen fit to prescribe her medication that she necessarily needs the meds – or even that she “should” be on them. Plenty of people have unjustified diagnoses and unneeded prescriptions.

But for those who do benefit from treatment, you’ve got to wonder how all the media attention affects their experience.

Continue reading… »



How Psych Drug Studies Shortchange Kids

By Kaitlin Bell Barnett

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.

Continue reading… »



Could Meds Make It Harder To Take the Heat?

By Kaitlin Bell Barnett

Thermometer 90New York, like much of the country, was mired in a massive heat wave for much of this week. Everyone was complaining that they could hardly stand to go outside – the heat index was 100 degrees. Once high temperatures set in, I began feeling particularly faint and achy, like I was getting sick.

At first, I figured I was about to get a migraine, since I often feel like this before a particularly bad one. But no big headache arrived. Then I figured I was getting the flu. But I didn’t have other symptoms, like a sore throat or an upset stomach.

And then, I read an article online from the Philadelphia Inquirer about how heat and certain medications affect how well the body can regulate its own temperature, making people who take them more susceptible to extreme heat.

I knew that people who take lithium as a mood stabilizer have to be careful in the heat. The drug has has a narrow therapeutic range and can reach toxic levels in your system if you get dehydrated, something that’s much more likely to happen in hot weather.

But it was news to me that other psychiatric drugs, including the antidepressants I take, could alter the body’s ability to regulate its temperature.

Continue reading… »



Do Meds Reduce the Risk of Being Bullied – or Increase It?

By Kaitlin Bell Barnett

In a recent post, I explored the question of whether meds can help reduce bullying behavior in kids with psychiatric conditions, since they are more likely to bully peers than kids without such problems.

But research shows that kids with psychiatric problems are also more likely to be bullied – and that those who are bullied are at elevated risk of suffering from psychiatric disorders later on.

In my own research for my book on young adults who grew up taking psychiatric meds, I was struck that almost everyone I interviewed reported having been bullied during childhood or adolescence (some also reported bullying other kids).

So how does taking psychiatric meds affect the likelihood of kids being bullied? Do the drugs enhance kids’ self-esteem and behavior so that they’re less likely to be picked on? Or do kids get teased because they take meds?

Continue reading… »



 
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