Dr_No_275@yahoo.com
7/18/2006 10:54:00 PM
Consumer Health
Ped Med: Anti-depressant pros and cons
By LIDIA WASOWICZ
UPI Senior Science Writer
SAN FRANCISCO, July 14 (UPI) -- The use of anti-depressants in children
raises support and skepticism.
Selective serotonin reuptake inhibitors, a newer class of the drugs,
are seen by most mainstream practitioners as a godsend that can
potentially transform, even save, lives. But to many critics, too often
they become a matter of convenience: pills unduly and undeservedly
pushed as panacea.
Pediatric prescriptions for the medicines have taken a dip since strong
warnings of increased risk of suicidal behaviors in some users were
affixed to their labels in 2004, by order of the Food and Drug
Administration.
Nevertheless, overall U.S. sales have been skyrocketing -- from $7
billion in 1999 to $11 billion in 2004, according to IMS Health, a
pharmaceutical information and consulting company.
During the same period, the number of prescriptions for the medications
-- which tripled during the 1990s -- jumped from 84 million to 147
million. That's a 175-percent increase in five years.
Even so, pharmaceutical companies, mental-health lobby groups and many
professionals maintain hundreds of thousands of depressed Americans
remain undiagnosed and untreated.
The anti-depressants placed third on the list of the top
prescription-drug sellers of 2004, raking in $11 billion that year,
according to figures from IMS, which obtained most of its information
from a survey of pharmacies.
Americans are popping so many SSRIs, the drugs' breakdown products in
human urine stream into the waterways, tainting fish, perhaps to toxic
levels, studies indicate.
SSRI skeptics looking askance at such gains have raised questions about
whether the phenomenal sales are the result of an over-medicalized
mindset.
"Society with its hurried spectator orientation does not tolerate
discomfort of any sort very well," said Stanley Spiegel, diplomat
emeritus of The American Board of Professional Psychology and author of
"An Interpersonal Approach to Child Therapy" (Columbia University
Press, 1989).
"If you buy your child a new dog within days of the death of the family
dog or replace the goldfish without even telling the youngster that the
other one died, what preparation are you giving to enable the child to
be able to handle such events ... later in life? What value are you
communicating about the meaning of life and death?" he asked.
"Of course, I do not believe in deliberate suffering, and I feel a
child in danger of suicide needs more than just time to get over it,"
he added. "Certainly, in some instances, medication may be part of the
treatment, but medication alone is not enough."
Spiegel continued: "If you have a headache, OK, take an aspirin, even
two, but if your heart aches from a relationship gone bad, you had
better attend to issues of the relationship as well as the resulting
feelings of depression. Drugs may change moods, but they do not solve
the problems of living."
Even as the FDA was formulating its suicidal-risk labeling mandate,
lines were being drawn around antidepressants as the bad guy or the
fall guy.
The barrage of investigations, advisories and alerts, trumpeted in
headlines around the world, provided seeming vindication and apparent
ammunition to skeptics gunning for what they saw as an overdose of bad
medicine.
To them, the astonishing proclamation that a risk factor for suicidal
behavior can be the very medication aimed at alleviating it, that drugs
designed to lift a forlorn spirit from the depths of despair may in
fact send it crashing there all the harder provides one more piece of
evidence they've been right all along.
Relentless critics like New York psychiatrist Dr. Peter Breggin, who
equate use of antidepressants in children and adolescents with a mind
game of Russian roulette, have long been warning Congress and others of
the drugs' potential for causing dangerous side effects, including
raised risk of suicidal behaviors, violence, abuse and addiction.
In addition, by perturbing the all-important activity of chemical
messengers called neurotransmitters, the medicines can push patients
toward chronic illness or other unforeseen consequences, they contend.
These diehard critics struggle to see any role for SSRIs since, from
their perspective, if the brain chemistry of depressed people hasn't
run amuck before they start taking the drugs, it surely must once
they're on them.
"With regard to Prozac and SSRIs, we know young animals develop lasting
changes in their brains (that point to) the capacity of these drugs to
drastically and permanently change brain chemistry," said Breggin,
author of "Talking Back to Prozac: What Doctors Aren't Telling You
About Today's Most Controversial Drug" (St. Martin's Press, 1994).
Over the past 30 years, he has served as a medical expert in numerous
civil and criminal suits against the manufacturers of psychiatric
drugs.
Equally fired up is the medical establishment which in many instances
views the warnings as overkill with the potential to endanger the
children they aim to protect.
The American Medical Association, proclaimed by Fortune magazine as one
of the top 10 most powerful interest groups in Washington, has adopted
as its policy support of SSRIs, including those not certified for
children under 18, as a treatment for depressed minors.
"The decision to issue the black-box warning was heavily influenced by
emotion and politics," asserted Dr. David Fassler, a trustee of the
American Psychiatric Association. "I am concerned the decision may
frighten and confuse parents and make them less likely to seek help for
their children/adolescents who suffer from depression."
"We can't always cure problems, but what we can do for almost all
children is reduce the extent to which the illness interferes with
their lives," he added. "Nor do data demonstrate antidepressants
increase the risk of suicide. There were no actual suicides in any of
the 4,500 children who participated in the studies (used as a basis for
the warning)."
Next: Causes and consequences of antidepressant alerts
(Editors' Note: This series on depression is based on a review of
hundreds of reports and a survey of more than 200 specialists.)
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