Monday, September 12, 2005
Medication for mental illness in children is focus of forum
One panelist said teen suicide from untreated depression is a greater problem than the risk from drugs.
Kathie St. Clair has traveled around the United States, talking to the family and friends of teens who have committed suicide.
The licensed clinical social worker, who has worked in the Roanoke Valley for decades, said one of the teens drowned herself. Several others hanged themselves. Another poured gasoline on her clothing, set herself on fire, then stabbed herself in the stomach - but managed to survive.
St. Clair works part time as a private investigator for a Houston lawyer who sues drug companies in connection with these cases. Since 2002, she's investigated about 15 cases involving teen suicides, interviewing family members, friends, school officials and others about what may have gone wrong.
St. Clair sees a common theme in the violent suicides: All of the teenagers had started taking a form of antidepressants called selective serotonin reuptake inhibitors.
She spoke, along with three other panelists, as part of a forum Sept. 1 at Lewis-Gale Medical Center called "Treating Depression in Children: Questions about the Use of Psychiatric Medications."
According to the 1999 Report of the Surgeon General on Mental Illness, 4 million American youths have a major mental illness that interferes with daily life. Only a third of the children who need treatment receive it, and many of those are not treated appropriately, according to the National Mental Health Association.
The question of the safety of certain types of antidepressants for children has generated controversy in recent years. After British authorities raised concerns about antidepressants and youth, the Food and Drug Administration held hearings on the issue last year.
In March 2004, the FDA urged the close monitoring of adolescents when they start some of these medications, or when their dosage changes. Some research suggests that suicidal thoughts are most likely to occur during the first three months of treatment, according to a report from the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.
Several months after urging the close monitoring, the FDA decided to attach a cautionary label, known as a "black box warning," on antidepressants used to treat depression and other mental health issues in children and adolescents. Three-quarters of all medications prescribed to children are what is known as "off-label," according to NMHA. That means they have not been completely approved by the FDA.
One antidepressant, Prozac, is formally approved by the FDA for use in pediatric patients. But off-label prescribing of antidepressants to adolescent patients is common and part of accepted clinical practice, according to a report prepared by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.
Still, the side effects of antidepressants in adolescents have surfaced as a controversial defense.
Earlier this year, the lawyer St. Clair works with defended Christopher Pittman, a South Carolina boy who killed his grandparents in 2001. The defense was that Pittman shot his grandparents in a Zoloft-induced mania, according to his attorney's Web site. But the jury in the case found Pittman guilty and he was sentenced to 30 years in prison. The verdict is on appeal, according to the Web site. (St. Clair did not work on that case).
Panelists who spoke at the Sept. 1 forum agreed, however, that antidepressants can be a beneficial treatment, as long as the patient is closely monitored and the medication is used along with other therapies. They pointed to studies that have shown that a combination of therapies is the most effective treatment.
Dr. Rick Claytor of Family Preservation Services in Roanoke County said the number of people diagnosed with depression has increased in recent years. But he also said people are getting better at recognizing it. It is believed to be caused by a combination of genetic, biological and environmental factors, he said.
Claytor pointed out that depression has both biological and physical symptoms. When patients are prescribed medications, their biological symptoms improve before their psychological symptoms, Claytor said. That might actually mean a patient's risk for suicide is higher when the patient initially starts taking antidepressants.
But Cynthia Folcarelli, executive vice president of NMHA, also pointed out that teenage suicide from untreated depression is a much greater problem. And she added that some health care plans pay for medication, but very little counseling.
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