June 22, 2009

Questioning Antipsychotics In Kids, SF Chron Supports Their Use

From time to time, I simply shake my head at the quality of health journalism in the US, particularly as regards children's mental health. Today's example comes to us from the San Francisco Chronicle in an article entitled "Antipsychotic drugs for kids raise hope, worry." While the article does get at both the hope and worry around the use of these drugs in kids, it remains uncomfortably biased toward promoting the use of antipsychotics in kids to the point where you've got to wonder who the reporter's sources were and who the hell is editing at the Chron these days.

The trouble starts in the lede:

"Increasingly powerful antipsychotic drugs available on the market, and growing evidence that starting these medications early can help children with conditions like bipolar disorder, is putting doctors under more pressure than ever to diagnose and treat young people with mental illnesses.

"As a result, some doctors say, mental illness, especially bipolar disorder, has been overdiagnosed much the same way attention deficit hyperactivity disorder was in the 1980s."

OK, how would the availability of a drug put docs under pressure to diagnose and treat people? What growing evidence that starting these medications early helps children with alleged bipolar disorder? Certainly, the article offers no evidence and, to date, there's no long term "evidence" to support the use of these drugs in kids and the shorter-term studies aren't particularly conclusive either. But there it is in black and white and you've got wonder if there's a skeptical eye at the paper at all, especially when we're talking about a diagnosis--pediatric bipolar disorder--that is deeply controversial within child psychiatry itself when applied to kids younger than 12 or so.

And the antipsychotics are "increasingly powerful?" Compared to what? Older antipsychotics? Really? That's a statement that makes no sense.

The article does a decent job of talking about of overdiagnosis of bipolar disorder in kids and teens and fleshes out some docs' concerns about misdiagnosis, but at core the paper completely accepts the validity of the disorder in children and then sets about quoting a NAMI official:

"Dale Milfay, vice president of the National Alliance on Mental Illness in San Francisco, said it's crucial that children with mental illness get a correct diagnosis as soon as possible and start treatment right away. There may be medical advantages to early treatment, she said, but children also benefit from staying in school and developing crucial relationships with friends and family.

"'The earlier people are diagnosed, the better their chances,' Milfay said. "'But you wouldn't want these drugs to be overused. There needs to be some real criteria that this is not something a primary care doctor can just diagnose.'"

While I appreciate someone from pharma-funded NAMI striking a cautionary note, I'd really love knowing where their evidence is of early diagnosis being crucial to child development, especially when you have some experts in child psychiatry who claim that kids who get hit with bipolar diagnoses as kids don't wind up having bipolar disorder as adults.

Like I said above, I sure do wonder about the state of health care journalism these days and my concern isn't idle given that health care comprises about 25 percent of the American economy these days.

Posted by Philip Dawdy at June 22, 2009 12:03 AM
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Comments

Philip,
I agree wholeheartedly with you. Where is journalism on Bipolar Disorder going to go next?

Bipolar Disorder is a real disease of the mind, not something that is made up. I got the feeling that the author of this article thinks mental illness is folly.

Journalists are supposed to inform the public, not mislead them. I hope that future journalists will carefully write stories with more of the facts in mind.

Thanks for your post.

Best,
Cristina

Posted by: Cristina Fender at June 22, 2009 04:07 AM

I share your concerns. To me, "health care journalism" = "let's make sure we suck up to the big bucks advertisers." Plain and simple. I worked long and hard to try to get my local paper to at least publish an alternate viewpoint on several health topics. Not psych stuff, but I have several "soapbox" issues. I wasn't asking that they stop publishing their content, just present another view. Finally, their health editor sat me down and, like an exasperated parent trying to explain to a child who wants something she can't have, said that "alternative viewpoints" don't have advertisers that are going to spend hundreds and thousands of dollars on pushing their stuff in the paper. So I might as well resign myself to seeing many more articles touting the "miracle" (*cough*) of gastric bonsai (i.e., weight loss surgery) and the like, but no articles on the concept of Health At Every Size. Unfortunately, the general public reads these pieces, on pmeds etc., and believes every word without realizing that there may be another agenda (or three) behind the story.

Posted by: InTheWild at June 22, 2009 04:41 AM

Children are often over emotional and irresponsible, this is why they are still called children and have few legal rights.
I don't believe children can be diagnosed mentally ill as they are children=non-adult. Only adults, adult behaviour can be judged "wrong" -M.I. .As adults are supposed to be responsible, reasonable, have control over themselves, have the correct amount of socially acceptable expressed feeling/emotion . We are supposed to LEARN how to be an adult during our childhood. A child forced to take a chemical (to affect behaviour) is NOT LEARNING. Well they are learning from authority that they (themselves/their mind) is considered brain chemically defective they MUST take medicine for. Which is a lie. Chemical manipulation pretending to be a nonviolent medical action upon the "wrong" behaviour of children will make some angry youths.

The Ferrals
Perhaps it is an inner hatred twisted outwards.
Link

Posted by: markps2 at June 22, 2009 06:16 AM

Of course, the new atypical antipsychotics still have patents whereas the new antidepressants are almost totally generic, so greed is most of the story.

But there is also another part of this story. The antidepressants wrecked such havoc with the youth of our country in the form of school shootings, rampage mall shootings, young girls slitting the throats of their even younger siblings, girls and boys killing their parents and grandparents, etc. that physicians are hesitant to prescribe antidepressants to youngsters, and, yes, some of these physicians even know about the Black Box warning on antidepressants.

So, hallelujah, along comes another diagnosis besides one whose criteria requires the use of monotherapy with antidepressants for children. That diagnosis is the so-called bipolar disorder diagnosis.

I think Columbine and the other rampage shootings by youngsters had some small part in all of this. Here is an article from the Denver Post where Eric Harris is posthumously diagnosed as "bipolar". Of course, pharma and the media want to downplay this event involving antidepressants, thus the book stating that Harris was a pscyhopath-----

But here is what three psychiatrists stated after extensive study of the case.

Last five paragraphs read: "The sheer number of symptoms Harris checked off are a red flag, Denver forensic psychiatrist Bert Furmansky said."

"Some of those symptoms hint at bipolar disorder - once called manic depression, Denver forensic psychiatrist Gordon Neligh said."

"Neligh and Furmansky pointed to another clue that bipolar illness might have been a problem:
In April 1998, Harris told his diversion counselor he'd had trouble with his medication for depression, Zoloft.
A few nights before, he had been unable to concentrate and felt restless. His doctor told him they would change medications, but he would have to wait two weeks until Zoloft was out of his system. Two weeks later, Harris reported feeling better without Zoloft and was looking forward to starting the new prescription."

"Neligh and Furmansky said Harris' reaction to Zoloft could have been a tip-off that he was bipolar."
--------------------------------------------------Harris offered candid hints that 'something was wrong'

By Carol Kreck
Denver Post Staff Writer
Tuesday, November 05, 2002

Nobody knew better than Eric Harris how serious his problems were.
He was remarkably candid about them, Denver adolescent psychiatrist Ronald Rabin said after reviewing 71 pages of juvenile-diversion records released by Jefferson County District Attorney Dave Thomas.
Rabin was one of four local and national experts who analyzed the Harris papers and offered their insights Monday at the request of The Denver Post.

Posted by: Rosie at June 22, 2009 07:29 AM

The antidepressants have been such a National
Tragedy for our country that doctors are looking somewhat more closely to determine if their patients are "bipolar" or not.

Dallas, Texas, which is awash in SSRI tragedies, is still in a state of shock over the recent murders of two young girls at the hands of their mother. Dallas was just recovering from a murder-suicide leaving four dead committed by a woman who was also on Zoloft.

Yet, in spite of all these precautions, all the psychiatrists in this mental hospital where the woman was an inpatient for five days [nine days before the murders] could not find that she was 'bipolar' so she was given monotherapy of 100 milligrams of Zoloft a day.

Here is the new story on this tragedy.

Paragraphs 6 & 7 read: "At the custody hearing June 4, Debra Jeter, who remains jailed in lieu of $1.5 million bail, told Hill County Court-at-Law Judge Lee Harris that she had been living with her parents in Malakoff, Texas, since her hospitalization at the DePaul Center in Waco from May 22 to May 26. Jeter was hospitalized after her suicide attempt in front of the girls at her home on Brazos Street in Hillsboro."

"She testified that she was taking 100 milligrams of the antidepressant Zoloft each morning and had been diagnosed with depression but was not bipolar."

http://www.wacotrib.com/news/content/news/stories/2009/06/12/06122009wachillcoupdate.html#comments

Prosecutor taking closer look at case of mom accused of slashing daughters in Hill County
By Tommy Witherspoon Tribune-Herald staff writer

Friday, June 12, 2009

Dan Dent has been Hill County district attorney for 29 years, but it didn’t take him long to categorize last week’s nightmarish incident in which Debra Janelle Jeter reportedly slashed the throats of her two daughters a week after undergoing psychiatric treatment.

“In all that time, it is either one of the worst, or the worst, that I have seen,” Dent said. “I have been thinking about that. It’s right up there at the top.”

Posted by: Rosie at June 22, 2009 07:37 AM

This writer came under the thrall of Kiki Chang and his minions as well as NAMI. I am very dismayed. What a terrible article to appear on the front page of the paper. So shallow, so thoughtless and putting innocent trusting people at risk. I made a comment on the sfgate site and see that almost to a man all the comments are critical -- only good thing to come out of it.

Posted by: Sara at June 22, 2009 07:42 AM

When the drug Pimp NAMI is your factual source, you would expect nothing less than an advertisement for Big Pharma and child poisons.

I would imagine full page ads by the Big three drug dealers will follow this article.

What ever happened to honest investigative reporting?

Posted by: SF Crock at June 22, 2009 08:52 AM

Sara brings up another noted named in the child bipolar diagnosis disaster: he was (maybe still is)associated with CABF bpkids dot org. Besides NAMI I can't think of any more 2 powerfully influential groups that shove drugging kids onto parents as if there is long term evidence of safety with the use of these drugs, etc.

CABF flat out states on their website that pediatric bipolar is GENETIC. Without any back up,it is just "so" on that site.

Most mainstream articles always seem to say the drugs help people, well I'd like to know why the state hospitals are full, and why I saw so many patients in a revolving door situation the last 3 years in psych wards.

If these drugs worked this topic wouldn't even exist.

Just my opinion

Posted by: Stephany at June 22, 2009 10:02 AM

The first child I ever heard dxed BP was a three year old girl who was being incested by her father, grandfather and grandmother. This was in Boston and the mother bought it hook, line and sinker, despite knowing and being upset by the incest. It didn't seem to occur to her that the supposed "BP" was actually the symptoms and sequalae of the incest. No mention whatsoever of the abuse in the Beideman group's report, of course, not even to deny it. It simply didn't exist.

This stuff makes me want to rip my hair out.

Posted by: Sherry at June 22, 2009 12:40 PM

http://aacap.confex.com/aacap/2009/webprogram/Session3286.html

american academy of child & adolescent psychiatry 56th annual meeting

Friday, October 30, 2009: 7:00 AM-3:00 PM

Chairs:Kiki Chang, M.D. and Melissa P. DelBello, M.D., M.S.

6.1 Diagnosis, Morbidity, and Comorbidity in Pediatric Bipolar Disorder: Clinical, Epidemiologic, and Familial Burden
Benjamin I. Goldstein, M.D., Ph.D. Sunnybrook Health Science Centre, University of Toronto, Toronto, PA

6.2 Genetic Epidemiology of Pediatric Bipolar Disorder

Eric Mick, Ph.D. Massachusetts General Hospital, Boston, MA

6.3 The Neurobiology of Pediatric Bipolar Disorder

Melissa P. DelBello, M.D., M.S. University of Cincinnati College of Medicine, Cincinnati, OH

6.4 Treatment of Mania in Pediatric Bipolar Disorder

Mani Pavuluri, M.D., Ph.D. Institute for Juvenille Research, University of Illinois at Chicago and Center for Cognitive Medicine, Chicago, IL

6.5 Treatment of Depression in Pediatric Bipolar Disorder

Kiki Chang, M.D. Stanford University School of Medicine, Stanford, CA

6.6 Evidence-Based Psychosocial Treatments for Youth with Bipolar Disorder

David J. Miklowitz, Ph.D. University of Colorado, Boulder, CO

6.7 Evaluating and Treating Children at High Risk for Developing Bipolar Disorder

Manpreet Singh, M.D. Stanford University School of Medicine, Menlo Park, CA
--
Now one might wonder about the influence of the speakers in that list, and the 2 chairs. With pharma ties and associated with CABF etc it doesn't take much to connect the dots of how the childhood bipolar 4000% increase happened.

Melissa Del Bello has been investigated for not disclosing money from AstraZeneca (seroquel)by Senator Grassley, and she has started a "personal" business listing her university as the address--with $60,000 invested in it given by AstraZeneca.

Really, this conference is for the "I-wanna-be suckered" into believing this bullshit.

The pharma connection, the NAMI pharma connection, KOL's having pharma connections, there isn't a clean pocket anywhere to form a true opinion based on guess what? scientific evidence!

Posted by: Stephany at June 22, 2009 01:18 PM

Child mental health issues are very real. When I was 3 years old was when my mental health issues were most intense. I was a vulnerable three year old who had so many emotions going on. My mental health issues were more intense at 3 years old then they were when I got older. Little kids can feel emotions just as strongly as adults. Kids that have emotions that are more intense than other kids aren't really understood. Kids who have mental health issues are able to feel more emotions then regular kids and little kids who have mental health issues have minds that just think much more than other kids.

Posted by: Princess at June 23, 2009 06:42 AM

With all due respect, Princess, emotions are not something to be medicated away, in fact if a child was to be place on these drugs at age 3 it could end up in death as a result, like Destiny or Rebecca Riley.

The key would be to give that child like the one you describe in yourself an outlet for those intense emotions...did you have that? I am just curious. Take care.

Posted by: Stephany at June 23, 2009 10:22 AM

Oh, um, you took my message wrong. I meant that child mental health issues are very real. Antipsychotics are not fun, believe me, I know. I think it's not fair to label children who have a much stronger sensitivity and emotions than others. When you are medicated as a kid, you are not told what the pills are. I started meds when I was 7 years old were so. I was given them in a way where I was told "These are kind of like vitamins, you take them the same way" I had no idea what the pills I were taking were called and what they did. However, I was always put on the lowest doses, so they didn't really do anything to my mind or personality. When I was 7, I started with Ritalin and Prozac. All the antipsychotics and combinations started much later. Still, things were normal and it was impossible to tell that I was medicated because for the most part the doses were very low, they were at the absolute lowest and never raised and I was on meds that had reverse affects, so the meds usually canceled out each other's mental and physical effects. Antipsychotics are given out to kids with anxiety disorders, attention defecit disorders and behavior problems and antipsychotics are not fun because you are never told the side effects and antipsychotics have really nasty side effects. I've had experience on these antipsychotics and they are not fun or helpful. Luckily they didn't do anything to my personality, but those antipsychotic side effects sucked. However, most of the time was off antipsychotics rather than on. Antipsychotics have really crazy side effects and you are never told about them.

Posted by: Princess at June 24, 2009 09:15 AM
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