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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by pseudoname on June 7, 2006, at 21:44:59
Use of Antipsychotics by the Young Rose Fivefold
By Benedict Carey • June 6, 2006 • New York Times
http://www.nytimes.com/2006/06/06/health/06psych.html?pagewanted=printThe use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday.
The researchers, who analyzed data from a national survey of doctors' office visits, found that antipsychotic medications were prescribed to 1,438 per 100,000 children and adolescents in 2002, up from 275 per 100,000 in the two-year period from 1993 to 1995.
The findings augment earlier studies that have documented a sharp rise over the last decade in the prescription of psychiatric drugs for children, including antipsychotics, stimulants like Ritalin and antidepressants, whose sales have slipped only recently. But the new study is the most comprehensive to examine the increase in prescriptions for antipsychotics.
The explosion in the use of drugs, some experts said, can be traced in part to the growing number of children and adolescents whose problems are given psychiatric labels once reserved for adults and to doctors' increasing comfort with a newer generation of drugs for psychosis.
Shrinking access to long-term psychotherapy and hospital care may also play a role, the experts said.
The findings, published yesterday in Archives of General Psychiatry, are likely to inflame a continuing debate about the risks of using psychiatric medication in children. In recent years, antidepressants have been linked to an increase in suicidal thinking or behavior in some minors, and reports have suggested that stimulant drugs like Ritalin may exacerbate underlying heart problems.
Antipsychotic drugs also carry risks: Researchers have found that many of the drugs can cause rapid weight gain and blood lipid changes that increase the risk of diabetes. None of the most commonly prescribed antipsychotics is approved for use in children, although doctors can prescribe any medication that has been approved for use.
Experts said that little was known about the use of antipsychotics in minors: only a handful of small studies have been done in children and adolescents.
"We are using these medications and don't know how they work, if they work, or at what cost," said Dr. John March, a professor of child and adolescent psychiatry at Duke University. "It amounts to a huge experiment with the lives of American kids, and what it tells us is that we've got to do something other than we're doing now" to assess the drugs' overall impact.
But many child psychiatrists say that antipsychotic medication is the best therapy available for children in urgent need of help who do not respond well to other treatments. Without them, they say, many unpredictable, emotionally unstable children would end up institutionalized.
[ More at link above ]
Posted by med_empowered on June 8, 2006, at 0:01:35
In reply to APs in kids and teens (NY Times), posted by pseudoname on June 7, 2006, at 21:44:59
its ridiculous. When thorazine and the other phenothiazines first hit the scene in the 50s, there were studies on using them in "hyperkinetic" (ADD, ODD, generally diffiult kids). Now, we've come full circle--perhaps in 20 years shrinks will own up to how potentially damaging these medications can be to anyone, especially young people.
Posted by SLS on June 8, 2006, at 6:30:45
In reply to Re: APs in kids and teens (NY Times), posted by med_empowered on June 8, 2006, at 0:01:35
> its ridiculous. When thorazine and the other phenothiazines first hit the scene in the 50s, there were studies on using them in "hyperkinetic" (ADD, ODD, generally diffiult kids). Now, we've come full circle--perhaps in 20 years shrinks will own up to how potentially damaging these medications can be to anyone, especially young people.
Nice to see you again.
:-)
I think these drugs have a place in treating certain pediatric conditions. I'm sure that they are overprescribed, though. There ought to be a coherent set of guidelines or a consensus as to when their use is appropriate.
- Scott
Posted by heaven help me on June 8, 2006, at 11:17:21
In reply to APs in kids and teens (NY Times), posted by pseudoname on June 7, 2006, at 21:44:59
I am reading "The Bipolar Child" book and find it to be and EXCELLENT resource addresing the use of such meds in children. My son has suffered depression his whole life (only 11 years-how sad) and this book has been a tremendous aide in helping us decide what to do to help him. I highly recommend it.
blessings
mary
Posted by pseudoname on June 8, 2006, at 11:39:56
In reply to Re: APs in kids and teens (NY Times), posted by heaven help me on June 8, 2006, at 11:17:21
Thanks, Mary. This sounds very interesting. I don't have a child and I'm not bipolar, but I'm ordering it from the library. I'd like to see how much I can relate to from my own childhood. Or adulthood.
"The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder" by Demitri & Janice Papolos (2nd ed; 2002)
Posted by honeybee on June 8, 2006, at 11:47:04
In reply to “Bipolar Child” book » heaven help me, posted by pseudoname on June 8, 2006, at 11:39:56
The Papalos have excellent credentials and, really, this book is considered the "gold standard" (or, in industry speak, is the category killer). No other book on bipolar disorder in children will likely ever be able to overshadow it.
That said, I haven't read it! I've just heard people talk a lot about it. And all I hear about the authors are good things.
Posted by pseudoname on June 8, 2006, at 12:43:40
In reply to Re: “Bipolar Child” book, posted by honeybee on June 8, 2006, at 11:47:04
From Tuesday’s “One Good Thing” blog, by a mom who just met her kid Alex’s kindergarten teacher:
> I gave her a Ritalin pill and told her she could either give it to Alex at noon or take it herself. It didn’t matter which…
Posted by MidnightBlue on June 8, 2006, at 17:32:11
In reply to “Bipolar Child” book » heaven help me, posted by pseudoname on June 8, 2006, at 11:39:56
I have this book. It is very interesting. We had wondered if our daughter was bipolar. She wasn't.
MB
> Thanks, Mary. This sounds very interesting. I don't have a child and I'm not bipolar, but I'm ordering it from the library. I'd like to see how much I can relate to from my own childhood. Or adulthood.
>
> "The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder" by Demitri & Janice Papolos (2nd ed; 2002)
Posted by linkadge on June 8, 2006, at 19:20:23
In reply to Re: “Bipolar Child” book » pseudoname, posted by MidnightBlue on June 8, 2006, at 17:32:11
Its discusting.
Linkadge
Posted by pseudoname on June 8, 2006, at 20:24:10
In reply to Re: “Bipolar Child” book, posted by linkadge on June 8, 2006, at 19:20:23
> Its discusting.
The book? Or what do you mean?
Posted by pseudoname on June 9, 2006, at 10:47:15
In reply to APs in kids and teens (NY Times), posted by pseudoname on June 7, 2006, at 21:44:59
NPR’s “Science Friday” today (Jun 9 2006) will discuss the New York Times article about increasing antipsychotic use in children and teenagers. The guests will be social work prof David Cohen on the “THIS IS BAD” side and psychiatry prof Jeffrey Lieberman on the “No it’s GOOD” side.
It’s a live, call-in show. Call 1-800-989-8255 during the segment or email comments in advance to scifri@sciencefriday.com. This will apparently be the first segment, beginning at 2:08 PM Eastern in the U.S. Listen live online, find a station, or later get the archived version at http://www.sciencefriday.com/pages/2006/Jun/hour1_060906.html
Cohen co-wrote the Public Library of Science article “Do Antidepressants Cure or Create Abnormal Brain States?” in the current PLoS Medicine (v7 n3): http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10%2E1371%2Fjournal%2Epmed%2E0030240
Lieberman is chair of psychiatry at Columbia. His research supports the use of the newer atypical APs over the older APs. http://nyspi.org/kolb/News%20Releases/liebermanstudy.htm
Posted by pseudoname on June 9, 2006, at 11:39:48
In reply to APs in kids on radio today, posted by pseudoname on June 9, 2006, at 10:47:15
Okay, maybe nobody would be interested in this but me, and me only because I'm avoiding doing scarier things (like going outside). I thank you for your gracious indulgence.
These are pictures of the two guys in the radio debate about antipsychotic use that starts in 90 minutes:
•social work prof David Cohen (ANTI drug)
http://www.ahrp.org/cms/images/board/cohen.jpg•psychiatrist Jeffrey Lieberman (PRO drug)
http://www.cumc.columbia.edu/news/in-vivo/Vol3_Iss11_nov_dec_04/img/jeff_lieberman.jpg
Posted by ed_uk on June 9, 2006, at 15:00:41
In reply to APs in kids on radio today, posted by pseudoname on June 9, 2006, at 10:47:15
I think it's inevitable that the more children take stimulants, the more will end up on APs.
Ed
Posted by pseudoname on June 9, 2006, at 15:18:46
In reply to APs in kids on radio today, posted by pseudoname on June 9, 2006, at 10:47:15
Both Cohen (the social worker) and Lieberman (the pdoc) constantly interrupted each other, talked over the other's turn so that nothing could be understood, did not reply to the other's substantive points, and engaged in ad hominem attacks. Purile.
I wanted to shout at them, What the h*|| is your problem! Stop interrupting each other!
Lieberman ultimately demonstrated the worst behavior with this snotty rebuttal: "Dr Cohen, are you a psychologist or a social worker? So you have no scientific or medical background."
If I were refereeing a debate, Lieberman would've defaulted at that point.
Desperate to regain deference to his psychiatric majesty, Lieberman ended the show with this pointless jab: "The journals that [Dr Cohen] publishes in are not considered to be very influential."
Oh, well. That's that, then. Q.E.D.
Lieberman also misrepresented Cohen's paper as saying that there is no underlying biology to depression, that depression is just "angst in living" and "disappointments." Cohen is actually more coy than that in the paper, never quite asserting one way or the other whether depression may have a biological basis. That sort of smarmy equivocation seems like a much more darning criticism of the paper. Didn't Lieberman actually read it?
Cohen is hardly blameless. He seems to have a Peter Breggin-ish anti-medication agenda. He makes too many arguments at once, latching onto anything that makes medication use look in any way dubious. That sort of attitude just tires me, and it detracted from any worthwhile points he was making.
For example, I have never understood how anyone can get behind the claim that psychiatric medicines target the symptoms, not the underlying disease. Cohen seems to think this is some kind of objection to their use. How?!
I think Cohen's drug-centered (as opposed to disease-centered) model of drug treatment for depression is fairly attractive, but I also think that a lot of pdocs and patients already think in those terms fairly often. People should be more explicit about it and that would be useful, but outside of psych med advertisements and naive GPs, it is hardly the radical new paradigm he thinks it is.
Anyway, the disease model (i.e., abnormality) was created long before drug treatments and is wholeheartedly embraced in non-drug treatments like psychotherapy by social workers.
Cohen made the great point that scientific research evidence doesn't seem to have much impact on what prescribers do.
At bottom, Cohen and Lieberman disagreed about whether the use of psych meds in the population as a whole helps or hurts. Cohen says they may mean as much harm to some people as benefit to others. Lieberman just trotted out a list of celebrities who've been helped by drugs; he seemed to have no comprehension of Cohen's point.
Posted by linkadge on June 9, 2006, at 15:50:28
In reply to Re: “Bipolar Child” book » linkadge, posted by pseudoname on June 8, 2006, at 20:24:10
Sorry I should have been more clear.
I think it is discusting the way that these medications are used so freely in children.
It is one thing that my doctor can hand me a prescription after 3-5 minuates saying that he knows which of my chemicals are imballenced, but another to do the same in a child.
There are *so* many other reasons that children can manifest the symtpoms which are currently being treated with AP's.
The developing mind is very precious. It should not be treated so carelessly.
Linkadge
This is the end of the thread.
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