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Friday 29 January 2016

BRITISH MEDICAL JOURNAL - Children who are prescribed a common antidepressant could be at a higher risk of suicide and aggressive behaviour, it has been claimed. - Courtesy of BMJ Website

Children who are prescribed a common antidepressant could be at a higher risk of suicide and aggressive behaviour, it has been claimed.
Researchers said that children and adolescents have a doubled risk of aggression and suicide when taking selective serotonin and serotonin-norepinephrine reuptake inhibitor drugs to combat depression.
The authors recommended “minimal use of antidepressants in children, adolescents, and young adults” after releasing their findings. The researchers stressed that there is not enough patient data available from clinical trials to assess the true risk of all associated serious harms.
The study, published in the BMJ, examined clinical study reports of 70 trials with 18,526 patients. The researchers, from Denmark, found no significant link between antidepressants and suicide and aggression among adults, but in children and adolescents the risk doubled.
“We suggest minimal use of antidepressants in children, adolescents, and young adults as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant,” the authors wrote.
“Alternative treatments such as exercise or psychotherapy may have some benefit and could be considered.”
The research led one expert to call for stricter prescribing rules. Shirley Reynolds, professor of evidence-based psychological therapies at the University of Reading, said that only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.
“Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication,” she said.
“But do the results mean that children and young people should never be prescribed antidepressant medication? No. There are alternative treatments and all young people should be offered an evidence-based psychological treatment immediately.
“However, antidepressants should be available when a young person does not respond to psychological treatment or does not want psychological treatment.
“Combining antidepressant treatment and psychological treatment is associated with improved outcomes and can lead to more a rapid reduction in symptoms.
“But only a specialist child and adolescent psychiatrist should prescribe antidepressant medication to children and young people and all children and young people who are prescribed antidepressants must be carefully and regularly monitored.”
However, Dr Mara Parellada, specialist in child and adolescent psychiatry at Complutense University of Madrid, said of the research: “The results from this study do not allow us to state that ‘antidepressants double the risk of aggression and suicide in children’.
“There was no single death by suicide in children and adolescents in the 70 trials reviewed for the article.”
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14

Monday 11 January 2016

Being Bullied by Age Eight Linked to Depression in Adulthood In The News - MadinAmerica January 8, 2016


Being Bullied by Age Eight Linked to Depression in Adulthood

There is a growing body of evidence suggesting that being exposed to bullying in childhood can contribute to mental health problems later in life. In a new study, published in JAMA Psychiatry, the researchers found that children who reported being bullied at age eight were significantly more likely to seek treatment for mental health problems by age twenty-nine.
“The findings of the study are important for mental health research, prevention, assessment, and intervention,” the researchers write. “Frequent exposure to bullying at 8 years of age was associated with later adult psychiatric disorders, even in the absence of childhood psychiatric symptoms.”
The study is the largest to date to look at childhood bullying in both boys and girls and includes the longest follow-up period for tracking the participants mental health. It is part of the multicenter Finnish Nationwide Birth Cohort Study which began with a nationwide sample of eight-year-old children in 1981. The connection between bullying and adult mental health problems, while previously examined, is strengthened considerably by this study's size, design, and ability to control for health and demographic factors.
“To our knowledge, the present study provides the strongest evidence todate that frequent exposure to bullying in early childhood increases the risk fordepressive disorder later in life,” they write.
The researchers point out that these findings strengthen psychological explanations of depression. Specifically, the interpersonal theory of depression suggests that our close relationships act as a buffer against depression and that negative relationships in early childhood, through bullying or other types of trauma and humiliation, can disrupt the ability to build and maintain quality relationships.
In their conclusion, the study authors urge parents, teachers, and doctors to take preventative measures to prevent bullying.

Sourander, A., Gyllenberg, D., Klomek, A. B., Sillanmäki, L., Ilola, A. M., & Kumpulainen, K. (2015). Association of bullying behavior at 8 years of age and use of specialized services for psychiatric disorders by 29 years of age.JAMA psychiatry, 1-7. (Abstract)

Sunday 3 January 2016

Children Still in a Crib, Yet Being Given Antipsychotics by the Thousand - Coutesy of The New York Times - Dec 15th 2015

Andrew Rios’s seizures began when he was 5 months old and only got worse. At 18 months, when an epilepsy medication resulted in violent behavior, he was prescribed the antipsychotic Risperdal, a drug typically used to treat schizophrenia and bipolar disorder in adults, and rarely used for children as young as 5 years.

When Andrew screamed in his sleep and seemed to
interact with people and objects that were not there, his frightened mother researched Risperdal and discovered that the drug was not approved, and had never even been studied, in children anywhere near as young as Andrew.
“It was just ‘Take this, no big deal,’ like they were Tic Tacs,” said Genesis Rios, a mother of five in Rancho Dominguez, Calif. “He was just a baby.”
Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-age youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.


Angela Davis, a speech-language pathologist, working with Andrew at home in Rancho Dominguez, Calif. CreditJenna Schoenefeld for The New York Times

Almost 20,000 prescriptions for risperidone (commonly known as Risperdal), quetiapine (Seroquel) and other antipsychotic medications were written in 2014 for children 2 and younger, a 50 percent jump from 13,000 just one year before, according to the prescription data companyIMS Health. Prescriptions for the antidepressant fluoxetine (Prozac) rose 23 percent in one year for that age group, to about 83,000.
The company’s data does not indicate how many children received these prescriptions (many children receive several prescriptions a year), but previous studies suggest that the number is at least 10,000. IMS Health researched the data at the request of The New York Times.
The data did not indicate the condition for which these prescriptions were written. Doctors are generally free to prescribe any medication for any purpose they see fit, so some drugs can occasionally be used in unproven and debatable ways. But the volume and rapid rise in psychotropics such as antipsychotics and antidepressants in children 2 and younger suggest a trend.
In interviews, a dozen experts in child psychiatry and neurology said that they had never heard of a child younger than 3 receiving such medication, and struggled to explain it. They presumed that parents and doctors, probably desperate and well meaning, were trying to alleviate thrashingtemper tantrums — the kind that get children kicked out of day care — or an overly depressed disposition, like being strikingly inhibited, nonverbal or lethargic.
“People are doing their very best with the tools available to them,” said Dr. Mary Margaret Gleason, a pediatrician and child psychiatrist at Tulane University School of Medicine. “There’s a sense of desperation with families of children who are suffering, and the tool that most providers have is the prescription pad.”
But Dr. Gleason said that children with ages measured in months had brains whose neurological inner workings were developing too rapidly, and in still unknown ways, to risk using medications that can profoundly influence that growth. She said the medications had never been subject to formal clinical trials in infants and toddlers largely because of those dangers.
“There are not studies,” Dr. Gleason said, “and I’m not pushing for them.”
Dr. Martin Drell, former president of the American Academy of Child and Adolescent Psychiatry, said he was “hard-pressed to figure out what the rationale would be” for the prescriptions. Similarly taken aback, some experts wondered if the medicine was never actually consumed by the child, or if it was issued in the name of a child covered by Medicaid but in fact taken by an ill parent who was uninsured.
“But where there’s smoke, there’s fire,” Dr. Drell said. “For the protection of kids, we should evaluate this. We should identify who these cases are. Maybe it’s not 10,000, but I’ll be unhappy if it’s even in the hundreds.”
Most experts suspected that the trend of medicating younger and younger children for suspected psychiatric disorders was trickling down to very young children. Last year, a report from the Centers for Disease Control and Prevention found that health care providers had given a diagnosis ofattention deficit hyperactivity disorder to at least 10,000 children age 2 or 3 and then prescribed medications such as Adderall outside American Academy of Pediatrics guidelines.
“I think you simply cannot make anything close to a diagnosis of these types of disorders in children of that age,” said Dr. Ed Tronick, a professor of developmental and brain sciences at the University of Massachusetts Boston. “There’s this very narrow range of what people think the prototype child should look like. Deviations from that lead them to seek out interventions like these. I think it’s just nuts.”
Prozac is approved by the Food and Drug Administration for depression in children 8 and older and for obsessive compulsive disorder in those age 7 and older. Most antipsychotics, which treat schizophrenia and bipolar disorder, are indicated only for children 10 and older. Risperdal is approved for children as young as 5, but only for irritability associated withautism.
Some other psychiatric medications, such as the antianxiety drugs Valium or Klonopin, are widely accepted to control intractable seizures in the very young. Although their effects on the young brain remain unknown, stopping a child’s seizure warrants their occasional one-time use, said Dr. Amy R. Brooks-Kayal, the head of pediatric neurology at Children’s Hospital Colorado and president of the American Epilepsy Society.

Antidepressants and antipsychotic medications, however, have no established use in young people beyond tempering chronically disruptive behavior, experts maintained, suggesting that the drugs were probably used for that purpose.
The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Neurology have no guidelines or position statements regarding use of antidepressants and antipsychotics in children younger than 3.
Finding specific examples of such children taking the drugs can be difficult, because of family privacy concerns or because the practice remains controversial. IMS Health records but does not release the names of prescribing physicians.
Mrs. Rios said that after Andrew began taking the epilepsy medication felbamate, he became strikingly erratic and aggressive: He pushed his siblings down and destroyed toys. She said that Andrew’s neurologist, at Children’s Hospital of Orange County, Dr. Lily Tran, then prescribed Risperdal, medication that can temper severe mood swings in older children.
Andrew took the medication for four months before his mother decided it was causing harmful side effects — behavior he had never shown before — and took him off it. “Everything became worse,” Mrs. Rios said.
Dr. Tran declined an interview request.
The use of Risperdal for children has been hotly debated among child psychiatrists, with some experts — many financially backed by the pharmaceutical industry — citing positive effects among suffering young people, and others criticizing their use as shortsighted responses to complex problems.
“There are behavioral ways of working with the problems rather than medication,” said Dr. Tronick, who runs a program that teaches health care providers to assist families with troubled children. “What is generating such fear and anger and withdrawal in the child? What is frustrating or causing stress in the parent? These are the things that have to be explored. But that takes time and money.”
Many experts say that the rise in the use of all psychotropics in children of all ages derives from the scarcity of child psychiatrists — only 8,350practice in the United States, many of them with long waiting lists and higher cost than a family’s established pediatrician. Those pediatricians receive little training in child psychiatry but are then asked to practice it.