Antidepressants/Suicide and Teenagers

[C.Ann]

Okay - I just had a minute to read through some of the info and this is the part that confuses me in regards to the hearings and the numbers:


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Baum Hedlund, a Los Angeles based law firm that represents thousands of victims adversely effected by the SSRI antidepressants (including more than 20 families whose children either committed suicide or attempted suicide while on an SSRI) is skeptical about the February 2, 2004 FDA Advisory Committee Meeting.
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If I'm reading this right, the number "thousands" represents those that were adversely effected (which would mean anything from unpleasant side effects to possibly behavioral problems) but the actual number of attempted and/or successful suicides was something over 20 - correct?

If thousands of children had attempted and/or were successful in their suicide attempts, the media would have had a field day with that.. I must have misunderstood the original post because I thought it meant that "thousands" of kids had actually died or came close to it.. No way I could miss THAT on the news - LOL..

Another interesting tidbit in that link was that they're thinking Prozac may be suitable for children, yet I specifically remember a big bru ha ha about that drug being responsible for suicidal actions and thoughts when it first came out..

 

[C.Ann]

Sorry, but I'm posting as I'm reading each one of the links provided..

This one confuses me even more!
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FDA issues suicide caution for antidepressants
Monday, March 22, 2004 Posted: 10:08 PM EST (0308 GMT)



The FDA said patients on certain antidepressants should be monitored closely for warning signs of suicide.

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WASHINGTON (AP) -- Patients on some popular antidepressants should be closely monitored for warning signs of suicide, the government warned Monday in asking the makers of 10 drugs to add the caution to their labels.

Although the Food and Drug Administration's investigation into the possible suicide connection initially focused on children given the drugs, its warning is aimed at both adult and pediatric use of the pills to alleviate depression.

It isn't clear yet that the drugs actually do lead to suicide, the FDA stressed. After all, depression itself can lead to suicide.

But until that is settled, advisers to the FDA called last month for stronger warnings to doctors and parents that the antidepressants may cause agitation, anxiety and hostility in a subset of patients who may be unusually prone to rare side effects.

On Monday, the FDA followed its advisers' recommendation and issued a public health advisory putting doctors, patients, families and other caregivers on notice to be particularly vigilant for signs of worsening depression or suicidal thoughts at the beginning of anti-depressant therapy or whenever the dose is changed.

The drugs of concern are all newer-generation antidepressants: Prozac, Paxil, Zoloft, Effexor, Celexa, Remeron, Lexapro, Luvox, Serzone and Wellbutrin. Most are known to affect the brain chemical serotonin.

British health authorities sounded the alarm last year, saying long-suppressed research suggests certain antidepressants might sometimes increase the risk of suicidal behavior in children and teenagers. Because only one drug, Prozac, has been proven to alleviate pediatric depression, Britain declared others -- drugs called SSRIs and their close relatives -- unsuitable for depressed youth.

The FDA issued a caution on pediatric use last year, but Monday's action -- especially the addition of the warning to drug labels -- goes significantly further.

Dozens of anguished parents pleaded with FDA in a meeting last month to add such warnings, citing preteens and teenagers who hanged themselves or slashed their wrists shortly after starting the antidepressants. Parent after parent described children who had become extremely agitated or anxious shortly after starting the antidepressants, and seemingly sudden impulses that turned deadly.

Among 25 studies of the suspect medications involving 4,000 children and teens, there were no completed suicides. But 109 patients experienced one or more possibly suicide-related behaviors or attempts, the FDA says.

The studies varied dramatically in what was considered suicidal behavior, making a clear link difficult, FDA scientists have contended. For example, among 19 patients classified as cutting themselves, almost all were superficial, with little bleeding.

Worse, the youths most likely to commit suicide weren't allowed into those studies, so existing data likely won't settle the issue, the FDA's scientific advisers have warned.

Depression occurs in up to 10 percent of youth, and 1,883 10- to 19-year-olds killed themselves in 2001. Some 1.8 million teenagers attempted suicide that year, a quarter of them requiring medical attention, according to Columbia University scientists who are helping the FDA's probe.

In 2002, almost 11 million prescriptions were dispensed to patients under 18 for SSRIs and other newer antidepressants, to treat depression and a host of other conditions, FDA said.



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Copyright 2004 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.

 

[lsyorke]

My reason for bringing this up is to educate people on the "possible" adverse effects of the category known as the SSRI's. Not all people have reactions as severe as others, but we all have the right to know that these reactions are possible. These drugs have never been approved for the pediatric population!!!! The GlaxoSmithKline clinical trials show they had the same effect in the major indices of depression as a placebo. If they work for your child great, but you have to be aware that there is a withdrawal process associated with stopping these drugs. Most patient aren't given this information from their doctors. The reasons for being placed on these meds must be explored FULLY before starting.Psychotherapy should be mandatory when these drugs are in use. In the last week I have talked to two Moms whose kids are on Paxil, one for Moodiness(13 year old girl) and one 13 year old boy for "anger".
I don't deny that there is Mental Illness in children that must be medicated to control but these drugs are being prescribed to "treat" normal teenage behavior,annoyance behavior, and transitional panic/anxiety. I fell into this trap with my son. I thought I was going to make him feel better, instead it almost killed him.

 

[caitycaity]

lsyorke, are you a medical professional?

 

[holycow]

This was the thread I read about the allegra on ...haven't done any research myself just happened to read it today...


http://www.disboards.com/showthread.php?s=&threadid=555774&highlight=+allegra

she mentions it on page one about 1/2 way down.


Lisa

 

[C.Ann]

Originally posted by lsyorke
In the last week I have talked to two Moms whose kids are on Paxil, one for Moodiness(13 year old girl) and one 13 year old boy for "anger".
I don't deny that there is Mental Illness in children that must be medicated to control but these drugs are being prescribed to "treat" normal teenage behavior,annoyance behavior, and transitional panic/anxiety. I fell into this trap with my son. I thought I was going to make him feel better, instead it almost killed him.

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I agree with you 100% on that.. A general practitioner or pediatrician should NEVER prescribe these types of drugs for children.. A complete work-up by a psychiatrist (not a social worker, psychologist, or PA) should be performed and the psychiatrist should prescribe and oversee the drug if it's deemed necessary..

Another problem is the withdrawl from antidepressants - which MUST be monitored by a psychiatrist.. Many drugs (not only those used for depression and such) can have devastating consequences if the patient abruptly stops taking them.. A long, slow weaning off period is of the utmost importance..

There are no easy answers for sure, but for anyone who feels that they - or their child - should no longer be on these meds, the most important message is do not stop them abruptly without following a set schedule from the psychiatrist who is overseeing the situation..

And I'm still confused as to why they seem to think Prozac for children is okay now.. Do you know why that is?

 

[lsyorke]

CAnn, Just to maybe clarify the Baum Hedlum numbers. My son attempted suicide twice, one episode of homicidal ideation, had two episodes of rage, and temporary debilitating depression while withdrawing. These episodes weren't considered "enough damage" for Baum Hedlum to take our case. So I'm assuming that the cases they do have are worse than that. I re read my original post and edited to add the missing debilitating side effects which give us the reported numbers in the thousands. Thanks



I don't really understand the Prozac being OK!!(Ill continue to research as see what I can find) The scariest part with my DS story is he was under he direct care of a psychiatrist who swore he never had any problems with the SSRI's with children, never had anyone go through withdrawal following a "half the dose every two weeks"schedule. The fact that he dropped my son as a patient after the suicide attempt makes sense now. He never had any problems because he never knew what he was seeing!!
Akasthisia is the term used to describe the "group" of side effects that can be exhibited in children on SSRI's.

"In the most recent edition of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (“DSM IV TR”) under Differential Diagnosis it states: “Serotonin-specific reuptake inhibitor antidepressant medications may produce akathisia . . .” “Akathisia may be associated with dysphoria (restlessness, depression & anxiety), irritability, aggression, or suicide attempts.”

The current thinking is that the suicide attempts are an attempt to escape the akathisia, not classically wanting to die. Excessive Pot smoking seems to be a common thread in children as an attempt to calm the inner restlessness.

 

[zurgswife]

My dd was on Paxil for a short time...when we did switch her off...she was put on the liquid form so it could be little bit by little bit...she was sick (stomach aches, flu like symptoms) but it worked...I definately would only recommend Paxil as a last resort for children and only under the direct care of a competant Dr. regular blood test to regulate the level is a good start ...

 

[danacara]

Having done a fair amount of reading on this topic, my opinion (and I am NOT a medical professional) is that the evidence is inconclusive.

I think parents look for reasons, something to blame when this occurs, which is understandable. I think the symptomology that leads to diagnosis and SSRI scripts is the main contributing factor to suicide among this population. It is extremely difficult to control this factor out of a study. To my knowledge, this has not been done to any medically acceptable level as of yet. Therefore = inconclusive.

 

[Bashful2]

lysorke, there's a difference between educating people on the possible dangers of SSRI's and calling for an outright ban in their use in a certain segment of the population. I would hate for these drugs to be unavailable for those children/teens who really need them.

Any parent whose child is prescribed any medication needs to be pro-active and educate himself on possible side effects and dangers of the drugs. He should read all he can, ask questions of the doctor and, if not satisfied, seek a second qualified opinion.

The only qualified professional who should be prescribing and monitoring these drugs is a psychiatrist. I would not think of sending my child to a pediatrician for a psychiatric illness anymore than I would of sending her to a psychiatrist if she had juvenile diabetes.

 

[C.Ann]

It's a tough situation to be in when you don't know for sure how a person is going to respond to any given drug.. Children in particular should be watched extremely closely by everyone involved, but often a parent may voice a concern and the doctor will respond by saying that it's just an "adjustment" period..

I happen to be extremely sensitive to most medications yet often times the doctors just don't "hear" me when I voice my concerns.. I once had to take one tiny pill - prior to a scheduled medical test -and ended up having a severe neurological reaction that is only seen in 1 in 5 MILLION patients! The doctor was so blown away he could hardly believe it - and now takes EVERYTHING I say quite seriously..

If you are a parent - and your child has to take one of these meds (or any other) - you're going to have to be prepared to throw a foot-stomping hissy fit if you notice something out of the ordinary and the psychiatrist doesn't respond to your satisfaction.. And the same goes for the withdrawl period.. A parent is with the child a good portion of the day and night - where the psychiatrist may only see them for an hour or less each week.. Unfortunately that means that the parent has to police the situation and be ready to do whatever is necessary to insure that child's safety - even if it means having them admitted to a mental health unit..

However, I think if you have a good psychiatrist and a good relationship with him or her, these meds can be useful in some situations - provided they are monitored very closely.. We have the numbers of children/teens who have had some sort of adverse effect, but I also have to wonder what the numbers are for those who were definitely helped by these meds and didn't have any serious problems..

 

[Bashful2]

C.Ann, I totally agree with everything you said in your last post.

I am very involved in the medical of my family and myself. Since I'm an RN and most of the doctors I deal with know me professionally, they tend to treat me with a little more credibility to me than they do the average patient. Even so, there have been times when I have had to be very persistent when I have a concern about something. There have also been times at work when I've had to be very persistent when calling an MD about a concern for a patient in the hospital.

I know it's even harder for a layperson to deal with healthcare professionals. I try to listen to my patients, but there have been a few times when I know I could have done better.

 

[Feralpeg]

I took my 16 DD to the doctor because she wasn't sleeping well and just felt poorly. Our regular family doctor was not available, so they had us see his nurse practitioner. She examined DD and decided that her allergies were acting up. She also decided that DD was depressed. We are moving to Florida at the end of May and DD has been anxious. What child wouldn't be. I am! The nurse practitioner decided that DD needed to be on Paxil. I was leary of this, but she said that we should just try it and see how things went. I was not satisfied and put a message out here on the DIS asking for feedback on the subject. Fortunately, several DIS members cautioned me and gave me links to information on the use of Paxil in children. I decided not to put DD on it. We went back to see this woman and told her what I had found. I told her that I was not comfortable putting DD on this medication and that I had read where it was not approved by the FDA for children. She agreed, but said not to worry. Lots of kids were on it. Not good enough. DD is not taking it. By the way, she's doing fine. Her allergies were just keeping her from sleeping.

The reason I bring this up is that it worries me to think of how many other children have been put on drugs without proper testing. Right or wrong, parents often just do what their doctors tell them is best and don't do additional research. Now that I've heard so much about it, I thank God that I didn't put DD on it!

 

[lsyorke]

"We went back to see this woman and told her what I had found. I told her that I was not comfortable putting DD on this medication and that I had read where it was not approved by the FDA for children. She agreed, but said not to worry"

This is the exact reason I posted originally here!!! The fact that people on this thread are saying that not all children have had problems doesn't mean that some children will! Children with NO suidical ideation, no self mutilation history, no drug history like my son were driven to these thoughts by these medications. My son is off Paxil now and can relate to me what was going through his head at that time. He is now back to his "normal," emotional state. I was wrong in allowing him to be put on Paxil in the first place, but didn't have the information I have now and was led to believe by an adolescent psychiatrist that this was the right thing to do. His answer to my questioning about using this drug in a child was "I've used alot in children and have had no problems". I am an RN and knew nothing about the reactions in children, and after hearing some of the posts here alot of people didn't know either including my fellow nurses.

These drugs are NOT approved by the FDA for use in children(with the exception of Prozac)

 

[Dan Murphy]

's for all.