Antidepressants and children-New Info

PRNMEDS · Sep 18, 2004

I take it you are opposed to the use of SSRI's for adolescents. Curious as to what your testimony was. Also what about all the kids that benefit from SSRIs?

lsyorke, RN · Sep 18, 2004

My testimony was about Paxil turning my son from a child experiencing anxiety to a raging, manic suicidal child. Yes, some children benefit from SSRI's. Why? Its unknown!The uncontrolled altering of seratonin levels is unresearched. The Clinical studies show that they act equal to a placebo and since the placebo effect is more pronounced on children that could be one answer. There is no documented positive effect, but there is a documented negative effect of increased aggression,mania and suicidal ideation. What we heard in the testimony was that those who have benefitted from SSRI's are usually on at least one other psychiatric medication, ie, antiseizure,antipsychotic. It has to make you wonder if the SSRI is a positive effect or contributor to the psychotic behavior.The suicides that were brought up were rapid,violent and showed no warning. The argument that adolescent depression is so hard to treat is real. But that said, most of these children were not put on SSRI's for depression! Anxiety,eating disorders, PMS and migraines were the most common diagnosis' listed. Just because we don't have a "good" medication for children doesn't make it right to continue to use one that is documented dangerous. Parents have a right to know that these are being prescribed off label and need to be made aware of the increased suicidal risk. And if the risk is as high as it's now shown to be a risk, these should be started in a controlled 24 hour observation environment.

talaxandra · Sep 19, 2004

I don't work in psych, or with kids; I have long been concerned about the increasing trend of medicating children, particularly as so many of the drugs are powerful, have significant side-effects, and aren't tested in children.

However, the behaviour of my autistic godson had been worsening since Easter. He's twelve, and went from being increasingly verbal to almost mute; he screamed for twenty hours at a time, threw objects at his teachers, and destroyed a glass door at school; he went from being wholly toilet trained to needing to be dragged, screaming, to the toilet. Starting with needing the lights out in the room he was in, within a month all the lights in the house needed to be off all the time, the curtains had to be closed all the time, and he wore sunglasses all day.

After seeing a paediatrician who specialises in autistic adolescents (who recommended an antipsychotic) he was referred to a paediatric neurologist. The referral letter was read by monitor light. According to the neurologist these symptoms are all manifestations of anxiety, which is not uncommon in autistic kids as they hit adolescence. The better they're doing, the harder they fall.

My godson started on a low-dose SSRI about seven weeks ago - he's now up to second-daily doses. He laughs, talks (a little), and the lights are not only on but the curtains can be open on occasion.

While I agree that these drugs should be used with caution, and parents should be told more about them, there are clearly situations where they are an appropriate treatment.

lsyorke, RN · Sep 19, 2004

I'm glad that your son is doing better Tala. My concern is the lack of accurate information that is provided on these drugs so that parents can make an informed decision. We're you made aware that the suicide risk is increased, that if at any point these drugs can "stop" working requiring higher doses, that at higher doses the suicide risk is even higher, that a large percentage of the population go through protracted withdrawal when trying to stop these drugs(even with a slow wean). If you feel comfortable with the use of SSRI's thats OK, but you have the right to all the information that is out there. My son did wonderful on Paxil for the first three months and then the drug pooped out. Final dosage was 50mg of Paxil CR. More that twice the recommended dosage. Withdrawal was horrible. Anger, anxiety,"brain zaps",insomnia etc... He is now off totally for 4 months and still has concentration problems that are keeping him out of school. Hopefully this will resolve soon. He is 95% himself again. I lost my child for 13 months on this drug. He became someone I didn't even recognize. He's back now!!

As a nurse I trusted the doc's to do the research before prescribing any medications. My faith in the system is shaken. I no longer take any medication without doing my own research and making my own conclusions. Yes, I now read clinical trials! This is what we are all under the impression that the FDA does. Not so! Until we have registry of all clinical trials requiring that all trials be submitted ,the drug companies can still "hide them in a drawer" if their not good.

I just took 6 hours to listen to the Congressional investigation hearing into this whole subject and was SHOCKED to learn that 75% of the drugs prescribed to pediatric patients are prescribed off label. What a sobering thought that the efficacy and safety in the pediatric population is very rarely the subject of a clinical trial even though the drug companies know that their being prescribed. This is unbelieveable!!

CliveUK · Sep 21, 2004

I take it you are opposed to the use of SSRI's for adolescents. Curious as to what your testimony was. Also what about all the kids that benefit from SSRIs?

Horses for courses, I suppose. Some kids get on with them, others don't. I guess the point is that the drugs companies should have been upfront and honest about the side effects, allowing patients a real choice, rather than practising the worst kind of snake-oil salesmanship in pushing SSRIs as some sort of panacea.

lsyorke, RN · Sep 21, 2004

The sad part is that I now deal with a child who experiences anxiety and has NO faith in the mental health system.

talaxandra · Sep 22, 2004

lsyorke, I'm sorry that your (and your son's) experince was so shattering - I can completely understand your feelings of anger and betrayal.

In case I wasn't clear in my original post, I too am opposed to what looks like a trend of massively medicating kids, particularly as a first-line course of action, and I agree that we don't know enough about them or their effects. My friend, who's son is autistic (not my son - I don't have children) was offered meds when her son was diagnosed, at the age of three, and the doc seemed surprised that she didn't want to sedate him for life.

StuPer · Sep 22, 2004

Hi Isyorke,

While obviously not knowing all the details of your son's situation I think its telling you wrote "Final dosage was 50mg of Paxil CR. More that twice the recommended dosage" those recommendations are there for a reason, and I would be looking at the physician who prescribed such a dose with a critical eye. Having said all that I too am against the prescription of powerful neuroleptic medication in minds that have not finished developing.

A short term fix may create a longer term problem... we just don't know... I feel looking at my own kids and those of people I know, that society and the way it is has changed (for the worse) is the reason many of these children run into problems, rather than they themselves being different and requiring medications. Maybe I'm just too naive... ho-hum

regards StuPer

lsyorke, RN · Sep 23, 2004

The physician will have to answer this. I was very uninformed, even as a nurse, to the problems with paxil until it became too late. I did the normal research ie drug insert,pdr, official websites and found nothing that would have made me question this doc. I asked about it's use in a 14 year old and was told "I've never had a problem in all my years prescribing it". My child was hurting and I wanted it fixed. I live with that guilt everyday!! I now know that I trusted him to fast, but heck that's my field and never really had a distrust of any doctor. As more and more information comes out on the SSRI's I can tell you now that I trust NO DRUG COMPANY!! I used to read the natural remedy stuff and think it was quackery. I read with an open mind now.

StuPer · Sep 24, 2004

I don't know if you caught the newsflash, but several of the worlds most important journals held a conference earlier in the year, and in the last few weeks announced a joint communique. In future they will not publish any evidence from drug trials unless the company concerned has set up a register of all research pertaining to a drug and that all the research is available, not just the positive trials.

I think its significant that the journals themselves came up with this measure, surely this should have been mandatory years ago and the subject of legislation.... wonder why it has'nt been

In theory this should mean any medication which does'nt demonstrate a clear benefit, without serious side-effect, never gets out of the lab...... here's hoping... next maybe the provision of drug company perks will be banned by the collective medical profession..... yeah right...

regards StuPer

lsyorke, RN · Sep 24, 2004

Stu, this is something we've been fighting for. At least if the clinical trials are tracked from inception in a MANDATORY registry the information will be there for those who want to see. Now getting doctors to read them is another story. Here's the latest report on the Congressional hearing into the FDA

http://www.nj.com/business/ledger/index.ssf?/base/business-0/1096004468320890.xml