Children under the age of 18 and Prozac

EricJRN, MSN, RN · Oct 25, 2006

Moved to Psychiatric Nursing Forum for more responses.

lsyorke, RN · Oct 27, 2006

This page has the listing of the current FDA warnings on this subject.

http://www.fda.gov/cder/drug/antidepressants/default.htm

Yes, it is a problem. I, unfortunately, experience it with my child.

Nurse`Chief~Chickie · Oct 27, 2006

not that it is without it's risks, but i know it has made a world of difference in my fiancees daughter. she is on it for anorexia nervosa, and she was almost out of control before prozac. besides the an, she lied, stole and had an impressive list of problems. now she is able to talk about her feelings that make her want to engage in whichever activity. i'm so thankful that she tolerates it well. only thing is her sleep cycles, we have to do some trial and error on the dose time, but other than that, it has been a life saver for her/us.

IMustBeCrazy · Oct 28, 2006

I have read various literature regarding children under the age of 18 being prescribed anti depressants. Some of the literature suggests that there may be a higher suicide ideation in these kids. I am just looking for some input here.. any thoughts???
Thanks

My argument against the suicidal ideation data is that this is being compared against what? Those adolescents with depression are *already* in the highest bracket for suicide. Playing devil's advocate, my question would be "how many lives were saved because these highly depressed adolescents DID take Prozac?"

BTW, I'm not a fan of drug companies at all, but I think this "increased suicidal ideation" idea was drummed up by attorneys for the almighty class action lawsuit.

I've seen lots of good results with Prozac in teens. Monitoring is extremely important however for the first few months. Like any psychotropic medication, you need to be keenly aware of the subtle changes in the person using the medication. This is why family is so important as the sentinel in any psychotropic therapy for a loved one.

Also it's important IMO that the person being treated gives at least one person consent to talk to the MD/Psychiatrist re: their care in case there are untoward side effects that need immediate intervention.

lsyorke, RN · Oct 29, 2006

My argument against the suicidal ideation data is that this is being compared against what? Those adolescents with depression are *already* in the highest bracket for suicide. Playing devil's advocate, my question would be "how many lives were saved because these highly depressed adolescents DID take Prozac?"
BTW, I'm not a fan of drug companies at all, but I think this "increased suicidal ideation" idea was drummed up by attorneys for the almighty class action lawsuit.

This argument would fly if all those who attempted suicide were given Prozac, or other ssri, for depression only. The reality is that kids are becoming suicidal on ssri/snri's when it's been prescribed for headaches, IBS,anxiety,anorexia,ADD,insomnia,social anxiety, and warts... yup, one was given this for warts. The "increase suicidal ideation" was drummed up in the clinical trials, not by attorneys. If the drug companies had been forthcoming about this risk, the lawyers wouldn't have any cases. It's the suppression of the data, resulting in missed signs of trouble and subsequent suicides that are causing the lawsuits.

Yes, some are helped by Prozac.. no one is questioning that, but parents and patients have a right to ALL of the potential risks of this category of drugs to be able to monitor any behavioral changes that occur. Denying that this possibility exists only puts more at risk, adult and child alike. I lived this reaction with my child.. never depressed, never suicidal.. until paxil.

IMustBeCrazy · Oct 29, 2006

This argument would fly if all those who attempted suicide were given Prozac, or other ssri, for depression only. The reality is that kids are becoming suicidal on ssri/snri's when it's been prescribed for headaches, IBS,anxiety,anorexia,ADD,insomnia,social anxiety, and warts... yup, one was given this for warts. The "increase suicidal ideation" was drummed up in the clinical trials, not by attorneys. If the drug companies had been forthcoming about this risk, the lawyers wouldn't have any cases. It's the suppression of the data, resulting in missed signs of trouble and subsequent suicides that are causing the lawsuits.
Yes, some are helped by Prozac.. no one is questioning that, but parents and patients have a right to ALL of the potential risks of this category of drugs to be able to monitor any behavioral changes that occur. Denying that this possibility exists only puts more at risk, adult and child alike. I lived this reaction with my child.. never depressed, never suicidal.. until paxil.

I agree that if there was clear suppression of facts of clinical side effects, that is another matter.

I know pts that are in on the class action for Seroquel because from (approximately) Oct 2003 - March 2004 there was a known side effect of increased risk of diabetes when taking this med, it was labeled with this side effect in Japan during this time, but never in the US during the same time frame. So if this is a situation like that, then I totally agree.

However, I know when I do med teaching, I tell the families that they are charged with watching for anything unusual AT ALL. Psychotropics are wonderful for the most part, but there are always chances of untoward side effects...they are messing about with brain chemicals after all. I would rather be safe than sorry.

lsyorke, RN · Oct 29, 2006

I agree that if there was clear suppression of facts of clinical side effects, that is another matter.

Yes, there was clear suppression of facts.

http://www.msnbc.msn.com/id/5120989/

http://www.ahrp.org/risks/SSRI0204/GSKpaxil/pg1.html

It's this situation that the lawsuits are stemming from. Now that the FDA warnings addressing this are out, as long as a patient is FULLY informed of the risks there is no basis for a lawsuit. Sadly, few are fully informed.

IMustBeCrazy · Oct 29, 2006

Yes, there was clear suppression of facts.
http://www.msnbc.msn.com/id/5120989/
http://www.ahrp.org/risks/SSRI0204/GSKpaxil/pg1.html
It's this situation that the lawsuits are stemming from. Now that the FDA warnings addressing this are out, as long as a patient is FULLY informed of the risks there is no basis for a lawsuit. Sadly, few are fully informed.

Your child was prescribed Paxil, which is not labeled by the FDA for child/adolescent use. That is a huge red flag. Seems to me, at least with THIS specific drug, your doc could be held wholly responsible for prescribing an offlabel use which was detrimental to your child. I have NEVER seen an adolescent prescribed Paxil on my unit. Ever.

BSNtobe2009 · Oct 29, 2006

I personally, had the privilege of having a Clinical Psychologist as a professor in college. He strongly feels that unless someone is a patient in a hospital setting, the medical doctors of any type should not be permitted to prescribe psychological drugs and these should be strictly prescribed by a Psychiatrist, who has the additional training and can render an opinion if depression really and truly exists.

He also feels that a person should not be permitted to receive a prescription for anti-depressants, initially, without undergoing one-on-one therapy, because it's like treating the symptoms and never treating the disease...how do you expect the disease to ever go away?

I have heard of children as young as 4 and 5 being on anti-depressants, and I have a friend who has a daughter that is 8 years old, that is on them. Want to know why? My friend claims that her daughter is still traumatized by the fact her father ran out on them...she was TWO when this happened...she is traumatized by the fact her mother won't shut up about it over the years and has always kept the drama going and that is what is upsetting her daughter.

I think we are in a society that over-drugs children.

IMustBeCrazy · Oct 29, 2006

I personally, had the privilege of having a Clinical Psychologist as a professor in college. He strongly feels that unless someone is a patient in a hospital setting, the medical doctors of any type should not be permitted to prescribe psychological drugs and these should be strictly prescribed by a Psychiatrist, who has the additional training and can render an opinion if depression really and truly exists.
He also feels that a person should not be permitted to receive a prescription for anti-depressants, initially, without undergoing one-on-one therapy, because it's like treating the symptoms and never treating the disease...how do you expect the disease to ever go away?
I have heard of children as young as 4 and 5 being on anti-depressants, and I have a friend who has a daughter that is 8 years old, that is on them. Want to know why? My friend claims that her daughter is still traumatized by the fact her father ran out on them...she was TWO when this happened...she is traumatized by the fact her mother won't shut up about it over the years and has always kept the drama going and that is what is upsetting her daughter.
I think we are in a society that over-drugs children.

Here is the flaw with that theory.

In the real world, the only time that someone qualifies for inpatient treatment for depression (due to insurance coverage) is 1) if they are suicidal or 2) have attempted suicide. So, what this psychologist is really saying is that he/she is willing to wait until there is a CRISIS...possibly an actual suicide attempt....for depressed persons to receive relief. I would argue the therapeutic benefit of that idea.

While I agree that in a perfect world it would be best for a psychiatrist to adjust meds all the time in an inpatient setting, this is just not practical. As far as other medical personnel (such as PCP's) writing for depression meds, again, this has to do with real world problems. In my area, for example, it is COMMON for new patients to need to wait anywhere from 3 to 6 months for an initial appointment with a psychiatrist. In fact, there is a nationwide shortage of psychiatrists atm. The good ones are telling corps to kiss off and starting their own practices because they don't have to take call or holiday hours AND are able to take the time to treat patients appropriately. Hospitals/clinics are losing talented psychiatrists because they are trying to force patient quotas. That is extremely difficult to do in psychiatry, at least if the provider is actually trying to do a good job with the patient and prevent them from relapsing.

I do agree, however, that counseling is an important part of the treatment process. And, if you REALLY want to try to make treatment successful, you would include not only individual therapy for the depressed person but also group therapy and family therapy. Most people never get or seek that level of aftercare though. Again because they can't afford it or insurance doesn't cover it.

BSNtobe2009 · Oct 29, 2006

Here is the flaw with that theory.
In the real world, the only time that someone qualifies for inpatient treatment for depression (due to insurance coverage) is 1) if they are suicidal or 2) have attempted suicide. So, what this psychologist is really saying is that he/she is willing to wait until there is a CRISIS...possibly an actual suicide attempt....for depressed persons to receive relief. I would argue the therapeutic benefit of that idea.
While I agree that in a perfect world it would be best for a psychiatrist to adjust meds all the time in an inpatient setting, this is just not practical. As far as other medical personnel (such as PCP's) writing for depression meds, again, this has to do with real world problems. In my area, for example, it is COMMON for new patients to need to wait anywhere from 3 to 6 months for an initial appointment with a psychiatrist. In fact, there is a nationwide shortage of psychiatrists atm. The good ones are telling corps to kiss off and starting their own practices because they don't have to take call or holiday hours AND are able to take the time to treat patients appropriately. Hospitals/clinics are losing talented psychiatrists because they are trying to force patient quotas. That is extremely difficult to do in psychiatry, at least if the provider is actually trying to do a good job with the patient and prevent them from relapsing.
I do agree, however, that counseling is an important part of the treatment process. And, if you REALLY want to try to make treatment successful, you would include not only individual therapy for the depressed person but also group therapy and family therapy. Most people never get or seek that level of aftercare though. Again because they can't afford it or insurance doesn't cover it.

I wasn't talking about having to be in a mental hospital, he felt that if they were in a regular hospital, it would be acceptable b/c they would be monitored by hospital staff.

Psychologists (PhD Level) are also well trained in looking for signs of depression during therapy and for assessment of clinical depression. Many mental health practices will schedule folks to undergo evaluations by the Psychologist and are referred to the Psychiatrist for meds only, b/c the Psychiatrist will review the Psychologists' notes in concurring with the fact the the patient needs to be medicated or if they feel that another course of therapy would be more appropriate.

There are just too many deaths, or even worse, people killing other people after there is a history of recent medicine changes or a new prescription....I look closely at these stories...very rarely is a psychiatrist or a psychologist involved at all.