Scared From Treatment
Although the intent of the FDA's Black Box Warnings is to educate doctors, patients, and parents about the potential side effects of medications, I'm concerned that when combined with sensationalized and distorted media reporting, they frequently create unnecessary fear and the decision to stop treatment or to not seek treatment at all.
Tragically, current evidence suggests that the black box warning regarding the use of antidepressants in children and adolescents is related to a dramatic increase in the number of suicides. Ever since SSRI antidepressants have been prescribed to treat depression in children and adolescents, the annual rate of youth suicide has steadily declined. A media frenzy started in 2003 when committee meetings were held at the FDA to discuss data suggesting that a very small number of youth experienced an increase in suicidal thoughts shortly after an antidepressant had been started. The result of this frenzy was a 20% decline in the number prescriptions written for antidepressants for children and adolescents in 2003, and a very disturbing increase in suicides by 18.2% from 2003 - 2004.
There is now a media frenzy over the black box warnings regarding medications for the treatment of ADHD and the potential for cardiac side effects in someone with structural cardiac abnormalities or heart disease, which has frightened many parents and care providers. Yet untreated ADHD is related to increased rates of academic failure, low self-esteem, alcohol and drug use in adolescents and adults, motor vehicle accidents, relationship problems and occupational problems. Some children with ADHD are "traumatized" and demoralized by frequent negative interactions with teachers and peers and live in fear and humiliation, and "give up" on learning.
While it's very important that accurate information regarding medications and their potential side effects is well known to doctors, patients, and parents, there shouldn't be the effect of scaring people without risk factors away from needed treatment. Black box warnings need to do far more than identify risk factors of medications, as often the risk of not providing treatment far outweighs the risk of providing it. They should also include, "Warning: untreated depression is a major cause of suicide. Warning: untreated ADHD is a major cause of..."
Related Topics: Technorati Tags: ADHD, FDA, black box warning, ADHD medication, SSRI, suicide, health-and-wellness
Tragically, current evidence suggests that the black box warning regarding the use of antidepressants in children and adolescents is related to a dramatic increase in the number of suicides. Ever since SSRI antidepressants have been prescribed to treat depression in children and adolescents, the annual rate of youth suicide has steadily declined. A media frenzy started in 2003 when committee meetings were held at the FDA to discuss data suggesting that a very small number of youth experienced an increase in suicidal thoughts shortly after an antidepressant had been started. The result of this frenzy was a 20% decline in the number prescriptions written for antidepressants for children and adolescents in 2003, and a very disturbing increase in suicides by 18.2% from 2003 - 2004.
There is now a media frenzy over the black box warnings regarding medications for the treatment of ADHD and the potential for cardiac side effects in someone with structural cardiac abnormalities or heart disease, which has frightened many parents and care providers. Yet untreated ADHD is related to increased rates of academic failure, low self-esteem, alcohol and drug use in adolescents and adults, motor vehicle accidents, relationship problems and occupational problems. Some children with ADHD are "traumatized" and demoralized by frequent negative interactions with teachers and peers and live in fear and humiliation, and "give up" on learning.
While it's very important that accurate information regarding medications and their potential side effects is well known to doctors, patients, and parents, there shouldn't be the effect of scaring people without risk factors away from needed treatment. Black box warnings need to do far more than identify risk factors of medications, as often the risk of not providing treatment far outweighs the risk of providing it. They should also include, "Warning: untreated depression is a major cause of suicide. Warning: untreated ADHD is a major cause of..."
Related Topics: Technorati Tags: ADHD, FDA, black box warning, ADHD medication, SSRI, suicide, health-and-wellness
6 Comments:
Hi Doc,
I am respondining to your "Scared From Treatment" article. I am an example of your statements in your article. I was taken off Ritalin when I was 16 (1977) because the doctor beleived I shouldn't be on Ritalin after 16 (according to my mother). It took from grade 2 to 7 to find out I was ADDHD. I put my parents through hell until they found out I was ADDHD. I dropped out of high school & eventually started medicating myself with alcohol & pot. I tried suicide too,not long after that. I am taking Celexa which gives me a better outlook on life & helps me focus,but I would like to to try some meds for ADD.
Helpful resource for those on the fence about medications; well balanced
"Making the Connection: A Parent's Guide to Medication in ADHD" by Mohab Hanna
I started Paxil in 1995 after a divorce. I put on 50 lbs. immediately and I had always been a thin person. And the worst, I had chronic suicidal thoughts over a few years. I planned and planned. It was all consuming. I took 40 mgs. One day I finally tolds my psychiatrist, in Orlando, FL and so he upped me to 60 mgs. That put me over the edge and I had two suicide attempts. With much pain, discomfort, and agony I finally weaned off the dreaded Paxil and am now living a peaceful and happy non suicidal life on lexapro. The weight also fell right off. And the clincher? I was between 47-51 years of age when all this happened to me. Not a child, not a young person, but a middle aged. person. Paxil is a dreaded and scary drug. If it happened to me, it could happen to anyone.
I think this was an awesome article!! Especially the comment about how Non-treatment increased odds of etc. That was great. What I think that is the worst part isa that some of those drugs really do a lot of good for some people. Just because a few people had bad experiences doesn't mean that it can't help someone else. My sister has taken all sorts of different drugs before she got the right combination for her. And that med combo isn't the same that works for her daughter. If people would tell their doctors what is going on, then the drug can be changed etc.
Even if it is a very small percentage that become suicidal from taking anti-depressants given the huge number of children taking drugs that were never tested on them it is a serious problem.
Nearly all of the school shootings in the past few years have been by young men who were taking SSRI's. The Chicago Tribune reports that Cho Seung Hui, the Virginia Tech shooter who killed 32 fellow students in a shooting rampage, was taking antidepressant drugs and so were the kids at Columbine.
Suicide is actually extremely rare among high school students although there are lots of young women who make attempts or feel suicidal.
When it comes to Ritalin I have to really wonder why anyone would give a child with a developing brain a class II drug with high abuse potential before they exhaust every other method possible. I wouldn't let my kids take meth and giving a child amphetamines (that is what Ritalin is) isn't all that different.
It is interesting that in China when you go into a class and they point out which children have ADD or ADHD that they would be the most well behaved children here in the states. Perhaps what has happened is simply that parents are over-worked and kids are overstimulated. (I do think some kids do need drug treatment and have ADHD but not the vast majority)
There is nothing wrong with having add/adhd/ or addhd. Unfortunately i have addhd, which makes it hard me to do a lot of things, but over the years ive gotten better at handling it without the meds. I can agree that we have become a society where we can "cure anything". it's terrible because some kids react different to ritalin or whatever meds theyre put on and they don't know any better. i think people should put more time aside to work with children with adhd, add, or addhd. there's nothing wrong with having it?
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