Local Doctors React to Kids and Antidepressants

September 21, 2004

I think the Psychiatrists should all fess up and tell the truth. They don't have

any solutions

but drugs and if those are taken away, God forbid, " what will I do for a

living? "

" I vill continue to drug zee children!!! "

http://www.theledger.com/apps/pbcs.dll/article?AID=/20040921/NEWS/409210301/1021

Published Tuesday, September 21, 2004

THE WORRY ABOUT WARNINGS

Local Doctors React to Kids and Antidepressants

By White

The Ledger

gary.white@...

Dr. Teston, during 12 years as a psychiatrist treating children and

adolescents, has prescribed antidepressants to dozens of patients.

Teston has no intention of removing those medications from her arsenal of

treatment options. But she worries that negative publicity arising from recent

Congressional hearings -- and the prospect of stark warning labels linking the

drugs to suicide -- will have a chilling effect, scaring some doctors away from

prescribing the drugs to youths and prompting more parents to refuse such

treatment for their children.

" That is going to be somewhat unfortunate since the evidence we have is that

antidepressants really do help, " said Teston, who practices at Lakeland's

Clinic.

" I'm going to continue, because I don't think there's anything we know that

gives us a reason not to prescribe. . . . I think the potential benefits of

using antidepressants that I've seen in my practice greatly outweigh the risk. "

The Food and Drug Administration earlier this year added cautionary language to

the packaging of antidepressants, and an advisory panel last week recommended

prominent, black warnings on container labels. The FDA announced plans to push

for the warnings but did not provide a schedule.

The widely publicized hearings followed clinical studies that found a slightly

increased risk of suicidal behavior among youths treated with newer

antidepressants, such as Prozac, Paxil, Effexor, Zoloft, Lexapro and Wellbutrin.

Only Prozac has been approved by the FDA as a treatment for depression in those

younger than 18. But the common practice of " off-label " prescribing allows

psychiatrists and pediatricians to use other antidepressants in their treatment

of youths.

The FDA hearings have stoked debate over the safety of that practice. Dr.

Schick, a Lakeland pediatrician, has long prescribed such medications for mood

disorders. Though firmly convinced of the drugs' efficacy, she said the studies

have made her more hesitant to prescribe them.

" Since the warning has been out (on packaging), I've been a little wary of

putting new patients on these medications, " Schick said. " It's a shame. I've

discussed it with all of my patients already on the medications, and none of

them have chosen to come off the medications because the children are doing so

much better. "

Schick, who has practiced for 21 years, now refers most new patients to a

psychiatrist rather than start them on antidepressants. Studies of depression

have found the best results come from a combination of counseling and

medication, but Schick said funneling patients to psychiatrists or mental health

facilities can hinder prompt treatment.

Many patients' medical plans, she notes, do not cover the full cost of mental

health treatment. Low-income patients on Medicaid in Polk County are referred to

either Peace River Center or Winter Haven Behavioral Health Care, high-demand

facilities that often have waiting lists, and Schick said some parents give up

before receiving treatment.

Dr. a Mimms, medical director at Peace River, said she has not been deterred

from prescribing antidepressants to youths. She estimates the facility has about

2,400 current patients younger than 18 who are being treated for mood disorders.

Mimms said her staff carefully explains the treatment risks to parents, who must

sign a consent form before medications are prescribed.

" If a child is truly mentally ill and having problems, we would be remiss in our

duties if we know we have a medication that can help them and we didn't give it

to them, " said Mimms, a child and adolescent psychiatrist. " I haven't had any

adverse reactions or suicides. I've had more positives and no negatives, but I

guess I've just been lucky. "

According to FDA figures, more than 10 million prescriptions were written in

2002 for patients younger than 18. While studies have raised concerns about the

drugs generally, Paxil and Effexor have attracted the most scrutiny. A lawsuit

by New York State Attorney General Elliot Spitzer prompted Paxil's manufacturer,

GlaxoKline, to release study results it had previously withheld.

Teston said she welcomes more studies of antidepressants. She expressed concern

over a recent trend in which drug studies are increasingly conducted by

manufacturers rather than independent agencies.

" The problem has been the pharmaceutical industry's interests and values are not

necessarily the same as the public's best interest and what the government would

set as standards, " Teston said. " So there have been some concerns about bias and

withholding information. "

Teston says a crucial statistic has gone overlooked in the debate: The suicide

rate among teenagers has decreased by about 25 percent in the last decade, a

period during which medication use by teens has become much more common.

The psychiatrist now uses Prozac as the " first-line " treatment for pediatric

patients. She refrains from prescribing Paxil or Effexor to new patients, though

she continues to treat some patients with those drugs.

The British government banned prescriptions of Paxil for youth last year after

studies found a higher incidence of suicide attempts by patients on the drug

than by those given placebos. Teston worries about such a ban in this country.

" Patients are different in terms of which medications work for them, " Teston

said, " and it's very important for us to be able to have the full range of

options for treating children, just like we have a full range of treatments with

adults. "

She has closely followed advisories from the American Psychiatric Association,

which supported the FDA actions but issued a statement saying medication " can be

extremely helpful and even lifesaving for many young people struggling with

depression. " The group added, " We believe the biggest threat to a depressed

child's well-being is to receive no care at all. "

Haines City resident Ed Albright, a licensed mental health counselor, said

experience has taught him that children with mood disorders often benefit from

antidepressants.

" I've worked in quite a few settings where I've worked with psychiatrists who

prescribed medication for children, " Albright said. " I don't see any correlation

between antidepressants and suicidal activity. "

Albright said finding the drug that works best for each patient requires trial

and error. He understands the anguish of the parents who testified in Washington

about their children's suicides, yet he believes the risks of treating children

with antidepressants should be weighed against the risks of denying treatment.

" I would be concerned (warnings) might scare a lot of patients, " Albright said.

" These kids might need antidepressants, and with a warning label on there and

any mention of suicide, (parents) might not give them what they need, and that

would be a tragedy. "

White can be reached at gary.white@... or at 863-802-7518.

September 21, 2004

I run into this all the time. My son continues to have problems --

though nothing like when he was on the Celexa -- that he didn't have

before the Celexa. Well meaning people believe that there is

something the " right " doctor or therapist can do. First, if the

" right " doctor or therapist exists, I have no idea how to find him

without exposing my son (and myself) to more voodoo that passes for

psychiatry. (My apologies to anyone who pratices or believes in voodoo

who might be offended by that comparison.) Since our trust of the

profession is zero to begin with, we are not very interested in

shopping for someone who might actually have a solution. Second, the

normal response is to attempt to find the magic pill that will " help "

him. Right, they don't know how the brain works, they don't know what

the drugs do to the brain (or any other part of the body for that

matter), but we should keep trying one drug after the other over a

period of years (and 10's of thousands of dollars) on the hope that we

will find something that helps. Would you employ a mechanic who

worked on your car that way??? But we should all rush our children to

the doctors at the first sign of a " behavioral disorder " . It's piled

high and it stinks.

> I think the Psychiatrists should all fess up and tell the truth.

They don't have any solutions

> but drugs and if those are taken away, God forbid, " what will I do

for a living? "

> " I vill continue to drug zee children!!! "

>

http://www.theledger.com/apps/pbcs.dll/article?AID=/20040921/NEWS/4092

10301/1021

>

> Published Tuesday, September 21, 2004

> THE WORRY ABOUT WARNINGS

>

> Local Doctors React to Kids and Antidepressants

>

> By White

> The Ledger

> gary.white@t...

>

> Dr. Teston, during 12 years as a psychiatrist treating

children and adolescents, has prescribed antidepressants to dozens of

patients.

>

> Teston has no intention of removing those medications from her

arsenal of treatment options. But she worries that negative publicity

arising from recent Congressional hearings -- and the prospect of

stark warning labels linking the drugs to suicide -- will have a

chilling effect, scaring some doctors away from prescribing the drugs

to youths and prompting more parents to refuse such treatment for

their children.

>

> " That is going to be somewhat unfortunate since the evidence we have

is that antidepressants really do help, " said Teston, who practices at

Lakeland's Clinic.

>

> " I'm going to continue, because I don't think there's anything we

know that gives us a reason not to prescribe. . . . I think the

potential benefits of using antidepressants that I've seen in my

practice greatly outweigh the risk. "

>

> The Food and Drug Administration earlier this year added cautionary

language to the packaging of antidepressants, and an advisory panel

last week recommended prominent, black warnings on container labels.

The FDA announced plans to push for the warnings but did not provide a

schedule.

>

> The widely publicized hearings followed clinical studies that found

a slightly increased risk of suicidal behavior among youths treated

with newer antidepressants, such as Prozac, Paxil, Effexor, Zoloft,

Lexapro and Wellbutrin.

>

> Only Prozac has been approved by the FDA as a treatment for

depression in those younger than 18. But the common practice of

" off-label " prescribing allows psychiatrists and pediatricians to use

other antidepressants in their treatment of youths.

>

> The FDA hearings have stoked debate over the safety of that

practice. Dr. Schick, a Lakeland pediatrician, has long

prescribed such medications for mood disorders. Though firmly

convinced of the drugs' efficacy, she said the studies have made her

more hesitant to prescribe them.

>

> " Since the warning has been out (on packaging), I've been a little

wary of putting new patients on these medications, " Schick said. " It's

a shame. I've discussed it with all of my patients already on the

medications, and none of them have chosen to come off the medications

because the children are doing so much better. "

>

> Schick, who has practiced for 21 years, now refers most new patients

to a psychiatrist rather than start them on antidepressants. Studies

of depression have found the best results come from a combination of

counseling and medication, but Schick said funneling patients to

psychiatrists or mental health facilities can hinder prompt treatment.

>

> Many patients' medical plans, she notes, do not cover the full cost

of mental health treatment. Low-income patients on Medicaid in Polk

County are referred to either Peace River Center or Winter Haven

Behavioral Health Care, high-demand facilities that often have waiting

lists, and Schick said some parents give up before receiving

treatment.

>

> Dr. a Mimms, medical director at Peace River, said she has not

been deterred from prescribing antidepressants to youths. She

estimates the facility has about 2,400 current patients younger than

18 who are being treated for mood disorders.

>

> Mimms said her staff carefully explains the treatment risks to

parents, who must sign a consent form before medications are

prescribed.

>

> " If a child is truly mentally ill and having problems, we would be

remiss in our duties if we know we have a medication that can help

them and we didn't give it to them, " said Mimms, a child and

adolescent psychiatrist. " I haven't had any adverse reactions or

suicides. I've had more positives and no negatives, but I guess I've

just been lucky. "

>

> According to FDA figures, more than 10 million prescriptions were

written in 2002 for patients younger than 18. While studies have

raised concerns about the drugs generally, Paxil and Effexor have

attracted the most scrutiny. A lawsuit by New York State Attorney

General Elliot Spitzer prompted Paxil's manufacturer, GlaxoKline,

to release study results it had previously withheld.

>

> Teston said she welcomes more studies of antidepressants. She

expressed concern over a recent trend in which drug studies are

increasingly conducted by manufacturers rather than independent

agencies.

>

> " The problem has been the pharmaceutical industry's interests and

values are not necessarily the same as the public's best interest and

what the government would set as standards, " Teston said. " So there

have been some concerns about bias and withholding information. "

>

> Teston says a crucial statistic has gone overlooked in the debate:

The suicide rate among teenagers has decreased by about 25 percent in

the last decade, a period during which medication use by teens has

become much more common.

>

> The psychiatrist now uses Prozac as the " first-line " treatment for

pediatric patients. She refrains from prescribing Paxil or Effexor to

new patients, though she continues to treat some patients with those

drugs.

>

> The British government banned prescriptions of Paxil for youth last

year after studies found a higher incidence of suicide attempts by

patients on the drug than by those given placebos. Teston worries

about such a ban in this country.

>

> " Patients are different in terms of which medications work for

them, " Teston said, " and it's very important for us to be able to have

the full range of options for treating children, just like we have a

full range of treatments with adults. "

>

> She has closely followed advisories from the American Psychiatric

Association, which supported the FDA actions but issued a statement

saying medication " can be extremely helpful and even lifesaving for

many young people struggling with depression. " The group added, " We

believe the biggest threat to a depressed child's well-being is to

receive no care at all. "

>

> Haines City resident Ed Albright, a licensed mental health

counselor, said experience has taught him that children with mood

disorders often benefit from antidepressants.

>

> " I've worked in quite a few settings where I've worked with

psychiatrists who prescribed medication for children, " Albright said.

" I don't see any correlation between antidepressants and suicidal

activity. "

>

> Albright said finding the drug that works best for each patient

requires trial and error. He understands the anguish of the parents

who testified in Washington about their children's suicides, yet he

believes the risks of treating children with antidepressants should be

weighed against the risks of denying treatment.

>

> " I would be concerned (warnings) might scare a lot of patients, "

Albright said. " These kids might need antidepressants, and with a

warning label on there and any mention of suicide, (parents) might not

give them what they need, and that would be a tragedy. "

>

> White can be reached at gary.white@t... or at 863-802-7518.

>

September 21, 2004