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Antidepressants for Children Worry Parents

Posted on: Thursday, 3 November 2005, 06:00 CST

By Katy Murphy, STAFF WRITER

HAYWARD -- The family of 13-year-old Jake Henry doesnt know what made him want to end his life on the railroad tracks near his Hayward school. They dont know if the medications he was taking to treat his depression had the opposite effect.

But to Cindy Young, Jakes aunt and godmother, one thing is clear: More needs to be known -- by the general public and the medical profession alike -- about the risks of antidepressants for children.

I cant conclusively say that the reason my nephew stepped in front of a train and committed suicide was because of the two drugs, but its the only conclusion I can come to, she said.

The debate over the risks of psychotropic medication for children is nothing new. Last year, the U.S. Food and Drug Administration required all makers of the drugs to include a warning that antidepressants might be linked to suicidal tendencies.

But Jakes death this month -- and the fact that the Tennyson Health Center will soon have a part-time psychiatrist on staff who will be able to prescribe psychotropic drugs to middle school and high school students -- has brought the issue closer to home.

Shortly before the end of the school year, the health clinic run by the nonprofit Tiburcio Vasquez Health Center Inc. received MediCal money to add therapists and a part-time psychiatrist to improve the overall mental health of the students -- many of whom would not otherwise have the resources for such treatment.

Alameda County Supervisor Gail Steele called the upcoming expansion of the center a godsend, and Tennyson High School Principal Theresa McEwen expressed optimism about the additional therapists available for her students.

As the center prepares to expand, however, few people -- including school administrators -- are aware that its new services will include prescriptions.

Josefina Ibarra, whose son attends Cesar Chavez Middle School and who is active in parent groups, said she had heard nothing about the changes at the health center, which serves children from that middle school and the Hayward Project School, in addition to Tennyson.

While she was enthusiastic about having more therapists to work with the children, she was wary of increased access to prescription drugs.

Many parents and students, she said, know little about the risks and benefits of the drugs. Although the center will require parental consent before prescribing them, Ibarra worries that uninformed parents will accept the doctors advice without weighing it for themselves.

Ibarra also thinks parents should be made aware of the centers statistics as the year unfolds. I definitely think, as parents, we need to be told, These are the numbers of kids that are on antidepressants at our school,'" she said.

The black box warning

Last year, the FDA released a public health advisory based on the results of several short-term trials involving more than 4,400 children and adolescents diagnosed with psychiatric disorders.

About 4 percent of the patients who took antidepressants reported suicidal thoughts, compared to 2 percent of those taking placebos, the FDA reported.

In October, the agency decided to place black box warnings on all antidepressants. It urged health care providers to balance the risk of increased suicidality with the clinical need, and to closely monitor their young patients -- especially those first starting the therapy -- for behavioral changes.

The FDA also cautioned parents to watch their children carefully and to stay in close touch with the doctor who prescribed the medication.

Young, who said her family was still raw from Jakes death on July 1, said she didnt know Jake had been on antidepressants -- Zoloft and Effexor -- until after his death.

When she learned of the tragedy, she said, she instantly recalled the heart-wrenching testimony she heard last year on the radio about a troubled teenage girl who seemed to improve dramatically with treatment.

The girl hung herself one day, without warning, after her mom left for work.

The first question I asked my sister-in-law was, What was Jake on?'" Young said.

Young said she didnt know what kind of dialogue the doctor had with Jakes mother before writing the prescriptions, or what kind of monitoring her nephew received thereafter. Jakes mother, Donna Lee, was not ready to talk about it, Young said.

My question is, When doctors prescribe that medication and give it to teenagers, do they engage the parents and the teenager thats taking it of the risks?'" Young said.

Some changes made

Although many doctors say that the clinical findings released by the FDA were far from conclusive, some acknowledge that the advisory has prompted some important changes.

Dr. David Shaffer, a professor of child psychiatry at the Columbia University College of Physicians and Surgeons, said many of his colleagues have since re-evaluated the way they monitor their young patients.

Before, he said, doctors were apt to see the child, make a diagnosis, prescribe antidepressants and schedule a follow-up visit in a month.

Now, he said, more doctors are setting aside a few hours each week to call the families to check up on the childs progress and behavior.

The FDA warning also seems to have curbed the steady rise in the use of prescribed antidepressants by young people -- a consequence that some psychiatrists regard with concern.

I do worry that there are children and adolescents with serious psychiatric problems that are not getting the treatment they need and deserve, said Dr. David Fassler, clinical professor of psychiatry at the University of Vermont College of Medicine.

But at the same time, he added, I know that not all children and adolescents with depression need to be treated with medication.

While researchers estimate that just half of children with depression receive any treatment, the number of antidepressant prescriptions has grown dramatically since the late 1980s.

In 2002, 6.36 percent of commercially insured high school girls in the United States were prescribed the drugs, up from 3.74 in 1998, according to data posted on The Center for Health and Health Care in Schools Web site, http://www.healthinschools.org.

Over 4 percent of boys in the same age group -- 15-18 -- took prescribed medicine in 2002 to treat depression or anxiety, up from 3 percent in 1998.

An online handbook for parents created by national psychiatric associations in the wake of the FDA warnings -- http:// www.parentsmedguide.org -- notes that the suicide rate among children dropped by 25 percent between 1992 and 2001, at the same time a growing number of children were being treated with antidepressant medication.

Like most in his field, Shaffer believes the risk of not medicating a severely depressed child outweighs those associated with the drugs. Still, the psychiatrist hopes that longer-term studies -- such as those sponsored by the National Institute of Mental Health -- will shed more light on the relationship between the drugs and suicidal tendencies.

Because many depressed patients contemplate or attempt suicide with or without medication, Shaffer said, it is difficult to know whether the drugs cause suicidal thoughts or if they simply fail to help with a patients depression.

And while psychiatrists and researchers can only theorize about the reasons behind it, they have recognized an unnerving pattern in patients with depression.

Shaffer wasnt surprised to hear that the 13-year-old Hayward boy ended his life despite the great progress he had shown during his treatment.

The greatest risk of suicide is when they start to get better, he said.

Mental Health Treatment In Schools

Although on-site psychiatrists are quite rare, schools around the country are increasingly being used for mental health screening and other services.

Julia Lear, PhD, director of the nonpartisan Washington, D.C.- based Center for Health and Health Care in Schools, called schools the default mental health system for kids in an interview earlier this month.

According to the centers Web site, 70 to 80 percent of all children receiving mental health services are treated in a school setting.

Jane McGrath, the school health officer for the New Mexico Department of Health and a professor of pediatrics at the University of New Mexico, said a doctor working at a school should more easily be able to provide the close monitoring patients need -- especially during the initial phase of treatment.

Though parents might have misgivings about the services, she said, open houses and other ways of involving families have proven successful. People can be scared about things they dont understand, she said.

As the fall semester approaches, Ibarra hopes she and other parents will have the opportunity to share their concerns and questions about the complex issues facing their children -- and the appropriate treatments for them.

Just the age alone is so hard, Ibarra said. We want them to succeed in life, she said.

Katy Murphy covers education in Hayward, Castro Valley, San Leandro and San Lorenzo. Call her at (510) 293-2479 or E-mail kmurphy@dailyreviewonline.com.

Source: Oakland Tribune

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