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IMH Press Releases and Events: http://www.nimh.nih.gov/
The suicide rate among
young persons 10-24 increased substantially from 2003-2004
after
twelve years of overall decline. The greatest increase was
among girls ages 10-19, a group that historically has been (and
remains) less prone to successful suicide than boys.
Suicide is the third leading cause of death among those aged 10-24, accounting for 4,599 deaths in 2004
Statistically, the increase coincides with tougher warnings against use of anti-depressants on children and a decline in the prescribing of such drugs for children. The statistics, provided by the Center for Disease Control in a recent report, will further fuel the intense debate over whether psychotropic drugs used to treat depression in adults are helpful or harmful to children.
The CDC identified three groups in which suicide rates rose in 2004. They were females aged 10-14 and 15-19 and males aged 15-19. The largest percentage increase -- 75.9% -- was among females aged 10-14. The rate of increase among females aged 15-19 was 32.3% and among males aged 15-19 it was 9%. The suicide rate for males ages 10-14 and 20-24 remained stable from 2003-04, but men 20-24 still are by far the most suicide-prone group, with 20.64 deaths per 100,000 in 2004. Female suicides remained a fraction of male suicides in all age groups 10-24 reported by the CDC. In absolute numbers, from 2003 to 2004 suicides increased from 56 to 94 among girls10-14, from 265 to 355 for women 15-19 and from 1,222 to 1,345 for men 15-19.
Firearms are the most common form of suicide among males. Women prefer hanging or suffocation, according to the CDC statistics. Due in large part to the increase in female suicides, the rate of use of firearms to commit suicide has declined overall since 1990 and hanging/suffocation has increased.
As the chart hyperlinked here shows, since 1990 the overall trend has been a decline in suicides among persons 24 and under, although the rate increased in some years slightly for some groups before continuing to decline. The percentage decline was most pronounced among males. The overall decline from 1990-2003 was 28.5%.
A statistical increase in suicidal thinking (not suicides) reported in studies of use by children of antidepressants such as Zoloft and Paxil, along with angry and sad testimony from parents of children who committed or attempted suicide while taking these drugs, led the FDA in 2004 to require a “black box” warning on drug packages stating that the drugs were not recommended for children under 18. The result was a decline in use of the drugs. The latest CDC data is statistical evidence proponents of therapeutic drug treatment of depression in children can cite to show that drugs can be helpful in preventing suicide. That there was only a slight increase among men and women 20-24, and thus not effected by the “black box” warning, also is evidence suggestive of the benefits of drug therapy. (The FDA extended the warnings to those up to age 24 earlier this year).
Thomas Insel, director of the National Institute of Mental Health, told The Washington Post, “We may have inadvertently created a problem by putting a ‘black box’ warning on medications that were useful.” He added, “If the drugs were doing more harm than good, then the reduction in prescription rates should mean the risk of suicide should go way down, and it hasn’t gone down at all -- it has gone up.”
The Post also reported that a study published in the American Journal of Psychiatry described a 22 percent decrease in antidepressant drug use among children in the Netherlands between 2003 and 2005 and a 49 percent increase in suicides in the same period in that country. The newspaper also noted prior studies that in countries where antidepressant use is higher, suicides are fewer, and that in a study of 200,000 depressed veterans, those taking antidepressants had one-third the risk of suicide of those who were not.
The New York Times quoted an FDA spokesman as saying that it would need to see more data over a longer time to determine if declines in prescriptions increase suicide risk. “You simply cannot reach casual conclusions from the new CDC data,” the spokesman said.
Insel told The Post that new research to be published soon examines genetic factors that may put some patients at particular risk for use of antidepressants, while those without genetic predisposition to depression might not face those risks. But he acknowledged it would be some time before physicians have tests that can reliably predict which patients are likely to become suicidal as a result of drugs. In the meantime, he said, “if I had a child with depression, I would go after the best treatment but also provide the closest monitoring.” To which The Depressed Child adds: AMEN. Sources: Center for Disease Control, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5635a2.htm, Washington Post 9/6/07 at A-1 and New York Times 9/7/07 at A22
FDA to Makers of Adderall, Strattera and Ritalin:
Beef Up Warnings to Patients, Parents
The Federal Food and Drug Administration has told manufacturers of the principal drugs prescribed for juveniles to treat ADHD (attention deficit/hyperactivity disorder) to provide patients and parents with brochures warning in some detail of the cardiac and mental health dangers posed by these drugs. (See the FDA release and materials linked to the release at http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html ). The demand for more detailed information follows by nearly a year requirements by the FDA to strengthen the labeling warnings on these issues. (See story below: Ritalin and Adderall: Black Box Warnings for Them, Too).
An FDA press release announcing the brochure requirement said "medicines approved for the treatment of ADHD have real benefits for many patients but they may have serious risks as well." Called "Patient Medication Guides," these short brochures are handed out to patients, families and caregivers when a medicine is dispensed. They have room for more detailed information about the risks of these drugs than can be easily printed on a label and, because they are a separate document, may be more successful in drawing the patient or parent's attention to the warnings.
The drugs required to be accompanied by brochures include Adderall, Concerta, Ritalin and Strattera.
FDA review of drug studies revealed a "slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems." Although the FDA did not specifically say so, these problems were identified in adolescents and younger. This information is to be included in the brochures.
The brochures also will warn of an increased risk of cardiac problems, including sudden death, in patients with pre-existing conditions and in adults who have certain risk factors.
A review of the brochure language for Adderall, Ritalin and Strattera (the language is linked to FDA website identified above), discloses that only Strattera contains an explicit warning about increased suicidal thinking, in language nearly identical to the "black box" warnings about suicide required in antidepressant drugs. The Adderall and Ritalin warnings are more general, identifying possible "new or worse behavior and thought problems, new or worse bipolar illness and new or worse aggressive behavior or hostility."
The FDA press release estimated that ADHD affects approximately 3 to 7 percent of school-aged children and about 4 percent of adults.
Source: FDA News, 2/21/07, and pages linked to the main page. See: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html [Return to Headlines Page]
Study: Little Correlation Between Substance Abuse and Suicide for Children 9-16;
Depression With Anxiety or Opposition Disorder Strongest Indicators;
Poverty Also a Factor
Substance abuse has little correlation with suicidal behavior among children ages 9-16, according to a recent study of 1,420 male and female children in western North Carolina reported in the September 2006 issue of the Archives of General Psychiatry (www.archgenpsychiatry.com). Less surprisingly, diagnosed depression is most commonly associated with suicidal thinking and suicide attempts in children, especially when it is accompanied by either general anxiety disorders (GAD) or oppositional/defiant disorder (ODD).
The study reviewed 6,670 psychiatric records of the children, who were selected based on in-home interviews conducted by trained interviewers separately with the child and the child’s parents. In 62 percent of the cases a child informed the interviewer that he/she thought about dying or suicide, or even in some cases had attempted suicide, but the parents were unaware of such thoughts. “In other words, parents were typically unaware of their child’s suicidality,” the study’s authors reported.
“Suicidal youth were 6 times more likely to have a psychiatric disorder and 22 times more likely to have multiple psychiatric disorders than were non-suicidal youth,” the authors reported.
“Anxiety, depressive and disruptive behavior disorders were all associated with a significantly increased risk of suicidality. Risk was greatest in association with depression. Drug abuse was not associated with suicidality. After controlling for all other disorders, anxiety, depression, and disruptive behavior disorders were all independently associated with suicidality. Illicit drug abuse was associated with a significantly decreased risk for suicidality.”
“There was a statistically significant interaction between depression and GAD and between depression and ODD, indicating that both co-morbidity profiles conferred a greater than expected risk for suicidality,” the authors concluded.
Among other findings:
Suicide attempts are increasing among girls age 13; Suicidal thinking increases at age 13 and later.
There is a “robust association between poverty and suicidality…” “In at-risk youth, poverty may index a vast list of potential risk factors, including abuse, trauma, social isolation or diminution of social support due to parental unemployment or illness, frequent residential moves, or the operation of other factors, that disturb familial or youth support structures.”
The report’s authors were Debra L. Foley, PhD., of the Virginia Institute for Psychiatric and Behavioral Genetics at the Medical College of Virginia; David B. Golston, PhD., Jane Costello, PhD and Adrian Angold, MRC Psych, all of the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center. The authors cautioned that their study was based on a sample from a small geographic area that may not be representative of other areas of the country.
Source: Archives of General Psychiatry, Sept., 2006
More Confusion: New Study Claims Antidepressants Cut Suicide Attempts in High Risk Cases
A study of more than 65,000 patients in
The 
taking either a serotonin
selective reuptake inhibitor (“SSRI”) antidepressant, such as Prozac
or Zoloft. Separately, it made the same statistical comparison
for older types of antidepressants. The study concluded that
suicide and suicide attempt rates were quickly and significantly
reduced by the SSRIs. Suicide attempt rates were significantly
higher in the month before the patients took the SSRIs than in the
months after. They were about the same among patients taking
the older types of antidepressants, but began to fall in the second
month of treatment.
“We don’t find any evidence to support the widely held belief that suicide risk increases when people start taking antidepressant medications,” Dr. Gregory Simon, an author of the report, told Psychiatric News. “What we did find was that suicide risk actually decreases when people start taking antidepressants.”
However, it was to be expected that suicide attempts would be high immediately before beginning treatment because the attempts themselves would prompt medical treatment. In other words, the statistics identify those at highest risk, and an inference is that they received the greatest immediate benefit from SSRI treatment. But, according to the report, it took five months of treatment for suicide attempts among treated patients to decline to the levels they were two and three months before treatment began. After six months of treatment, attempted suicide rates among those taking the SSRIs were somewhat lower than they were three months before treatment began.
The statistical study, which included adults and teens, but not children, certainly seems to support pharmaceutical industry claims that SSRIs and, to a lesser extent, older antidepressant formulas, are effective in reducing the threat of suicide in high risk patients. But the data is less persuasive when it comes to patients who are not in the high risk category. Suicide attempts were higher in each of the first five months of treatment with either kind of antidepressant than in the two and three months before treatment was initiated. It is difficult to know if this means the FDA “black box” warning of increased suicidal ideation and attempt is warranted, or if the drugs are effective in a continual reduction of risk over time.
The report was funded by the National Institute of Mental Health,
not by the pharmaceutical industry. It appears in the January
issue of the American Journal of Psychiatry (click the underlined
title for a link to the article). Here is the table, as
produced in the Journal (bars indicate 95 percent confidence levels:
Sources: American Journal of Psychiatry, January 2006; Psychiatric News, 1/20/06, p. 18
Depressed Child comment:
In our view, this study should at least allay some of the worst
fears raised by various clinical (as opposed to epidemiological
statistical) studies suggesting a heightened risk of suicide from
SSRI antidepressants. We always thought the link to “cause”
was thin in such studies, and were surprised that the “experts” were
surprised that some kids taking antidepressants occasionally
entertained thoughts of suicide. That said, we also are in
favor of caution in the use of any psychotropic drugs on children
and teens. Antidepressant prescriptions to teens and children
declined 20 percent after the “black box” label was required by the
FDA. That could be good or bad in any individual case, but
statistically suggests that second thoughts are being applied to
drug treatment, which is nearly always good. The
Depression: It Really Is All In Your Head
More evidence that depression is a result of the chemistry in your brain, not something readily under conscious control. According to a report in the January 6 issue of Science, a newly discovered protein, called p11, increases the serotonin in the brain which enables efficient communication across synapses among the neurons. A reduction in serotonin has been equated with depression. Modern antidepressants such as Prozac and Adderall act to effectively increase serotonin. According to the latest study, p11 increases the ability of receptor cells to use serotonin.
Nobel Laureat Paul Greengard, a professor of psychiatry and
pharmacology and director of the Laboratory of Molecular and
Cellular Neuroscience at
The researchers examined p11 levels in post-mortem samples from the brains of depressed patients and a mice model of depression and compared the levels with those found in non-depressed humans and normal mice. Levels of p11 were found to be substantially lower in depressed humans and mice. They also tested p11 levels on mice who were treated with antidepressants and found the drugs elevated p11 levels.
“This new-found protein may provide a mores specific target for new treatments for depression, anxiety disorders and other psychiatric conditions through to involve malfunctions in the serotonin system,” Dr. Elias Zerhouni, director of the National Institutes of Mental Health (which helped fund the project) told Psychiatric News.
Source: Psychiatric News, 2/3/06 p. 18
Depressed Child comment: The evidence that depression is a result of biochemical imbalances in the brain is impressive. The evidence that current medications are effective without significant risk is less so. A question not answered: Can behavior modification, or even realigned thinking, that could result from counseling with or without drugs also alter these imbalances? While our chemical balances may be controlled by our unconscious, isn’t our unconscious also shaped by our consciousness? When we tell the brain to do something, it does so by changing a chemical balance in communication among the brain cells. Can we identify a way of doing the same thing with serotonin and other chemicals related to depression?
Depression Drug Prescriptions for Adolescents and Kids Drop 20%
Physicians and psychiatrists are prescribing fewer antidepressant
drugs for minors since the FDA required "black box" labels warning
of increased suicide risk from taking the drugs, according to an
analysis by Psychiatric News, the newspaper of the American
Psychiatric Association (APA). The APA and the 
The FDA requirement was imposed in October 2004 (click here for
article on this page). The warning must appear on the labeling of
all antidepressant medications distributed in the
The nearly 20 percent decline in less than a year is was called "a decline whose public health consequences are unknown and must be monitored by policymakers, physicians, parents and patients," in the letter sent by the APA and AACAP to the FDA.
"This dramatic shift raises the serious questions of whether those children and adolescents with depression who are no longer taking these medications are receiving any care at all -- or are receiving the most effective care," they wrote.
The FDA told Psychiatric News when it first printed the news of the decline in prescription-writing in September 2005 that "even tracking suicidal behavior in this population is not a failsafe approach to assessing the impact of this labeling change, because secular trends in such behavior are influenced by many different factors."
The APA and the AACAP said in their letter that several studies, including at least one funded by the National Institute of Mental Health, have shown that the most effective treatment for juvenile depression is a combination of medication and counseling. The organizations observed that the prescription decline would seem to "endanger" this course of treatment.
[Click here for an essay by The Depressed Child questioning if reduction in drugs results in better or different treatment, or no treatment at all.]
Source: Psychiatric News, p. 18, 10/7/05 [Return to Headlines Page]
Diagnosis by Psychiatrists: Mental Health Care For Children by Primary Care Givers Poor
Child psychiatrists give primary care physicians low marks for
treatment of youth with emotional disorders. According to data
presented during the annual meeting of the
According to Psychiatric News, a publication of the American Psychiatric Association, the report "provided stark contrast to numerous upbeat AACAP meeting sessions devoted to the interplay of child psychiatry with pediatrics and primary care." Some of these more "upbeat" sessions involved test programs in which child psychiatrists actively consulted with pediatricians or other primary care givers. Other presentations described what the News called "diagnosis mills" to which children are referred by primary care givers for a quick diagnostic evaluation and then referred back to the primary care giver with detailed treatment recommendations.
Other programs highlighted at the convention included efforts to place mental health specialists directly into schools to identify children with mental health issues for referral for evaluation and treatment.
The consensus reported by the News was that although there is
greater interest in making diagnosis and treatment of mental health
problems in children among professionals, educators and others,
there are still significant obstacles. The AACAP has been
working with the
Source: Psychiatric News, Dec. 2, 2005, p. 9 [Return to Headlines Page]
NIMH Survey: Half of Americans Develop a Mental Illness, Most at a Young Age;
Adds to Debate on What Is a Mental Illness
Here's some depressing news: According to a recent survey sponsored by the National Institute of Mental Health, more than half of all Americans will develop a mental illness at some point in their lives, often beginning in childhood or adolescence. One quarter of all Americans met the criteria for having a mental illness within the past year, and one-fourth of those (about 6 percent of the surveyed population) had a disorder that significantly disrupted their ability to function day-to-day. Less than half of those in need of treatment got it, and those who did seek treatment typically did so after a decade of delay during which their symptoms got worse. The treatment was usually inadequate, according to the survey.
The report concluded that younger sufferers are especially overlooked, even though mental illness is a disease of youth. Half of those who will ever be diagnosed with a mental disorder show signs of the disease by age 14, and three-quarters by age 24, but few get help, according to an article about the survey in The Washington Post.
The study was immediately questioned by some experts as defining mental illness too broadly, according to a report in The New York Times. But Dr. Thomas Insel, director of the NIMH, told reporters that "the key point to remember is that mental disorders are highly prevalent and chronic" and that the survey "demonstrates clearly that these really are the chronic disorders of young people in this country." The illness most often found to have occurred in the survey was major depression (16.6 percent of those surveyed). But the largest overall category of illness was "any anxiety disorder" (28.9 percent), including panic disorder, agoraphobia, "specific phobia" and "social phobia." Another large category included as mental illness was substance disorder (14.6 percent), including alcohol abuse (13.2 percent). Mood disorders, including depression, dysthymia (2.5 percent) and bipolar disease (3.9 percent) accounted for 20.8 percent of all mental illnesses reported.
The report was based on face-to-face interviews with a broad cross-section of 9,282 Americans ages 18 and over. According to The Times, interviewers asked the participants whether they had experienced periods of extended sadness, alcohol or drug abuse, irrational fears or a host of other symptoms. If so, the interviewers probed more pointedly about the episodes. If the symptoms described met the criteria outlined in the American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM IV) then the respondent was classified as having experienced a mental disorder. The results were reported in a series of papers in The Archives of General Psychiatry.
Impulse control disorders, which are commonly identified in children, accounted for 24.8 percent of the past or present mental illness in the population surveyed. Oppositional-defiant disorder was reported by 8.5 percent; 9.5 percent reported "conduct disorder" and 8.1 percent reported attention deficit/hyperactivity.
There is an important debate among psychiatrists and psychologists
about whether the DSM IV identifies too many everyday emotional
struggles as "mental illness" and whether the symptoms in the DSM
are too generalized to be of use in diagnosing and treating a
patient's problems. Dr. Paul McHugh, a professor
of psychiatry at
Sources: The Washington Post, p. A3; The New York Times, p. A17, both June 7, 2005 [Return to Headlines Page]
Study Pursues Genetic Link to Depression
It has long been supposed that there is a genetic predisposition to depression, often reflected by family histories of "self-medication" such as alcoholism and drug addiction, or simply a line of relations who exhibit symptoms of depression. Now scientists in North Carolina have discovered a genetic variation that could account for this predisposition. The findings were posted in December 2004 in the on-line edition of the journal Neuron and reported in several newspapers.
Biologists at 
antidepressants operate to cause serotonin to, in effect, remain
active to better complete the communications between the neurons.
That is why they are called "selective serotonin reuptake
inhibitors" (SSRIs). Zoloft and Prozac, among others, are in
this category of drugs.
The Duke team tested for the variation in the gene in 87 people diagnosed with depression. They found that 10 percent of the sample had the mutation. Fewer than one percent of a comparison group that was not diagnosed with depression had the mutated gene. This is deemed a significant correlation. The researchers caution that if depression is sometimes a result of genetic predisposition, more than one gene likely is involved in a complex process that is poorly understood.
"The results need to be replicated, but they suggest that we may be able to personalize the treatment of depression," Dr. Thomas Insel, director of the National Institute of Mental Health, which helped finance the study, told The New York Times. "We might be able to predict, based on the presence of this gene variation, whether someone will respond to certain antidepressants."
Source: The New York Times, 12/10/04, p. A 36. [Return to Headlines Page]
Whom Do You Trust: Prozac Beats Talk, Says Government Study
A study financed by the
These agencies vary their views almost as often as the weather. It should be noted that the FDA also approved Prozac for treatment of youth depression before it warned against use of such antidepressants for children. A story about the FDA warning is below. The British have banned use of all antidepressants except Prozac for persons under 18. In May 2002, NIMH reported that talk therapy is at least as effective as SSRIs. In that case, the study was co-sponsored by the manufacturers of Paxil, another SSRI, and compared only Paxil and therapy. That study did not focus on teenagers, however, and Elliot Spitzer, the New York State attorney general, has sued the manufacturers of Paxil for withholding information about its effectiveness with children.
According to NIMH, the Prozac study was the first to compare psychotherapy and drug treatment for depressed adolescents. It does lend further weight to contentions that, among all the antidepressants, Prozac has performed best in trials with children.
According to a report on the latest NIMH study by The New York Times, researchers found talk therapy by itself no more effective in reducing depression than treatment with placebos. "But when combined with drug treatment, psychotherapy appeared to provide added benefit and to reduce the risk of suicide," The Times reported.
The Times quoted Dr. Graham Emslie, a professor of psychiatry at the
"Despite the popular belief that they are all the same," Dr. Pies continued, "these drugs . . . . have important neurochemical differences." He also warned that antidepressants such as Prozac are not appropriate medications for victims of bipolar disease, which shares many traits with depression.
The NIMH study involved 439 youths ages 12 to 17 who were suffering from moderate to severe depression. These youth were randomly assigned to four groups for 36 weeks of treatment. The test subjects were provided (1) Prozac, manufactured by Eli Lilly & Company; (2) the most common form of talk therapy, cognitive behavioral therapy; (3)a placebo or (4) a combination of Prozac and talk therapy. The NIMH report was based on analysis of data for only the first 12 weeks of treatment completed by 378 subjects. The mean age was 15.
According to The Times report, based on one measurement scale for depression, the researchers found that after 12 weeks, 71 percent of the subjects who received both Prozac and talk therapy responded well, compared with 61 percent who received Prozac alone, 43 percent of those who received talk therapy alone and 35 percent of those who received a placebo treatment. By another measure of depression, talk therapy alone "fared no better than treatment with placebos," according to The Times summary.
All patients became less suicidal, no matter what their treatment, including with placebos, but there were five suicide attempts among those given Prozac and just one among other participants.
Another study delivered at the conference and reported by The Times suggested that another SSRI, Zoloft, was less effective than talk therapy for treatment of obsessive/compulsive disorder. Those who received talk therapy did better than those receiving Zoloft.
Sources: The New York Times, 6/2/04, p. A1 and 6/5/04, p. A24 (Letters to Editor). [Return to Headlines Page]
Scientists Find Gene Linked to Depression
Scientists have suspected for many years that chronic depression -- the kind that occurs with no evident causal event in life -- may be an inherited genetic disorder. But the evidence has been indirect. Now, the same research group that identified the genes responsible for some breast cancers claims to have identified a gene that causes depression.
Myriad Genetics, Inc.,
Abbott Laboratories has joined with Myriad to develop drugs based on the genetic discoveries. Abbott cautioned that "this is an early-stage discovery, but we are excited that we have opened a new pathway to attack depression."
Myriad said the DEP1 gene acts in a "novel pathway, not previously known to be involved the cause of depression, and may lead to a novel class of anti-depressive therapeutics." Myriad claimed the "pathway" is different from the path used by Selective Serotonin Reuptake Inhibitors (SSRIs) which are now considered the best combination of effectiveness with minimal side effects used to treat depression. SSRIs include Zoloft, Prozac and Paxil. Myriad noted in its press release announcing the gene discovery that SSRIs can take up to six weeks to provide relief. The Wall Street Journal noted in an article announcing the discovery that some patients do not respond well to SSRIs.
The Journal article said that "about 30% of depression patients
don't improve with existing drugs, and as many as 50% still suffer
some depression symptoms despite medication. Of the roughly
30,000 suicides in the
In addition to working with Abbott on new drugs to treat genetically-based depression, Myriad said it is "pursing a predictive medicine product" to identify at-risk individuals so that they can take preventative measures to avoid depression.
Abbott told the Journal that it would be 18 months to three years before the company could begin clinical trials in human patients based on the discovery of a "depression gene."
[Depressed Child Note: Parents should take heed that there is only one immediately practical effect on the possible treatment of your own child: This is reason to be even more skeptical of mental health care givers who immediately rule out a physical cause of your child's depression. Especially where there has been no evident event to "cause" depression -- divorce, death, serious mistreatment by fellow students or playmates -- ruling out drug therapy even for children can be very shortsighted and dangerous. Unfortunately, it is unlikely any drug to address genetically based depression will be available until your youngster is an adult, or nearly so.]
Sources: Myriad Genetics Inc. press release, 2/4/03; The Wall Street Journal, 2/5/03, p. B1. [Return to Headlines Page]
More in College Seek Help for Deeper Psychological Problems
Add college students to the list of those needing care for deeper
and more difficult psychological problems. A new study from
the counseling center at
The number of students showing suicidal ideation also nearly doubled, to 9 percent in 1996-01. Grief treatment more than doubled to 10 percent of patients seen, while developmental problems -- which cover a range of behaviors and symptoms, including separation from parents, anxiety over romantic relations, etc. -- more than doubled, to 41 percent of patients in 1996-01. (Obviously, many patients of the clinic showed symptoms of multiple mental health problems).
The center's study was published in the journal Professional Psychology Research and Practice.
In a separate survey referenced by The New York Times, more than 80
percent of 274 directors of counseling centers said they thought the
number of students with severe psychological disorders had increased
over the previous five years. The survey was conducted in
2002. The Times quoted Dr. Robert Portnoy, the director of
counseling and psychological services at the
Doris Bertocci, a social worker at
Perhaps not surprisingly, given the increased number and severity of mental illness reported, use of prescribed psychotropic medications also increased at the KSU counseling center. While only 9 percent of patients used such medications in 1988-92, 22 percent reported using them in the 1996-01 time period.
Source: The New York Times, Feb. 3, 2003, p. A-11 [Return to Headlines Page]
Anger and Depression Linked to Same Cause: Serotonin Reduction
Often childhood depression is accompanied by unusual temper tantrums, defiance and opposition by the child against parents, although may not be demonstrated against other adults, such as teachers. There is evidence that these symptoms of depression and defiance may arise from the same source: low levels of serotonin in the brain.
A recent article in the New York Times health section (Nov. 12, 2002, p. D5) by a medical doctor, Richard A. Friedman, describes how some people are genuinely unable to control rage because of damage to the brain or abnormal brain function. Though he says most people with bad tempers can be helped with anger management and self-control, such treatments are more problematic for those with low serotonin.
The article quotes a
Dr. Friedman writes: "What is interesting is that impulsive aggressive behavior is also tightly linked to the neurotransmitter serotonin. Researchers have found that some violent and impulsive patients have significantly lower levels of brain serotonin compared with normal people in control groups. That is probably why serotonin reuptake inhibitors like Prozac and Zoloft, which enhance serotonin function, have an anti-aggressive effect and are useful in treating violent criminals as well as patients prone to rage who also suffer from ailments like depression or personality disorders."
Depressed Child note: This article was not addressed to childhood illness, but there is no reason this site knows of why serotonin dysfunction cannot also be a factor in childhood symptoms. This is more evidence that proper treatment of childhood depression requires serious consideration of both counseling and pharmacological solutions.
Source: The New York Times, Nov. 12, 2002, p. D5 [Return to Headlines Page]
NIMH Study: Therapy Works as Well as Drugs for Depression
A study funded in part by the maker of Paxil concludes that cognitive therapy is as effective as drugs for treating severe depression.
The study, funded by the National Institute of Mental Health
and GlaxoSmithKline, PLC (which makes the antidepressant Paxil),
were presented at the annual meeting of the American Psychiatric
Association in
Researchers at the
The psychotherapy sessions were intended to coach patients to see that their thoughts of worthlessness and hopelessness are exaggerated.
After two months, 50 percent of the medicated patients had improved, as measured by a standard scale of depression. So had 45 percent of the patients receiving only cognitive therapy. Only 25 percent of the placebo patients reported getting better.
The Wall Street Journal, which reported on the study, noted that the results are counter to those of an earlier NIMH study. In 1989, that trial concluded that although therapy is as effective as drugs for mild depression, it is much less effective for the moderate-to-severe kind.
[Comment by The Depressed Child: The article reporting on this survey said nothing specific about childhood depression. We wonder if children are much less conversational or able to absorb two hour doses of therapy involving concepts such as exaggerated feelings of hopelessness. Also, we are continually skeptical of surveys in which patients are asked to judge the effectiveness of their treatment via “standard scales.” Based on such self-evaluation, in the last few weeks we have had studies reporting that drugs were no better than placebos and this study reporting that drugs were twice as effective as placebos. Plus, we have NIMH studies contradicting themselves, as described above. Our view is that counseling can be helpful, but that children at risk also need a thorough psychiatric evaluation with possible drug treatment. Kids change for better or worse much faster than a therapist can keep track of them! End our comment.]
Article source: The Wall Street Journal, p. B1, May 24, 2002 [Return to Headlines Page]
Parents' Verbal Abuse Can Bring Long-Lasting Psychological Damage
A report by the
Johnson's research breaks psychological abuse into five categories, according to an article in The Washington Post. These include terrorizing (often by threatening physical abuse), exploiting or corrupting (including putting children in inappropriate situations or even expecting too much of them), denying personal responsiveness (such as rejecting or isolating a child on unreasonably restricting a child's freedom).
The Post quotes Johnson as saying, "We have so much focus on physical and sexual things, but things we can't see can be much more damaging and may never heal."
Source: The Washington Post Health Section, p. F5, May 14, 2002 [Return to Headlines Page]
Study: Boys and Girls Show Different ADHD Symptoms
A study reported in the January issue of the American Journal of Psychiatry of 280 children diagnosed with ADHD suggests that girls with ADHD are more likely than boys to have the predominantly inattentive type of ADHD (i.e., without the hyperactivity), less likely to have learning disabilities and less likely to manifest problems in school or in their spare time. In addition, girls with ADHD were less at risk for co morbid major depression, conduct disorder and oppositional-defiant disorder than boys with ADHD. ADHD Boys also may be more likely to be substance abusers.
The study included 140 boys and 140 girls diagnosed with ADHD. They, along with 120 boys and 122 girls who were not diagnosed as suffering ADHD, were subjected to diagnostic interviews and a battery of tests for ADHD and emotional , school, intellectual, interpersonal and family functioning.
The authors' conclusion was that because ADHD symptoms are less evident in girls, they are referred for professional help less often than boys.
[Note from The Depressed Child: We are not signing up for the child "gender wars" on this page. All children need love and attention and all children will experience difficulties growing up. But each child must be dealt with individually. There is no common mold that automates diagnosis and treatment, and certainly not one based on gender. That said, this page continues to worry that the schools/mental health institutions are demonizing what was considered "boy" behavior. This is not to say that bullying, inappropriate joking, fighting and sexism are to be tolerated and not disciplined, but we ask the question: Is it so often mental illness? Is it so often ADHD? Or have several horrific school shootings and other events caused us to lose our perspective and -- God forbid -- even fear our male children?)
Article Source: Abstract, Journal of Psychiatry , 159:36-42, January 2002. Influence of Gender on Attention Deficit Hyperactivity Disorder in Children Referred to a Psychiatric Clinic. Biederman, Mick, Faraone, Braaten, Doyle, Spencer, Wilens, Frazier and Johnson. [Return to Headlines Page]
Is the DSM-IV Framework Appropriate for Diagnosis of Preschoolers?
DSM-IV, the diagnostic "Bible" of the mental health profession, contains a list of identifiable symptoms of depression (See the Symptoms page on this website). Although the DSM makes observations and distinctions between adults and children and adolescents -- and still is difficult to apply -- it is not clear if these clinical symptoms are applicable to pre-schoolers. "It is debatable whether behavioral problems in young children should be considered within a diagnostic framework at all, since normative behavioral disruption occurs during the preschool period," write Kate Keenan and Lauren S. Wakschlag in the March issue of The American Journal of Psychiatry.
Keenan and Wakschlag compared different approaches to diagnosis of disruptive behavior in young children and examined evidence to assess the validity of DSM-based characteristics of oppositional defiant disorder and conduct disorder in preschool children. Although this work is being used to outline an agenda for further study, Drs. Keenan and Wakschlag conclude that the DSM model is useful for distinguishing between typical and atypical behavior problems, but care must be taken to address the child's developmental level. They conclude that "empirical investigation is needed to standardize modification of existing assessment tools so that they can be used with preschool children and to develop more clinically sensitive methods for using observational data" to assess a child's mental health in the context of preschool development.
Source: Abstract, The American Journal of Psychiatry, 159:351-358, March 2002. "Can a Valid Diagnosis of Disruptive Behavior Disorder be Made in Preschool Children?" Keenan, Kate, PhD. and Wakschlag, Lauren S., PhD. [Return to Headlines Page]
Sugar Pills as Good as Antidepressants?
Sugar pills may be as effective as high-priced prescription anti-depressants such as Prozac, Zoloft and Paxil, according to a new analysis. All seem to cause changes in the same area of the brain, adding fuel to arguments that to a great extent the idea of taking a drug cure is about as good as actually receiving the pill.
The placebo effect is well-known in many areas of medicine, but the latest analysis suggests that for patients suffering from depression, it acts on the brain in about the same fashion as expensive drugs. (See the story immediately below based on another study suggesting that neither Zoloft nor St. Johns Wort are especially effective in treating depression).
Kahn analyzed trials that were made public in medical literature, which tend to show positive results according to the Post article, and those that were not.
In another study published in the January edition of the American Journal of Psychiatry written by Andrew Leucter, a professor of psychiatry at UCLA and also reported in the Post, brain changes associated with selective serotonin reuptake inhibitors (SSRIs such as Zoloft and Prozac) often were in the same part of the brain in which placebos also showed an effect. Thirty-eight percent of the patients responded to the placebo with heightened activity in the frontal lobe of the brain and 52 percent of patients taking SSRIs also showed heightened activity in the frontal lobe.
The Post reported reactions of several psychiatrists and psychologists who cited results of the study as support for the need for patients suffering from depression to obtain counseling, and not just rely on dispensation of pills by a general practice physician.
[Depressed Child Note: The philosophy of this web site is that parents who suspect their child suffers from mental illness should learn as much as they can about the relevant illness -- in the case of this site, depression -- so they can speak intelligently with mental health professionals, challenge them if necessary, and feel more confident about what their instincts tell them about their kids. The above article proves the wisdom of using, but not surrendering to, the mental health profession.
Among other things, there is a continuing battle between the drug-oriented MDs, including psychiatrists, and the Ph.D./M.S. group -- psychologists, social workers and other counselors not permitted to prescribe drugs. The former point to numerous studies which purport to show the positive impact of drugs, including SSRIs. That many people now take them and find them helpful suggests they may be more useful than the above report concludes. The non-MD counselors always argue strongly for the benefits of counseling, sometimes denigrating the value of drug treatment.
Unfortunately, it is not easy to truly test the value of drugs and it is nearly impossible to evaluate counseling effectiveness in a controlled study. As the tests for depression and ADHD found elsewhere on this web site show, even recognizing symptoms of depression can be difficult, since many of those symptoms may also at least temporarily be experienced by those who don't suffer serious depression. Determining who is "sick" and who is getting "better" is highly subjective, relying on the impressions of the patient, even in the best of tests. Effective counseling depends on the nature of the illness, the personality and training of the counselor, the personality of the patient and perhaps even matters as subjective and difficult to measure as the surroundings of the office. The non-M.D. group has the advantage of counseling being virtually non-testable for effectiveness on a large population of patients, at least as compared to the more controlled (but hardly perfect) testing of drugs.
The Depressed Child is only concerned with this "battle" to the extent that parents should be aware of it in assessing the various treatment options for their children. You should know the vested interests involved in this fight. It is disheartening that the field of mental health contains so many basic issues that are unanswered. The best approach is to learn as much as you can, don't arbitrarily rule out anything that seems it might be useful, and work with mental health professionals on both the M.D. and PhD sides of the system. End editorial note.]
Article Source: The
Do Antidepressants Prevent Suicide in Teenagers? Answer: Maybe
A
Dr. David Shaffer, Irving Philips Professor of Child Psychiatry at
Dr. Shaffer noted that the suicide rate for youth 15-19 had steadily declined since approximately 1988 for white males, who commit the most suicides in the age group, and since 1994 for minority males. Use of drugs and alcohol in this age group either increased significantly (drinking) or remained fairly constant (drug use), according to slides presented by Dr. Shaffer. However, use of antidepressants for children 0-17 increased 10-fold since 1985, suggesting at least a statistical cause-and-effect for the suicide rate drop.
He said the conclusion was buttressed by autopsy studies showing that suicides had reduced levels of serotonin in their brain, suggesting a biological connection. SSRIs generally act to slow the brain’s absorption of serotonin, which generally assists the central nervous system in, among other things, the thought process. Dr. Shaffer noted that suicide generally is a result of diagnosable depression combined with impulse and loss of self-control. SSRIs act as a brake on such impulses and improve self-control, according to Dr. Shaffer.
Some attendees noted that the few double-bind trial experiments of SSRIs on children had been somewhat inconclusive because placebos were shown to be nearly as effective as the drugs. However, the “placebo effect” has been widely noted even in studies of physical illness to provoke an improvement in condition among many patients.
Dr. Shaffer spoke at a forum called Improving Children’s Mental Health: The Bright Futures Approach, co-sponsored by the National Institute for Health Care Management and the U.S. Department of Health and Human Services. The overall purpose of the seminar was to present methods for encouraging pediatricians and general practice physicians to diagnose mental health problems in children for referral to a specialist. In this way, speakers said, there could be greater identification of children with mental health problems and unmet needs provided for.
Source: Conference attendance, 2/5/02 [Return to Headlines Page]
Depressive Symptoms in Welfare Moms Bring
Depression to their Children
Mothers on welfare are more likely to be depressed than others, and this condition negatively influences their children, according to a study summarizing seven earlier reports on the subject. Thirty to 45 percent of welfare moms reported symptoms of depression, compared to 20 percent of moms in the general population. Children of these moms ages 5 to 7 were more likely to exhibit disobedient or bullying behavior. Children 8 to 10 displayed more depressive behaviors than the general peer population, including acting sad or showing low self-esteem. Children of depressed welfare moms who also were illiterate or had low literac