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  • From: "Lynda" <lurine AT softcom.net>
  • To: <homestead AT lists.ibiblio.org>
  • Subject: [Homestead] More Corporate Welfare
  • Date: Wed, 26 Jan 2005 12:33:12 -0800

Children's Depression-Drug Use May Rise, Guideline Critics Say
By HOLLISTER H. HOVEY DOW JONES NEWSWIRES
January 26, 2005

New federal mental-health guidelines could lead to more schoolchildren taking
branded drugs to treat depression, according to some critics of the program.

In the next few weeks, federal agencies will issue final guidelines taken
from the President's New Freedom Commission on Mental Health recommendations.
Millions of dollars in grants for states to revamp such programs will follow.
But critics fear all this will culminate in more children being prescribed
antidepressants or other branded pharmaceuticals. Treating young people with
antidepressants has come under intense debate because the powerful drugs,
while helpful to many, can lead to suicidal thinking.

It's a potentially big market for drug companies and one that grew strongly
until recent warnings about the increased risk of suicide for children on
antidepressants. The number of children taking behavioral medicines in the
U.S. jumped 20% from 2000 to 2003, according to Medco Health Solutions Inc.
data. Spending on hyperactivity drugs increased threefold for children under
five over the period.

The government and some psychiatry groups say more drugging isn't the
commission's intention. Recommendations so far propose "quality screening and
early intervention" in the likes of primary health-care facilities, schools,
criminal-justice and child-welfare systems.

"Both children and adults will be screened for mental illnesses during their
routine physical exams," the commission's report, which came out in 2003,
recommends.

The recommendations "never called for universal or mandatory screening
without parental consent," said Kathryn Power, director of the Department of
Health and Human Services' Substance Abuse & Mental Health Services
Administration's Center for Mental Health Services.

"We were flabbergasted at the way in which some of the controversy was going
on about screening. ... If parents want and desire that their child should
have an assessment, they should be allowed to do that. It's a health service
that's no different from a hearing screening or a vision screen."

Late last year, Congress approved an omnibus appropriations bill that
included $20 million of grants that states could apply for to revamp their
mental-health programs. These changes would likely have to adhere to the New
Freedom Commission guidelines that the government will eventually recommend.

"The problem is that we don't know which recommendations that they're going
to take," said Karen Effrem, a screening opponent who sits on the boards of
EdWatch, the Alliance for Human Research Protection and the International
Center for the Study of Psychology and Psychiatry.

"There's no discussion about protecting families from coercion to screen,"
Dr. Effrem said. "There's no discussion about what happens if parents say no.
There's no widespread protection against medication coercion, either."

Ms. Power, who is heading the review of the commission report, said that the
final guidelines from the federal agencies should come out within about a
month. Separately, the government is in the process of making the grant
application forms that the states and Indian tribes can submit in hopes of
receiving $1.5 million to $3 million to transform their state mental-health
programs.

"They have to show that they have a vision to change their infrastructure,"
Ms. Power said.

Many see the government's goal in simple terms: Screen for children with
possible problems and get them counseling or support services first.

David Fassler, a member of the American Psychiatric Association's Board of
Trustees and a practicing child and adolescent psychiatrist in Burlington,
Vt., said the goal seems to be early detection of signs and symptoms of
mental illness so children "get comprehensive evaluations and appropriate
intervention when necessary. Different states will approach this in different
ways."

Critics welcome early detection -- after all, suicide is the third-leading
cause of death among young people, according to Centers for Disease Control
and Prevention statistics. But it's the likely treatment that worries them.
They say doctors, schools and parents have been too eager to medicate
children as a quick fix for alleged mental problems and that this could
increase under the guidelines. In some instances, parents have been
threatened with child-abuse charges for refusing to put their children on
psychiatric drugs and schools have suspended children for not taking their
medicines.

During that 2000-2003 period in which Medco noted the jump in children on
behavioral medications, spending on antidepressants was up 25% and the use of
antidepressants rose 27%.

That growth stalled last year. In October 2003, the Food and Drug
Administration warned about reports that some children who were taking
certain antidepressants had shown increased risks of suicide and suicidal
thoughts. In September, an agency advisory committee recommended that
antidepressants carry the government's strongest warning that the drugs can
make teenagers become suicidal and that it's unsure if these drugs even work
on children.

Prozac, which is made by Eli Lilly & Co. and now competes with generics, is
the only antidepressant approved for use in children, but doctors commonly
prescribe other drugs.

In the aftermath of the suicide warnings, Medco data showed that the number
of children under 18 on an antidepressant in the first quarter last year fell
18% and 5% more in the second quarter.

Part of the controversy around the pending government guidelines stems from
the commission report highlighting the Texas Medication Algorithm Project,
which has been criticized because of conflicts of interest linked to the
pharmaceutical industry, Dr. Effrem said.

The TMAP has led to the creation of a flow chart recommending that doctors
prescribe the newest medications first for psychiatric disorders.

"The Texas Medication Algorithm Project illustrates an evidence-based
practice that results in better consumer outcomes, including reduced
symptoms, fewer and less-severe side effects and improved functioning,"the
commission report says. "However, too few consumers benefit from this
practice because it is not widely used."

The flow chart recommends that children diagnosed with major depression first
receive a selective serotonin re-uptake inhibitor, or SSRI, which includes
drugs such as Prozac, Pfizer Inc.'s Zoloft and Forest Laboratories Inc.'s
Lexapro and Celexa. The SSRIs are the same drugs the government linked to
higher risks of suicide in young people.

The commission's report came out long before the suicide warnings were added
to these drugs. It's unclear if this would be a part of the government's
final recommendations.

Write to Hollister H. Hovey at hollister.hovey AT dowjones.com1
URL for this article:
http://online.wsj.com/article/0,,SB110669008910835726,00.html
Hyperlinks in this Article:
(1) mailto:hollister.hovey AT dowjones.com
Copyright 2005 Dow Jones & Company, Inc. All Rights Reserved This copy is
for your personal, non-commercial use only. Distribution and use of this
material are governed by our Subscriber Agreement and by copyright law. For
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Reprints at 1-800-843-0008 or visit www.djreprints.com.



  • [Homestead] More Corporate Welfare, Lynda, 01/26/2005

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