Care homes dispense 'chemical cosh'/Antidepressant Use in Children Soars /TV blamed for suicide

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Wednesday, 5 December, 2001, 14:51 GMT

Care homes dispense 'chemical cosh'

 

http://news.bbc.co.uk/2/hi/health/1693854.stm

Thousands may be getting the wrong drugs

 

Prescriptions of powerful anti-psychotic drugs for older people are soaring,

says an MP, who claims care homes are misusing them.

Liberal Democrat Paul Burstow says that many residents who do not need such

drugs are being kept in a sedated state simply to make life easier for

staff.

 

He has produced more evidence that some homes may be abusing their clients

in this way.

 

One in 10 care home residents have some kind of psychotic symptom such as

hallucinations or paranoid ideas.

 

However, previous research suggests that the number of residents actually

given anti-psychotic drugs is nearer one in three.

 

Figures for 1999 and 2000, obtained by Mr Burstow, showed that, in just one

year, there was a 70% increase in the use of one type of anti-psychotic

medication for elderly patients.

 

 

 

Older people are the victims of a chemical cosh and it is getting worse.

 

 

Paul Burstow

This is partly due to the changeover to this more modern type of drug, but

still represents an increase of almost 100,000 prescription items.

 

The report claims that at least 35,000 elderly people in nursing homes, and

possibly 53,500 in residential homes are being given anti-psychotic

medication inappropriately.

 

The drugs can only be justified when used on people with psychotic symptoms,

as there is the chance of severe side-effects, and there is also the chance

they will interfere with other drugs being taken.

 

Cocktail of drugs

 

Mr Burstow said: " Older people are the victims of a chemical cosh and it is

getting worse.

 

" With serious shortages of specialist staff, and little chance of attracting

more, care homes are turning to chemical cocktails to make residents easier

to manage.

 

" Successive governments have failed to tackle this abuse. New research and

prescribing guidelines are urgently needed, along with investment in

specialist dementia training for staff. "

 

Government plans

 

The government's National Service Framework for Older People does address

the problem of inappropriate prescribing of such drugs in care homes.

 

It recommends reviewing of repeat prescriptions - and that doctors follow

guidance on when to give anti-psychotics.

 

By next year, the framework says, all those over 75 should have their

medication checked once every year - and every six months if they take four

or more drugs.

 

Antidepressant Use in Children Soars Despite Efficacy Doubts

http://www.washingtonpost.com/ac2/wp-dyn/A20624-2004Apr17?language=printer

By Shankar Vedantam

Washington Post Staff Writer

Sunday, April 18, 2004; Page A01

 

 

The number of depressed American children being treated with antidepressants

has soared over the past decade -- a tectonic shift in the practice of

psychiatry -- but new scientific reviews of the research that fueled the

trend suggest that the drugs' benefits have been dramatically oversold.

 

 

 

 

The use of antidepressants among children grew three- to tenfold between

1987 and 1996, data from various studies indicate, and a newer survey found

a further 50 percent rise in prescriptions between 1998 and 2002. The

explosion in antidepressant use occurred even though the vast majority of

clinical trials have failed to prove that the medicines help depressed

children.

 

The spike in prescriptions over the past five years has been especially

sharp among children younger than 6, even though there is virtually no

clinical trial data on these youngest patients.

 

Paradoxically, drugs that have never shown benefits for depressed children

in clinical trials have some of the largest increases in prescription rates.

Pediatric prescriptions for Paxil, for example, doubled between 1998 and

2002, even though the medicine failed to show it was any better than dummy

pills in three trials. The drug has not been approved for use in children,

and last year the Food and Drug Administration and British health authoritie

s warned physicians not to prescribe Paxil for children, citing safety

concerns.

 

Paxil is not alone. Of 15 trials conducted among depressed children, 10

failed to show antidepressants were better than dummy pills. Two were

inconclusive, and three showed positive results. The negative results have

mostly been withheld from public scrutiny by the pharmaceutical companies

that paid for the trials, which say that the data are proprietary.

 

Although many psychiatrists swear by the drugs in children and adults,

leading specialists agree they have limitations.

 

" These drugs are by and large efficacious, but they are only moderately

efficacious, " said Steven Hyman, former chief of the National Institute of

Mental Health.

 

" A lot of clinical trials for antidepressants fail, " added Hyman, now

provost at Harvard University. " Partly that's the difficulty of trials in a

waxing and waning disease, but we also need drugs of greater intrinsic

efficacy. "

 

Prozac remains the only antidepressant that the FDA has approved for

children's depression, after the agency accepted two studies that

demonstrated the drug worked better than dummy pills.

 

But an FDA internal analysis of the trials found Prozac failed on the

statistical measure that researchers had originally chosen as their primary

benchmark: " The evidence for efficacy based on the pre-specified endpoint is

not convincing. "

 

Senior officials at the agency, however, concluded that the improvement on

another measure justified approval. For one of the studies, a senior

official, Russell Katz, wrote in July 2001 that " one could argue that this

post hoc choice of primary outcome is inappropriate, " but in the end he and

others said that this was the proper benchmark.

 

Australian researchers writing this month in the British Medical Journal

reviewed the published studies of Prozac and other drugs and concluded they

were consistently weak. The review charged that researchers doing the

studies had selectively dramatized successes and glossed over problems.

 

Another analysis this month in the journal Psychiatric Services said the

drugs had only modest benefits, with " many treated patients continuing to

experience symptoms. " The report tracked antidepressant prescription

increases among children with private health insurance.

 

" When a patient takes a medicine or a family physician or a pediatrician

prescribes medicine, their understanding when they hear this medicine works

is they believe, 'My child will recover from depression,' " said Jane

Garland, head of the mood and anxiety disorders clinic at the British

Columbia Children's Hospital in Vancouver.

 

" But the data says they are not going to get any better than on a placebo, "

she said. " They will have some improvement in symptoms, which is a good

thing, but it means there is clearly more than medication needed for

treatment. "

 

Concerns over the quality of the data have been heightened by a recent

warning by British health authorities that urged caution in using the drugs,

citing indications that they may cause suicidal behavior.

 

" The risk-benefit ratio starts to look dodgy, " Jon Jureidini, a child

psychiatrist at the Women's and Children's Hospital in Adelaide, said in an

interview. " But if you look at the published literature, you can be forgiven

for not reaching that conclusion. "

 

The American psychiatric establishment firmly supports the drugs -- even

those not specifically approved by the FDA for children. Psychiatrists say

children's depression is severely undertreated.

 

Most psychiatrists say that the fears about suicide risk are overreactions.

Patients who suddenly stop taking medicine without consulting their doctors

could put themselves at risk, Harvard's Hyman and other physicians say. Many

doctors are convinced the drugs save lives.

 

The review in Psychiatric Services said that growing awareness about

depression, better diagnosis and incentives by insurance companies in favor

of medication rather than talk therapy may have fueled the rise in drug

treatment. Although the drugs are also used for anxiety and other

conditions, depression accounts for the majority, the review said.

 

The report also cited doctors' belief that positive data from adult studies

can be extrapolated to children. In a 1999 letter to Prozac's manufacturer,

however, the FDA expressed " substantial concern about the ability to

extrapolate positive antidepressant findings from adult to pediatric

patients. "

 

" I'm not anti-drug, but I don't know what to believe, " said Wayne Blackmon,

a Washington psychiatrist who worries that clinicians have been fed

misleading data. " Once you start delving into it, you start going, 'Oh no,

no, no -- this is not valid.' "

 

Across the board in clinical trials of antidepressants, about half of all

depressed children improve whether they are on a drug or a placebo (dummy

pill). And new evidence suggests that the placebo effect -- the tendency to

get better when patients believe a treatment will help -- may be even

greater in the real world, because patients deemed susceptible to placebos

are screened out of clinical trials.

 

While supporters and critics of the medicines present the issue in

black-and-white terms, the data from clinical trials paint a complicated

picture.

 

In one of the two trials of Prozac used to win FDA approval, for example,

the original benchmark was recovery -- how many depressed children recovered

on Prozac compared with dummy pills. The difference was not statistically

significant.

 

But Prozac's manufacturer, Eli Lilly & Co., then evaluated how many children

improved by 30 percent on a commonly used scale to measure depression. Among

children taking Prozac, 58.3 percent had a 30 percent improvement, whereas

only 31.9 percent of those on dummy pills improved that much. By this new

measure, the difference was statistically significant, and the company

claimed success.

 

The internal FDA statistical analysis, however, found the difference

vanished when officials looked at how many children improved by 10 percent.

And there was again no difference when they evaluated how many children had

a 50 percent improvement: " The largest treatment effects was found when 20

percent or 30 percent cut-off points were chosen, " an FDA statistician

wrote.

 

Within the FDA, officials also worried that the group of depressed children

who got Prozac included a large number who also suffered from anxiety,

raising questions about the validity of the results. FDA officials also said

a nurse with access to codes showing who got the drug was involved in

evaluating two patients, a potential bias.

 

In the end, however, senior FDA officials concluded that the drug had

succeeded on yet another measure, which they said was the best way to

evaluate antidepressants -- the average improvement on the children's

depression scale.

 

FDA officials Thomas Laughren, team leader for psychiatric drug products,

and Robert Temple, associate director of medical policy, said in a recent

interview that the children with anxiety did not undermine the result. While

the study had been conducted as an academic research project, not an

industry-sponsored trial, FDA officials said they had confidence in it.

 

" There is nothing to suggest this was not a rigorously conducted study, "

Laughren said. Eli Lilly spokeswoman Jennifer Yoder said the company stands

behind its drug.

 

Part of the problem for doctors and parents trying to evaluate the data is

that experts starkly disagree on the statistics. Graham Emslie, for example,

a professor of psychiatry at the University of Texas Southwestern Medical

Center, who conducted the two positive trials for Prozac, said six

antidepressant studies in children showed benefits; the FDA counted three.

 

Emslie co-chaired a panel of the American College of Neuropsychopharmacology

that declared in January that the drugs are safe and effective for depressed

children.

 

However, at least one manufacturer, Wyeth, has itself told doctors not to

prescribe its drug Effexor for children. Philip Perera, medical director at

Glaxo SmithKline, which makes Paxil, said: " Our point of view with respect

to pediatrics is that it is still up in the air. "

 

Jureidini's analysis in the British Medical Journal, which examined six

published trials for Prozac, Paxil, Zoloft and Effexor, found that of 42

measures used to evaluate patients in these studies, only 14 showed a

statistical advantage for the medicine over placebo.

 

The psychiatrist, who himself prescribes the medicines to children -- but

rarely -- said the moderate benefits of the drugs have been oversold. He

blamed pharmaceutical industry marketing and the alliances the industry has

made with top psychiatrists: Once prominent doctors said they supported the

medicines, general practitioners and the public accepted the conclusion,

Jureidini said.

 

The researcher said that doctors had a subtle -- but powerful -- bias:

" There's this kind of view that we all know antidepressants work and if the

research doesn't support that, there must be something wrong with the

research. "

 

 

© 2004 The Washington Post Company

 

 

 

Television Blamed For Suicide Rise

 

http://www.rense.com/general51/tv.htm

Britney Spears Video Reignites Debate

Over 'Irresponsible' Shock Scenes

Jamie Doward

Social Affairs Editor

The Observer - UK

4-18-4

 

A young woman slashes her wrists. A prisoner hangs herself in a cell. A man

swallows scores of paracetamol tablets in a desperate bid to end his life.

 

The three haunting scenes all feature in television story lines which have

provoked alarm from mental health charities who fear the media are becoming

increasingly irresponsible in their treatment of suicide and self-harm.

 

Suicide awareness groups have highlighted several recent television dramas

that have given cause for concern. These include Footballers' Wives and an

episode of the prison drama Bad Girls, both of which showed one of the main

characters hanging herself. Samaritans points out that prisoners are seven

times more likely to take their lives than the average person.

 

Many production companies now consult mental health experts when writing

suicide story lines into scripts. EastEnders, for example, will soon feature

a suicide. The show's writers worked with mental health groups to ensure the

scenes were not gratuitous and did not provide a graphic description of the

method. Hollyoaks, William and Mary and the Inspector Lynley series have

also sought advice from experts.

 

But not all producers are so sensitive, according to suicide experts. 'Over

the past few years, we've become aware of quite a few instances of suicide

being portrayed in a way that isn't entirely appropriate,' said Sarah

Nelson, media manager for Samaritans.

 

The debate over the way the small screen treats suicide will be reignited

later this month when the latest Britney Spears video, in which the singer's

wrists are accidentally slashed and she then drowns in a bath, is aired on

UK television.

 

The singer denies the scene could be mistaken for suicide but experts say it

is 'almost inevitable' that the video will spark a wave of copycat attempts.

In the month after Marilyn Monroe killed herself, for example, the suicide

rate in the US went up by 12 per cent.

 

'It would be almost surprising if there wasn't a rise in suicide attempts

after the Britney Spears video is aired,' said Greg Philo, professor of

communications at Glasgow University.

 

Philo was part of a team that monitored suicide attempts following an

episode of Casualty which showed a character swallowing more than 50

paracetamol tablets.

 

The episode, watched by 12.8 million viewers, prompted a 17 per cent rise in

hospital admissions for paracetamol poisoning the week after it was shown

and nine per cent the week after that.

 

The episode raised awareness that paracetamol could kill if taken in large

enough doses. 'We asked people who had seen the programme what they thought

about it and the main point that came across was a new awareness that if you

are thinking of killing yourself paracetamols " could do the trick " ,' Philo

said.

 

The study's findings appear to be corroborated by events in Germany where a

television series, Death of a Student, depicted the suicide of a young man

who walked in front of a train. Studies showed that, during the series, the

number of young men killing themselves by similar means rose 175 per cent.

Suicide by other means did not decrease, suggesting the series was

responsible for a real increase in attempts, rather than influencing the

choice of method.

 

The controversial video for Spears's new single, 'Everytime', has already

been reworked once. An earlier edit, which showed the singer killing herself

with an overdose, was banned by record bosses who feared a backlash from

conservative groups.

 

Guardian Unlimited © Guardian Newspapers Limited 2004

http://www.guardian.co.uk/medicine/story/0,11381,1194410,00.html