Should children get mood-altering pills?

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> Should children get mood-altering pills?

> (18/08/2004)

>

> Daily Telegraph survey on the use

> of Prozac and Ritalin on children

>

> As an initiative on paediatric medicine

> is announced, a survey reveals fears over the use of

> psychoactive drugs. Ananyo Bhattacharya reports

>

> Thousands of children are being

> prescribed mood-altering drugs in what some fear is

> an unregulated experiment with repercussions that

> will not be known for many years.

>

>

> Prozac nation: some doctors say

> behavioural drugs are justified by the benefits;

> others worry about long-term risks

> A Telegraph survey conducted among brain

> researchers and psychiatrists has uncovered

> considerable unease over the widespread use of

> Ritalin and Prozac. And further weight was added to

> our findings yesterday when the Government announced

> that research into drugs for children will receive a

> much needed boost.

>

> Ritalin is widely used to treat

> hyperactivity, while Prozac is prescribed for

> depression and other types of mental illness. Some

> doctors claim that both are now being increasingly

> used to treat children in Britain because they

> provide a cheap alternative to talking therapy.

>

> Three quarters of the experts who

> responded to our poll said that they did not feel

> enough was known about the effects of either drug on

> the developing brain to prescribe them to children.

>

> " There is ample evidence that it is

> possible for psychoactive drugs - and stimulants in

> particular - to harm the brain, " said Dr Terrell

> Gibbs, of the Boston University School of Medicine,

> whose research has shown that high doses of

> amphetamines can cause brain damage in animals.

> " Wide use [of Ritalin] in children began before

> information on its long-term effects were available,

> and we are very lucky not to be seeing an epidemic

> of neurological disease. Prozac is now in the

> position that Ritalin was a few years ago, with

> widespread paediatric use despite very limited

> evidence of safety. "

>

> The use of stimulants such as Ritalin

> has more than doubled in the UK since 1995 with

> doctors writing a quarter of a million prescriptions

> in 2002. Ritalin is a brand name for the

> amphetamine-like drug methylphenidate, which is used

> to treat children with attention deficit hyperactive

> disorder (ADHD). There is controversy over how to

> diagnose the disease and estimates for the number of

> British children suffering from it range from 70,000

> to 350,000.

>

> The symptoms - which include a short

> attention span, always being " on the go " and

> fidgeting - are diverse and no single test for the

> disorder exists, raising questions about where to

> draw the line between a lively child and an ADHD

> child and whether some affected children could

> respond as well to firm parenting as to

> pharmacology.

>

> Fluoxetine hydrochloride, marketed under

> the trade name of Prozac, is prescribed for a host

> of childhood conditions, including depression,

> obsessive compulsive disorder and selective mutism -

> a debilitating form of shyness. Around 300,000

> children are thought to suffer from emotional

> disorders such as anxiety and depression, and the

> Government's medicines watchdog estimates that

> Prozac was administered to more than 20,000 children

> in Britain. With other anti-depressants in the same

> class no longer recommended for use in children

> because they led to an increased risk of suicide,

> that figure is set to rise further this year.

>

> There are no systematic long-term

> studies assessing the safety of using Prozac to

> treat children. In 2001, the average clinical trial

> with Ritalin lasted only three and a half weeks and

> very few studies to date have looked at the effects

> of the drug for longer than two years. Writing in

> the British Medical Journal in October 2000, experts

> concluded that the evidence on the benefits of

> stimulants to ADHD sufferers in the longer term was

> limited: " Little is known, for example, about

> outcomes such as educational achievement,

> employment, or social functioning. "

>

> Both Ritalin and Prozac are none the

> less being prescribed to increasing numbers of

> children and many clinicians are convinced of the

> benefits of the drugs because they often bring

> immediate relief from the symptoms of mental

> disorders.

>

> " Kids really suffer without help, and

> the theoretical risk of medication has to be weighed

> against the immediate benefits, " said one doctor.

>

> Dr John Mathai, a consultant child and

> adolescent psychiatrist from East Sussex, agrees. He

> is adamant that drugs are the most important

> component of a comprehensive treatment programme.

>

> " Both these medications are the mainstay

> of child psychiatry and have given much relief to

> parents and reduced their stress levels remarkably, "

> he said. " No amount of other therapy has had the

> same effect as these drugs. "

>

> Of the experts polled, 86 per cent

> agreed that cognitive behavioural therapy (CBT) -

> where patients talk out their problems with a

> qualified therapist - is effective and should be

> given more prominence in treatment programmes. But

> many were concerned that the shortage of trained

> therapists in the NHS means that the therapy is

> practically unavailable.

>

> " There is pressure on child

> psychiatrists to use drugs as agents for social

> control because they are cheaper than comprehensive

> assessments and social or educational management, "

> said one practising child psychiatrist, who asked

> not to be named.

>

> Others felt doctors were ignoring

> government guidelines and prescribing the drugs

> without considering alternative treatments.

>

> " Sadly, methylphenidate has become the

> panacea of all ills. It is even being prescribed to

> help children with school grades, " said one

> anonymous child psychiatrist, who had taken on a

> number of children only treated with medication.

> After therapy she found that the children were able

> to come off the amphetamines. " None of them has come

> back to me and I hope to conduct a 10-year follow up

> next year, " she added.

>

> Clinicians were particularly worried

> about the use of Prozac, one of a family of

> anti-depressants known as selective serotonin

> reuptake inhibitors (SSRIs). Last December, the UK

> Committee on the Safety of Medicines (CSM) advised

> doctors against prescribing almost all SSRIs to

> treat depression in children because they increased

> suicidal thoughts and self harm without conferring

> significant benefits. Prozac was the only drug for

> which the benefits were found to outweigh the risks,

> though young patients on other SSRIs were warned not

> to stop taking them without consulting their

> doctors. Even for Prozac the positive outcome rested

> on a relatively small number of studies.

>

> " The evidence base for SSRIs is

> inconclusive and inadequate, but clinicians believe

> they work as well for children as adults, " said a

> consultant psychiatrist who commented in our survey.

> " In fact, they don't work that well for adults. "

>

> In some cases, while published data

> suggested that the drugs were effective in treating

> depression, adding unpublished negative drug trial

> results to the analysis showed that overall the drug

> did children more harm than good.

 

Indeed, GlaxoSmithKline is

> currently being sued by the state of New York for

> allegedly suppressing studies that showed that its

> SSRI Paxil - marketed in the UK as Seroxat -

> increased suicidal tendencies in children.

>

> Responding to our straw poll, more than

> 90 per cent of clinicians agreed that pharmaceutical

> companies should make all clinical trial data

> publicly available.

>

> Consultant child and adolescent

> psychiatrist Dr Morris Zwi is involved with the

> Cochrane Collaboration, an international non-profit

> organisation dedicated to providing unbiased reviews

> of clinical trials for doctors. He thinks that

> researchers should be able to see the full results

> of all trials, positive or negative. " This is a

> basic public health issue that needs to be addressed

> in which there is conflict between the public

> interest and the pharmaceutical industry, " he said.

>

> The situation may be exacerbated by

> psychiatrists conducting clinical trials for the

> pharmaceutical industry. A recent study published in

> the Canadian Medical Association Journal found that

> trials funded by drug companies tended to report

> more favourable results. But Zwi points out that

> government money for drug trials is limited.

>

> " There is a real difficulty in getting

> funding for trials from anywhere but the

> pharmaceutical industry, " he said.

>

> The new Government initiative recognises

> the urgent need for more clinical trials to assess

> the safety of using drugs on children.

>

> Responding to the survey, a spokesman

> for Novartis Pharmaceuticals, which produces

> Ritalin, said: " Ritalin has been used safely and

> effectively in the treatment of millions of ADHD

> patients for over 40 years and is the most studied

> drug prescribed for the disorder, with more than 170

> studies completed in more than 6,000 school-aged

> children.

>

> " Novartis Pharmaceuticals endeavours to

> get all its trials published. Some of the trials on

> Ritalin have been conducted independently of the

> company so we do not have any involvement in their

> publication.

>

> " Any increase in prescriptions is

> probably due to the greater awareness of the

> disorder. "

>

> The maker of Prozac, Eli Lilly and Co,

> said: " It is difficult to comment on the survey

> questions related to Prozac because we have and

> continue to stand by the extensive clinical data

> supporting both the efficacy and tolerability of

> Prozac in treating major depressive disorder. Prozac

> is among the most studied medicines in history. "

>

> The company has just announced plans to

> disclose all clinical trial data on a

> publicly-available online registry starting later

> this year.

>

> Daily Telegraph survey on the use

> of Prozac and Ritalin on children

 

> In all, 55 of the experts we

> contacted this month responded to the poll. Of

> these, 28 were neuropharmacologists or

> neuroscientists, 25 were psychiatrists practising in

> the UK and two were clinical psychologists. The

> majority had dealt with either Prozac or Ritalin in

> a professional capacity.

 

> YES NO

> 1. Are you concerned about current

> levels of prescription of Prozac or Ritalin for

> children*? 80% 20%

> 2. Should alternatives to drugs,

> such as cognitive behavioural therapy, be given more

> prominence in the treatment of psychiatric disorders

> in children? 86% 14%

> 3. Do you feel that we know enough

> about the effects of these drugs on the developing

> brain to prescribe them to children? 22% 78%

> 4. Should pharmaceutical companies

> make all clinical trial data publicly available? 84%

> 16%

> *96% of the researchers, and 62%

> of the child psychiatrists, who responded to our

> survey expressed concern about the current levels of

> either Ritalin or Prozac.

>

> 8 August 2004[Education]: 'Happy

> gene' could solve mystery of depression

> 11 December 2003[News]:

> Antidepressants do children 'more harm than good'

> 19 January 2003[News]: Hyperactive

> children test Ritalin substitute

> 14 November 2001: Ritalin may have

> 'long-term side effects'

>

 

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