from The Wall Street Journal
New federal mental-health guidelines could lead to more schoolchildren taking branded drugs to treat depression, according to some critics of the program.
...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.
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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.
Ryan,
Thank you for posting the entire article. It was an interesting and disturbing read. It raised some of the same questions I've asked for years.
What kind of test would they use to determine a mentally "healthy" child?
How would they be able to tell if a child who does not "pass" this test isn't just having a "sad" day today and will be ok with the passage of time?
Other then the option to medicate, which is a quick and easy fix for many, what will be the plan treatment once illness is determined? Long term counseling was mentioned and this would be more helpful to those who are depressed due to some outside event (my grandmother passed away... we just moved to this new school and I don't know anyone... my mommy and daddy are fighting a lot, things every child faces at some level). But it's an expensive and time consuming option for schools, the state and the nation, so where will the nation find funding without raising taxes?
The most important question it raises is: When did it become "unhealthy" to be sad? Isn't that all depression really is to most people (those who don't experience the illness, or live with anyone who does, anyway)? They talk about mental illness, which could be anything from depression to schizophrenia, and could entail feelings from slightly blue, to the urge to murder. The only drugs they discuss are those for hyperactivity and the emotional inhibitors used mostly for depression. And it might be helpful to deal with the emotional effect of screening children and then singling the few out of each classroom for treatment. In any government plan there would have to be in school screenings, for catching the children without insurance for doctor’s visits.
It was bad enough to have lice during the lice screening, or those awful height and weight screenings... Can anyone imagine the terror of a mental health screening if it’s done in schools?
Anyway, thanks for the read Ryan,
Susie G.
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