ANTIDEPRESSANTS: Murder-Suicide: Woman Kills Husband, 2 Year Old Son

How sickening that this horrific antidepressant-induced murder/suicide could happen right in the same city where a jury found eight years ago that ONLY TWO PILLS of the antidepressant Paxil were the main cause for Donald Schell to shoot his wife, daughter, infant granddaughter and then himself!

WHY DID THE LOCAL MEDIA ALLOW THE TRAGIC WARNING BY THE SCHELL FAMILY (AT THE COST OF SO MUCH INNOCENT BLOOD) TO LEAVE THE PUBLIC EYE LONG ENOUGH FOR ANOTHER SIMILAR TRAGEDY TO HAPPEN??????!!!!!!!!!! HOW LONG DO WE ALLOW THIS TO HAPPEN AND DO NOTHING?! WHERE IS THE MEDIA RESPONSIBILITY TO WARN THE PUBLIC?! IS IT BURIED UNDER THEIR LARGE ADVERTISING ACCOUNTS FROM PHARMACEUTICAL COMPANIES?!

Sorry to shout, but people are dying horrible deaths and no one seems to care. After 20 years of witnessing so many senseless deaths you start shouting. PLEASE encourage your local media to warn of this possibility with these drugs. If they need more information have them contact me.

Dr. Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness
www.drugawareness.org & www.ssristories.drugawareness.org
Author of Prozac: Panacea or Pandora? – Our
Serotonin Nightmare (Order #)

Paragraph three reads: “In a toxicology test, forensic pathologist Dr. Patrick Allen found opiates, tranquilizers, anti-depressants and pain killers in the woman, according to the autopsy report.”

Paragraphs seven and eight read: “Luna said the woman did have some anti-depressants that were prescribed, and that she had a history of such medication.

“There’s no prescription for the (opiates and morphine),” Luna said Wednesday. “You can surmise she got it from other sources.”

http://www.wyomingnews.com/articles/2009/09/10/news/19local_09-10-09.txt

Some of the many prescription meds in Joy Hofer’s system were prescribed, some weren’t, surmised the coroner.

By Michael Van Cassell
mcassell@wyomingnews.com

CHEYENNE – A woman who authorities say shot her husband and killed her 2-year-old son had a cocktail of prescription drugs in her system when she took her own life on July 24.

On Wednesday, the Laramie County Coroner’s Office released results from the autopsy performed on 31-year-old Joy M. Hofer.

In a toxicology test, forensic pathologist Dr. Patrick Allen found opiates, tranquilizers, anti-depressants and pain killers in the woman, according to the autopsy report.

Some of those drugs were in her blood at levels ranging from twice to potentially 1,200 times the therapeutic level, the report shows.

Laramie County Coroner Marty Luna said there were “high amounts of opiates and morphine” in her system.

“She should have been shut down,” he said. “I don’t know how she functioned.”

Luna said the woman did have some anti-depressants that were prescribed, and that she had a history of such medication.

“There’s no prescription for the (opiates and morphine),” Luna said Wednesday. “You can surmise she got it from other sources.”

Her husband, Kelly J. Hofer, 28, and son Gunnar Hofer, 2, were both found July 25 in at the family’s residence in the 4700 block of Hickory Place. Autopsies indicated Joy M. Hofer killed them.

Kelly Hofer died from a gunshot wound to the back of his head; Gunnar Hofer died from suffocation and strangulation, according to autopsies.

Luna has said evidence suggested Kelly Hofer died first, and that he and Gunnar died July 24.

Bruises were found on the child’s neck and face as well as lidocaine, an anesthetic or numbing agent, in his blood stream, an autopsy report shows.

The autopsy report for Joy M. Hofer said she suffered a gunshot to the right side of her head.

Cheyenne Police Detective Cathleen Trujillo said Wednesday that she is awaiting test results for gunshot residue kits and fingerprints from the state crime laboratory.

“When I have those, I’ll finish the report,” she said.

Luna said he is continuing an investigation into why this all happened.

“If I can get close to answering that question, then I want to do that,” he said

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PROZAC: Woman Threatens State Patrolman: Missouri

HOW SAD!!! Reminds me of a talk I had with parents in Louisiana just last week who are completely overwhelmed dealing with a daughter with similar problems – ALL BECAUSE OF THE WIDESPREAD PRESCRIBING OF THESE DEADLY AND VERY ADDICTIVE PRESCRIPTION DRUGS!!!! They know she can get them from just about any doctor around.
Doctors have truly become our biggest drug pushers in this country! What on earth are we doing to our children?!!! How can so many families be left alone to deal with this – never knowing from one minute to the next if they are going to find their child unresponsive and dying due to yet another overdose of these drugs?
This country is in SO MUCH trouble and it has NOTHING to do with any outside threat to our nation – it is within.
Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness
Author: Prozac (ETC): Panacea or Pandora? – Our
Serotonin Nightmare! & Audio: Help! I Can’t Get Off
My Antidepressant/Antipsychotic, ect. ()
Paragraphs three & four read:  “According to the criminal complaint, when Parsley made contact with West  ‘her speech was slurred and her eyes were bloodshot and glassy.’  He adds that he did not notice an odor of intoxicants on her.”SSRI Stories note:  “

 

“West reportedly admitted she had taken Xanax and Prozac at 6 a.m. After failing sobriety tests, West was placed under arrest.”

Hostility”  is listed as an Infrequent, but not Rare, reaction to Prozac in the Physicians Desk Reference.

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Antidepressant Romance Fuels “Premedicated” Murder

Note From Ann Blake-Tracy: I must say that in the 20 years I have been specializing in adverse reactions to antidepressants and lecturing and writing about these drugs this is possibly the best article I have ever read on the overall problem with antidepressants!! EXCELLENT WORK!!!
The only thing I might have added is that the hypothesis behind the serotonin THEORY (everyone keeps forgetting it is a theory and not a fact) is backwards. According to research serotonin is elevated in depression, anxiety, violence, mania, psychosis, etc. NOT low. What is low is the ability to metabolize serotonin.
Now enjoy the article! As I said, it is excellent!!
Dr. Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness

Website: www.drugawareness.org & www.ssristories.drugawareness.org
Author: Prozac: Panacea or Pandora? – Our Serotonin Nightmare
& CD or audio tape on safe withdrawal: “Help! I Can’t Get
Off My Antidepressant!”
Order Number:

August 17th, 2009

From The Desk of The People’s Chemist:

Are antidepressant’s a silent killer? Read more to learn how to avoid “Premedicated Murder.” Then visit my blog at http://www.thepeopleschemist.com/blog to leave your comments. I want to hear your voices on this! This is one of the most important articles I’ve ever written. Invest 6 minutes into your health by reading this.

Antidepressant Romance Fuels “Premedicated” Murder

By Shane “The People’s Chemist” Ellison

I wish medicine wasn’t so damn complicated. If it weren’t, people would see how Big Pharma cleverly plays prescription cupid to hook the masses into an antidepressant romance. Fueled by dreamy ads, sexy actors, and medical experts who get paid to give pharmaceutical fellatio, the romance has grown into a full-fledged orgy.

Antidepressants are among the best selling drugs, yet not one single diagnostic test supports their effectiveness. Romance makes for great business. But, are patients getting the love they deserve or are they facing another life threatening disaster akin to the Vioxx fiasco (killing an estimated 30,000 people who could have just used aspirin)? Perhaps the chemical facts behind antidepressants will give way to reality and help Americans sever ties to the deadly affair.

Life can be a bitch at times. Everyone knows it and Big Pharma profits from it. To answer our cries for happiness, they sell us a slew of molecules ripe with supposed happy atoms purported to elicit wanton pleasure. It’s a pipe dream. Like a parent who doesn’t like their daughter dating drug reps or psychiatrists, the FDA started using Black Box Warnings to inform us that, “Antidepressants, compared to placebo, increase the risk of suicidal thinking and behavior in children in short term studies.” Psychiatrists quickly refuted this.

Massaging our fears, Dr. McAllister-Williams of the Institute of Neuroscience at Newcastle University publicly insisted that “I believe they work and have an acceptable risk: benefit ratio for many patients.” Taking his cue, psychiatrists from around the world did what they do best: Ignore scientific ethics and get on their knees for Big Pharma.

In a vulgar display of medical ineptitude, prescribing habits surged. From 1996 to 2006, use of antidepressants increased 50% among children, 73% among adults and a ghastly 100% among the elderly – so much for Black Box Warnings. Why not rename them Profit Warnings? As prescribing habits have surged, so has antidepressant reality.

The so called disease of a “serotonin” chemical imbalance among depressed patients has never been proven. The Journal of Psychiatry and Neuroscience recently reminded doctors that, “Brain serotonin cannot be directly measured” and that even in the deceased, “Serotonin levels are unstable, within 24 hours of death.” Therefore, “direct evidence that serotonin is low in depressed persons is unavailable.”

Panicked, psychiatry hypothesized yet another cause of a chemical imbalance: Bad genes. Apparently, select people (basically anyone with a heartbeat) have a defective gene that makes them susceptible to depression – and drugs, drugs and more drugs can save them from the scourge of sadness. Bio-babble like “alleles” and “transporter genes” were thrown around like condoms at a high school pep rally. The jargon confused everyone. And in their dizzy stupor, most were convinced that it must mean one thing: antidepressants are the Holy Grail to attaining happiness. Psychiatry was once again renewed with the stench of pharmaceutical pheromones. But it didn’t last.

Thanks to scientific methodology, the industry was slapped with the facts. The New York Times delivered the blow and wrote, “One of the most celebrated findings in modern psychiatry – that a single gene helps determine one’s risk of depression in response to a divorce, a lost job or another serious reversal – has not held up to scientific scrutiny.”

You don’t need science to disprove the antiquated, reductionist propaganda surrounding the chemical imbalance theory. You only need the common sense of a child.

The human brain floats in thousands, billions or maybe even trillions of brain chemicals – all working in orchestra like unison to confer proper brain function. Even serotonin exists not as a single molecule, but instead as an ever changing chemical cascade of 5-htp, niacin, L-tryptophan, quinolinate, kynurenine and more. You’d have to be Paris Hilton or a psychiatrist to miss this logic and adhere to the simplistic serotonin imbalance theory.

With no such thing as a chemical imbalance or “depression inducing genes,” psychiatry did what any organization would do in the face of impending demise: Get the U.S Government to do their dirty work.

Today, an insidious collusion between Big Pharma and Big Government is doling out drugs paid for by our tax dollars to foster children, to our U.S. Troops, and to the elderly at breakneck speeds. With so many being drugged, a harsh reality is emerging: Antidepressant romance fuels “premedicated murder.”

While researching my upcoming book, Over-The-Counter Natural Cures (SourceBooks, October), I uncovered stories of horrific suicide and rage that occurred after being medicated with antidepressants. But none more disturbing than the Chris Wood story. Doped up on his prescribed cocktail of antidepressants – all three of them – he shot his 33 year old wife Francie and their three children – Chandler, 5, Gavin, 4, and Fiona, 2. Shockingly, in his drug damaged mind, they weren’t “dead enough” and gruesome decapitation followed. Afterwards, he picked up a shotgun and killed himself. This isn’t an isolated incident.

Among our US troop, suicide and rage is at an all time high – in direct correlation to mass prescribing. The same trend exists among teens as seen by the ever growing act of spraying classmates with bullets. Psychiatrists don’t seem to be alarmed with these trends, or at all interested in seeing the obvious correlations. In an attempt to “leave no American un-medicated,” they encourage subjective mental screening tests for the rest of us as a means of converting healthy people into psychiatric patients.

Psychiatry wants to position antidepressants as the cure for the premedicated violence. So to counter the growing evidence that their drugs are the cause, they insist that, “The only evidence that would be acceptable is the demonstration in a double blind trial that a difference in suicide rates was consistently seen. There is no evidence at all for a differential suicide attempt rate with antidepressants. Suicidal thoughts are an integral part of depression.” Here comes the backhand.

Writing for the Journal of American Physicians and Surgeons, Dr. Joel Kauffman elucidates that combined clinical trials on antidepressants show five times the risk of suicide among the treated compared to placebo.

The suicide/aggression trend is not inexplicable from a chemistry viewpoint. Using the latest cloning techniques and laboratory methods, it’s been shown that antidepressants elicit “neurotransmitter hijacking.” This may be partially responsible for the mental state that causes a person to gruesomely murder their loved ones, then put a shotgun to their chin and pull the trigger.

Once swallowed, antidepressants sail past the blood brain barrier and congregate on top of “neurotransmitter recyclers.” This can prevent the cellular “recycling factories” from activating previously used neurotransmitters like serotonin or any of its chemical cousins. With nowhere to go, the inactive brain compounds get “hijacked” by recycling facilities found in other regions of the brain. This would be similar to a square peg being shoved into a round hole. As shown by Baylor College of Medicine, the recycling facilities of key neurotransmitters, like dopamine (round), begin to retrieve serotonin (square) into dopamine vesicles. A dastardly consequence ensues.

Commenting on the hijacking, CNN publicized that, “Antidepressant drugs actually create a perilous brain imbalance.” And Psychiatric Times hypothesized that blocking transporters on cell bodies could drop neurotransmitter levels in the synapse. Is it true?

To measure if neurotransmitter hijacking leads to an empty synapse, you can simply look for clinical manifestations of poor neurotransmitter function (like Parkinson’s disease, which is due to poor output of dopamine) among antidepressant users. As far back as 1995, the American Journal of Medicine showed that 37% of all prescriptions for the treatment of Parkinson’s disease are due to Psychiatric drug use. Case closed. These antidepressant actions are the exact opposite of the claimed “neurotransmitter boosting” actions purported by most doctors!

Once neurotransmitter hijacking takes place, pharmacopossession (due to poor neurotransmitter function) may also set in. As patients come fully under the spell of antidepressants, the brain can become so scrambled that all normal reality and reason are overwritten by a new confusing and violent agenda. A new personality arises – one with homicidal and suicidal tendencies. And for an ever increasing number of antidepressant users, these tendencies are manifesting as premedicated murder – the deliberate killing as a result of being medicated in advance.

Unbalanced by drugs, the brain of an antidepressant user faces a slew of mind altering outcomes. What kind? What was Chris Wood thinking and feeling prior to committing premedicated murder of his family while pharmacopossessed? To answer these questions just go back to the beginning of this article and read the “profit warning” that comes with every Prozac prescription. It’s all there in black and white.

Even though the FDA “compels” drug companies to warn the public about antidepressant risks, their “death grip” on the medical industry has kept doctors and patients from knowing the real extent of the danger. Dr. Catherine DeAngelis, editor of the Journal of the American Medical Association said that “Pharma’s influence on medicine is so blatant now you’d have to be deaf, blind and dumb not to see it.” I guess psychiatrists are all three since they continue to ignore science and romance the masses with promises of happiness courtesy of antidepressants.

Before your doctor gives you an antidepressant, ask him to read you the Black Box Warning that comes with your prescription. This will ensure that the potential romance quickly gives way to reality and that you don’t succumb to premedicated murder.

About the Author

Shane Ellison’s entire career has been dedicated to the study of molecules – how they give life and how they take from it. He was a two-time recipient of the prestigious Howard Hughes Medical Institute Research Grant for his research in biochemistry and physiology. He is a best selling author, holds a master’s degree in organic chemistry, and has first-hand experience in drug design. Learn to get lean fast like is Mom (photos included) at http://www.ampmfatloss.com

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ANTIDEPRESSANTS: Murder-Suicide: 81 Year Old Man Kills Wife & Self: En…

Note From Ann Blake-Tracy: I do not know if I can tolerate reading another one of these stories!
This last week I went to the Iowa State Fair for the first time with my daughter and her family who were visiting. While riding the trolley through the fair the man sitting across from me asked an elderly couple as they got off how many years they had been together.
They answered that it was 53 years. And he wished them the best for their next 53 years together.
They smiled and said “Thank you.”
As we drove on I looked at the man across from me and said, “As long as neither of them take an antidepressant they should do okay.” And I went on to share with them how many of the absolutely horrifying reports we are getting of elderly couples, married for many years, killing one another.
I then returned home to open this report of yet another horrific tragedy for a couple who had been married a few years longer than the couple I had just met on the trolley  . . . there is just no excuse for this to continue! How sad! I is NORMAL for a man who has worked all of his life to become depressed if he has to sell his business. It is NOT a reason to medicate him!
What an absolutely horrific way to end a life of 60 years together. I hope their children know what really happened in the loss of their parents instead of one woman I met after one of my lectures who came forward crying. As she reached me she said, “I cannot thank you enough for helping me to finally have answers to why my father killed my mother and then himself 20 years ago while taking one of the older antidepressants!”
Dr. Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness

Website: www.drugawareness.org & www.ssristories.drugawareness.org
Author: Prozac: Panacea or Pandora? – Our Serotonin Nightmare
& CD or audio tape on safe withdrawal: “Help! I Can’t Get
Off My Antidepressant!”
Order Number:

Paragraph seven reads:  “The court heard how Mr Mann became depressed after he sold his business in 2000 and from 2002 to 2005 was placed on anti-depressants, and again in 2008 after a reoccurrence of the mental illness.”

http://www.yorkshireeveningpost.co.uk/news/Depressed-pensioner-bludgeoned-wife-to.5548006.jp

Depressed pensioner bludgeoned wife to death before drowning himself

Published Date:
12 August 2009
By Charles Heslett

A pensioner bludgeoned his wife of almost 60 years to death before drowning himself in the bath.

Police discovered the body of retired sales rep Doreen Mann, 80, sprawled in the living room of the house she shared with husband Kenneth.

The retired factory owner, 81, was found dead upstairs face down in a bath full water wearing only his vest and underpants.

Officers took away a hammer, a craft knife and another knife from the scene at Foxroyd Lane, Thornhill Edge, Dewsbury, after the alarm was raised by a visiting mental health nurse on December 23 last year (2008].

An investigation was launched at the time by West Yorkshire Police’s Homicide & Murder Inquiry Team.

But Detective Sergeant Ian Lawrie told Wednesday’s inquest at Huddersfield Coroner’s Court that no-one else was being sought in connection with the death of the couple, who were both born in Leeds and had been married for 57 years.

The court heard how Mr Mann became depressed after he sold his business in 2000 and from 2002 to 2005 was placed on anti-depressants, and again in 2008 after a reoccurance of the mental illness.

On December 18, 2008, he and his wife were visited by psychiatrist Dr Vinood Shukla and a psychiatric nurse, the court heard.

A psychiatric nurse came to the red-bricked home called Kendoreen, where the couple had lived for 21 years, at 2.30pm on December 23.

After getting no answer from the front door apart from the couple’s barking collie dog, the nurse saw a bathroom light on and called police.

Detectives found the two knives and the hammer close to Mrs Mann’s body.

Her cause of death was later found to be a blow to her head and cut wounds to her neck and forearms.

Mr Mann’s corpse was found in an upstairs bathroom, face down in a full bath – his cause of death was given as self-drowning.

Barbara Moore told the inquest three weeks before her sister’s death Doreen had said she feared her husband might harm her.

West Yorkshire Coroner Roger Whittaker described the deaths as a “double tragedy”.

He recorded a verdict that Mrs Mann was unlawfully killed and that her husband drowned.

Mr Whittaker said he was satisfied that the balance of Mr Mann’s mind was disturbed at the time of his death and “that imbalance…was present at the time of the death of his wife“.

Mr Whittaker added that Mr Mann had given no indication on December 18 that he intended to harm his wife and that Mrs Mann had raised no similar concerns.

But the coroner said lessons “had been learned” by the mental health trust involved.

A South West Yorkshire Partnership NHS Foundation Trust spokeswoman said: “The Trust re-iterates its sincere sympathies to the family and others affected by these tragic deaths.

“The circumstances have been thoroughly investigated, and we are grateful to the family for their input into this.

“Sadly, we cannot change the tragic events that happened but we can learn from them and a number of changes have been made as a result.”

These included: Improved systems for referrals between services and exchange of information; Improved training for staff on assessing risk; Improved record keeping following home visits.

The spokeswoman added: “The investigation findings have been shared with the family and we are continuing to offer support as appropriate.”

The full article contains 574 words and appears in n/a newspaper.
Page 1 of 1

  • Last Updated: 12 August 2009 4:14 PM
  • Source: n/a
  • Location: Leeds

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MEDS FOR PTSD: Soldier with brain injury, treated for PTSD commits suicide

Note: Anyone who has suffered a brain injury should never be given an antidepressant according to Dr. Jay Seastrunk, a neurologist. It can lower the seizure threshold and produce seizure activity faster than normal.

Also keep in mind that antidepressants affect memory so strongly that “amnesia” is listed as a “frequent” side effect. Combine that with the information we have that Alzheimer’s is a condition of elevated serotonin levels and antidepressants are designed to specifically increase serotonin levels and you can see how many of the problems Ray was dealing with we being caused by the medication he was being given.

Dr. Ann Blake-Tracy, Executive Director, International Coalition for Drug Awareness, www.drugawareness.org
____________________________________________________________________________________

In the very hours we were celebrating Andrew in Washington, tragedy was unfolding in Texas. Lt. Col. Raymond Rivas, a 53-year old civil affairs officer who had dedicated his career to rebuilding war torn countries, was found dead in his car in the parking lot of Brooke Army Medical Center in San Antonio Texas.

Colleagues of Ray’s said prescription pills and notes he wrote to his family and wife, Colleen, were found. A military source told me all indications are Ray took his own life.

His devastated family understandably declined to talk publicly, and the military won’t discuss the case citing privacy concerns. But friends and colleagues I spoke to confirmed that Ray had suffered multiple blast injuries to his brain from bomb attacks during several deployments over the years.

In October 2006, Ray survived an attack in Iraq that rendered him briefly unconscious. He was transferred to Europe but somehow talked the doctors into sending him back to the war zone. A week later, ill and confused, he was sent back to the United States.

A close associate tells me that at first, despite being diagnosed with traumatic brain injury in Iraq, some doctors thought Ray might be suffering from post-traumatic stress disorder. They didn’t realize he had all the symptoms of traumatic brain injury. He had trouble talking, reasoning and remembering.

He was sent to Brooke Army Medical Center in San Antonio so he could be near his family, but for the first few months he just sat in his room. Fellow soldiers helped him with his bathing, dressing and eating.

Finally, Ray was assigned a case manager, and things began to move rapidly. He got therapy and was able to go home.

But by all accounts from his friends, Ray had become seriously debilitated by the injuries to his brain. A private email shown to CNN revealed that Ray had been diagnosed with rapidly emerging Alzheimer’s disease. The cumulative impact of all those bomb blasts were destroying his brain. Colleagues say Ray knew he might have to move to an assisted living facility.

Ray’s doctors are not discussing his treatment because of privacy concerns.

A colleague told me Ray was tired and in pain on the night of July 15. He was found in his car in the parking lot at the army hospital where he had spent so long trying to get better.

http://www.cnn.com/2009/US/07/27/starr.extraordinary/index.html?iref=24hours
Behind the Scenes: Triumph and tragedy for two wounded soldiers

* Story Highlights
* CNN’s Barbara Starr celebrated a victory and mourned a loss on July 15
* An injured Marine was celebrating getting into Harvard Law School
* On same night, a warrior with a traumatic brain injury was found dead in his car
* Men’s stories are linked — both pleaded with the government to aid injured soldiers

By Barbara Starr
CNN Pentagon Correspondent

WASHINGTON (CNN) — Where were you on the night of July 15? You may not even remember, but for me it was an extraordinary evening, an evening of unimaginable triumph and unbearable tragedy.

But I would not actually know everything that happened until the night was long over.

A couple of weeks before July 15, a friend who works with injured troops emailed me to say it was time for Andrew’s going away party.

Andrew Kinard is a young Marine I first met a few years ago at Walter Reed Army Medical Center in Washington where he was recovering from a devastating IED attack in Iraq. He had stepped on the roadside bomb and lost his entire body below the hips.

The party being arranged was Andrew’s farewell to D.C. Andrew is off to the rigors of Harvard Law School. He’s says he’s itching to get into a courtroom.

You need to remember the name Andrew Kinard. Many of his friends believe Andrew is such an amazing man that he will become president of the United States. If I had to bet, I’d say it could happen.

I wouldn’t have missed the party for the world. I was touched that this tight-knit community of wounded warriors had included me in this very special, very intimate evening.

There was a display of photos of Andrew serving in Iraq. I suddenly realized I never knew how tall he was before the war. There were a few sniffles and wiping of eyes in the room for a Marine whose dream of service to his country ended within a few months of getting to Iraq. But sniffles didn’t last long and the evening became one of hugs, laughter and good wishes (and more than a few beers) for a young Marine who had triumphed over what the war had dealt him.

But my warm feelings didn’t last long. The next day another source in the wounded troop community came to me in the Pentagon hallway with another tale.

“You have to do something about the story of Ray Rivas,” he said.

In the very hours we were celebrating Andrew in Washington, tragedy was unfolding in Texas. Lt. Col. Raymond Rivas, a 53-year old civil affairs officer who had dedicated his career to rebuilding war torn countries, was found dead in his car in the parking lot of Brooke Army Medical Center in San Antonio Texas.

Colleagues of Ray’s said prescription pills and notes he wrote to his family and wife, Colleen, were found. A military source told me all indications are Ray took his own life.

His devastated family understandably declined to talk publicly, and the military won’t discuss the case citing privacy concerns. But friends and colleagues I spoke to confirmed that Ray had suffered multiple blast injuries to his brain from bomb attacks during several deployments over the years.

In October 2006, Ray survived an attack in Iraq that rendered him briefly unconscious. He was transferred to Europe but somehow talked the doctors into sending him back to the war zone. A week later, ill and confused, he was sent back to the United States.

A close associate tells me that at first, despite being diagnosed with traumatic brain injury in Iraq, some doctors thought Ray might be suffering from post-traumatic stress disorder. They didn’t realize he had all the symptoms of traumatic brain injury. He had trouble talking, reasoning and remembering.

He was sent to Brooke Army Medical Center in San Antonio so he could be near his family, but for the first few months he just sat in his room. Fellow soldiers helped him with his bathing, dressing and eating.

Finally, Ray was assigned a case manager, and things began to move rapidly. He got therapy and was able to go home.

But by all accounts from his friends, Ray had become seriously debilitated by the injuries to his brain. A private email shown to CNN revealed that Ray had been diagnosed with rapidly emerging Alzheimer’s disease. The cumulative impact of all those bomb blasts were destroying his brain. Colleagues say Ray knew he might have to move to an assisted living facility.

Ray’s doctors are not discussing his treatment because of privacy concerns.

A colleague told me Ray was tired and in pain on the night of July 15. He was found in his car in the parking lot at the army hospital where he had spent so long trying to get better.

But Ray will be remembered for all he did for others. Even with all his suffering, he wanted to make sure other injured troops were helped. In April he and his wife Colleen went to Capitol Hill to testify with other wounded warriors about their needs.

Sitting on that panel with Ray was Andrew Kinard.

All AboutBrooke Army Medical Center

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ANTIDEPRESSANTS: Suicide: Man Out of Prison for 3 Hours: England

Notice from the article below that this fellow had been abruptly discontinued from his antidepressant when incarcerated in November. Then while still in the critical withdrawal stage was re-introduced to the use of an antidepressant – likely a new one since jails and prisons have access to a select few they prescribe. So he likely had three strikes against him leading to his sudden and very determined suicide.

Dr. Ann Blake-Tracy, Executive Director, International Coalition For Drug Awareness

Paragraph four reads: “The jury inquest at Nottingham Coroner’s Court heard Mr Brown had been at the prison for five weeks and was four days away from being released when he was seen by a psychiatrist and given anti-depressants.”

SSRI Stories note: The most likely time for suicidal behaviors and SSRI antidepressants are: 1. When first starting the drugs: 2. When stopping the drugs. 3. While increasing the dose: 4. While decreasing the dose. 5. When switching from one SSRI to another antidepressant.

http://www.thisisnottingham.co.uk/homenews/Coroner-criticises-healthcare-Nottingham-Prison/article-1196220-detail/article.html

Coroner criticises healthcare at Nottingham Prison
Monday, July 27, 2009, 07:00

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A CORONER has criticised health services at Nottingham Prison after an inmate committed suicide hours after his release.

Gary Brown, 39, of Cranwell Road, Strelley, drowned on December 24, 2007.

He was seen jumping off Trent Bridge less than three hours after he was released from the prison.

The jury inquest at Nottingham Coroner’s Court heard Mr Brown had been at the prison for five weeks and was four days away from being released when he was seen by a psychiatrist and given anti-depressants.

Notts coroner Dr Nigel Chapman said there was a “huge gap” between Mr Brown seeing a GP on his arrival at the prison and seeing a psychiatrist.

The inquest heard there was a lack of communication between health workers, and one doctor at the prison called it “an entirely haphazard system”.

Mr Brown arrived at Nottingham Prison on November 15, 2007. He saw a GP, Dr Lloyd, the next day, who said Mr Brown was not showing symptoms of mental health problems.

Mr Brown said he had previously been prescribed anti-depressants but Dr Lloyd did not renew the prescription as he could not obtain any previous medical records.

Other members of the health team said they tried to get hold of Mr Brown’s medical records but were unable to trace them.

Dr Julian Kenneth Henry, who also saw Mr Brown, told the inquest the amount of time between the prisoner arriving and seeing a psychiatrist was “unprecedented”.

He said: “Unfortunately, in a prison setting there are an awful lot of people involved and there are failures of communication on a daily basis.

“It’s an entirely haphazard system. It’s a very disjointed system and there is not an excuse for it.”

Mr Brown saw psychiatrist Dr Trevor Boughton on December 20 and was given a prescription for anti-depressants.

Dr Boughton said Mr Brown seemed anxious but not psychotic or suicidal.

He said: “He seemed very eager to be released from prison. He spoke very fondly of his brother, whom he was hoping to spend Christmas with.”

The inquest heard the medication was not likely to have had any effect on Mr Brown by the time he was released four days later.

Senior prison officer Vince McGonigle said Mr Brown was released between 9am and 9.30am on December 24 and seemed “in an agitated state”.

Less than three hours later, at around 11.45am, a member of the public saw him jump from Trent Bridge into the River Trent.

Kyle Charles told the inquest: “I saw a person in the water and tried shouting at him. I managed to get the orange ring off the wall and threw that into the water but he swam away from it.

“When he saw me taking my jacket off he held his nose and then started to push himself under the water. He went down, came back up, went down and never came back up again.”

Mr Brown’s body was pulled from the water at 2.55pm. There was no evidence of any violence and no alcohol found in his system.

The jury returned a verdict of suicide, with a majority of six to two. They said there had been a “severe breakdown” of communication during Mr Brown’s care.

Coroner Dr Chapman said: “Clearly there have been difficulties here and the prison has taken those on board.”

But he said Mr Brown’s time in prison would have been a good opportunity to put him on medication and monitor him.

He added “a simple phone number” for a crisis team would be beneficial for people leaving prison.

samantha.hughes@nottinghameveningpost.co.uk

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NEJM: On Zoloft Homicidal Ideation Frequent In Those 17 & Under

Since I believe that people should always get credit for the hard work and contribution they make in life I want to give our thanks to Rosie Meysenburg for getting this out to us today and for her comments on it. Rosie has done so much, along with her husband Gene, in posting our years and years worth of work gathering these SSRI & SNRI cases together for the _www.ssristories.drugawareness.org_
(http://www.ssristories.drugawareness.org) site.

“This Adverse Event Report, from a study appearing in the New England Journal of Medicine, shows that of 133 children 17 & under on Zoloft there were 2 who reported “Homicidal Ideation”. There were no reports of “Homicidal Ideation” in the placebo group.

[According to the Physicians Desk Reference, a Frequent adverse reaction is one that occurs in 100 people or less.  Homicidal Ideation occurred in 1 in 66 children on Zoloft aged 17  and under.]

“According to the Physicians Desk Reference, a Frequent adverse reaction is one that occurs in 100 people or less. Homicidal Ideation occurred in 1 in 66 children on Zoloft aged 17 and under.

“This Adverse Event Report was the appendix for this study in the New England Journal of Medicine.”

adverse event report1.pdf

This Adverse Event Report was the appendix for this study in the New England Journal of Medicine:

http://content.nejm.org/cgi/content/full/NEJMoa0804633

And with this new information from the New England Journal of Medicine I want to include information out of Australia which is that Pfizer, the maker of Zoloft, along with the Therapeutic Goods Administration (TGA similar to our FDA), recommends that any SSRI antidepressant should not be prescribed to Australians under the age of 24. Funny, but I missed that warning from Pfizer for Americans under 24, didn’t you?

Next I will send that article that just came out over the weekend because it ties in so closely with this new information on Zoloft. And because there is so much to read in this article alone I am going to cut my comments at this point and let the article speak for itself.

Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness
_www.drugawareness.org_ (http://www.drugawareness.org/) &
_www.ssristories.org_ (http://www.ssristories.org/)
Author of Prozac: Panacea or Pandora? – Our
Serotonin Nightmare & the audio, Help! I Can’t
Get Off My Antidepressant!!! ()

_atracyphd1@…_ (mailto:atracyphd1@…)

_http://content.nejm.org/cgi/content/full/NEJMoa0804633_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633)

Published at www.nejm.org October 30, 2008 (10.1056/NEJMoa0804633)
Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood
Anxiety

John T. Walkup, M.D., Anne Marie Albano, Ph.D., John Piacentini, Ph.D.,
Boris Birmaher, M.D., Scott N. Compton, Ph.D., Joel T. Sherrill, Ph.D., Golda
S. Ginsburg, Ph.D., Moira A. Rynn, M.D., James McCracken, M.D., Bruce Waslick,
M.D., Satish Iyengar, Ph.D., John S. March, M.D., M.P.H., and Philip C. Kendall, Ph.D.

ABSTRACT
Background Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy.

Methods In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at
weeks 4, 8, and 12.

Results The percentages of children who were rated as very much or much improved on the Clinician Global Impression “Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo
(23.7%). Combination therapy was superior to both monotherapies (P<0.001).

Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal
ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline.

Conclusions
Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate.

(ClinicalTrials.gov number,
NCT00052078 _[ClinicalTrials.gov]_
(http://content.nejm.org/cgi/external_ref?access_num=NCT00052078&link_type=CLINT\
RIALGOV
) .)

____________________________________
Anxiety disorders are common in children and cause substantial impairment in
school, in family relationships, and in social functioning._1_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R1) ,_2_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R2) Such disorders
also predict adult anxiety disorders and major depression._3_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R3) ,_4_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R4) ,_5_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R5) ,_6_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R6) Despite a high
prevalence (10 to 20%_3_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R3)
,_7_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R7) ,_8_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R8) ) and substantial
morbidity, anxiety disorders in childhood remain underrecognized and
undertreated._1_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R1)
,_9_

(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R9)

An improvement in outcomes for children with anxiety disorders would have important public health
implications.In clinical trials, separation and generalized anxiety disorders and social
phobia are often grouped together because of the high degree of overlap in
symptoms and the distinction from other anxiety disorders (e.g., obsessive compulsive disorder). Efficacious treatments for these disorders include cognitive behavioral therapy_10_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R10) ,_11_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R11) and
the use of selective serotonin-reuptake inhibitors (SSRIs)._12_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R12) ,_13_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R13)

However, randomized, controlled trials comparing cognitive behavioral therapy, the use of an SSRI, or the combination of both therapies with a control are lacking. The evaluation of combination therapy is particularly important because approximately 40 to 50% of children with these disorders do not have a response to short-term treatment with either monotherapy.
_14_(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R14) ,_15_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R15)

Our study, called the Child “Adolescent Anxiety Multimodal Study, was designed to address the current gaps in the treatment literature by evaluating the relative efficacy of cognitive behavioral therapy, sertraline, a combination of the two therapies, and a placebo drug. This article reports the results of short-term treatment.

Methods

Study Design and Implementation

This study was designed as a two-phase, multicenter, randomized, controlled trial for children and adolescents between the ages of 7 and 17 years who had separation or generalized anxiety disorder or social phobia. Phase 1 was a 12-week trial of short-term treatment comparing cognitive behavioral therapy, sertraline, and their combination with a placebo drug. Phase 2 is a 6-month open extension for patients who had a response in phase 1.

The authors designed the study, wrote the manuscript, and vouch for the data gathering and analysis. Pfizer provided sertraline and matching placebo free of charge but was not involved in the design or implementation of the study, the analysis or interpretation of data, the preparation or review of the manuscript, or the decision to publish the results of the study.

Study Subjects

Children between the ages of 7 and 17 years with a primary diagnosis of separation or generalized anxiety disorder or social phobia (according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision
[DSM-IV-TR]_16_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R16) ),
substantial impairment, and an IQ of 80 or more were eligible to participate. Children with coexisting psychiatric diagnoses of lesser severity than the three target disorders were also allowed to participate;
such diagnoses included attention deficit–hyperactivity disorder (ADHD) whilereceiving stable doses of stimulant and obsessive compulsive, post-traumatic stress, oppositional defiant, and conduct disorders. Children were excluded if they had an unstable medical condition, were refusing to attend school
because of anxiety, or had not had a response to two adequate trials of SSRIs or an adequate trial of cognitive behavioral therapy.

Girls who were pregnant or were sexually active and were not using an effective method of birth control
were also excluded. Children who were receiving psychoactive medications other than stable doses of stimulants and who had psychiatric diagnoses that made participation in the study clinically inappropriate (i.e., current majordepressive or substance-use disorder; type ADHD; or a lifetime history of bipolar, psychotic, or pervasive developmental disorders) or who presented an acute risk to themselves or others were also excluded.

Recruitment occurred from December 2002 through May 2007 at Duke University Medical Center, New York State Psychiatric Institute Columbia University Medical Center New York University, Johns Hopkins Medical Institutions, Temple University University of Pennsylvania, University of California, Los Angeles,and
Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center. The protocol was approved and monitored by institutional review boards at each center and by the data and safety monitoring board of the National Institute of Mental Health. Subjects and at least one parent provided written informed consent.

Interventions

Cognitive behavioral therapy involved fourteen 60-minute sessions, which included review and ratings of the severity of subjects’ anxiety, response to treatment, and adverse events. Therapy was based on the Coping Cat program,_17_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R17) ,_18_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R18) which was adapted for the
subjects’ age and the duration of the study._19_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R19)

Each subject who was assigned to receive cognitive behavioral therapy received training in anxiety-management skills, followed by behavioral exposure to anxiety-provoking situations. Parents
attended weekly check-ins and two parent-only sessions. Experienced psychotherapists, certified in the Coping Cat protocol, received regular site-level and cross-site supervision.

Pharmacotherapy involved eight sessions of 30 to 60 minutes each that included review and ratings of the severity of subjects’ anxiety, their response to treatment, and adverse events. Sertraline (Zoloft) and matching placebo were administered on a fixed flexible schedule beginning with 25 mg per day and adjusted up to 200 mg per day by week 8. Through week 8, subjects who were considered to be mildly ill or worse and who had minimal side effects were eligible for dose increases.

Psychiatrists and nurse clinicians with experience in medicating children with anxiety disorders were certified in the study pharmacotherapy protocol and received regular site-level and cross-site supervision.
Pill counts and medication diaries were used to facilitate and document adherence. Combination therapy consisted of the administration of sertraline and cognitive behavioral therapy. Whenever possible, therapy and medication sessions occurred on the same day for the convenience of subjects.

Objectives
Study objectives were, first, to compare the relative efficacy of the three active treatments with placebo; second, to compare combination therapy with either sertraline or cognitive behavioral therapy alone; and third, to assess the safety and tolerability of sertraline, as compared with placebo. We hypothesized that all three active treatments would be superior to placebo and that combination therapy would be superior to either sertraline or cognitive behavioral therapy alone.

Outcome Assessments
We obtained demographic information, information on symptoms of anxiety, and data on coexisting disorders and psychosocial functioning using reports from both the subjects and their parents and from interviews of subjects and parents at the time of screening, at baseline, and at weeks 4, 8, and 12.

The interviews were administered by independent evaluators who were unaware of study-group assignments.
We used the Anxiety Disorders Interview Schedule for DSM-IV-TR, Child Version,_20_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R20) to establish diagnostic eligibility. The categorical primary outcome was the treatment response at week 12, which was defined as a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impression Improvement scale,_21_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R21) which ranges from 1 to 7, with lower scores indicating more improvement, as compared with baseline. A score of 1 or 2 reflects a substantial, clinically meaningful improvement in anxiety severity and normal functioning. The dimensional primary
outcome was anxiety severity as measured on the Pediatric Anxiety Rating Scale, computed by the summation of six items assessing anxiety severity, frequency, distress, avoidance, and interference during the previous week._22_(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R22)

Total scores on this scale range from 0 to 30, with scores above 13 indicating clinically meaningful anxiety. The Children’s Global Assessment Scale_23_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R23) was used to rate
overall impairment.

Scores on this scale range from 1 to 100; scores of 60 or lower are considered to indicate a need for treatment, and a score of 50 corresponds to moderate impairment that affects most life situations and is readily observable. Agreement among the raters was high for anxiety severity (r=0.85) and diagnostic
status (intraclass correlation coefficient= 0.82 to 0.88) on the basis of a videotaped review of 10% of assessments by independent evaluators that were performed at baseline and at week 12.

Adverse Events
Adverse events were defined as any unfavorable change in the subjects’ pretreatment condition, regardless of its relationship to a particular therapy. Serious adverse events were life-threatening events, hospitalization, or events leading to major incapacity. Harm-related adverse events were defined as thoughts of harm to self or others or related behaviors. All subjects were interviewed at the start of each visit by the study coordinator with the use of a standardized script. Identified adverse events and harm-related events were then evaluated and rated by each subject’s study clinician.

This report presents data on all serious adverse events, all harm-related adverse events, andmoderate and severe (i.e., functionally impairing) adverse events that occurred in 3% or more of subjects in any study group. The data and safety monitoring board of the National Institute of Mental Health performed a quarterly review
of reported adverse events. Given the greater number of study visits (and hence more reporting
opportunities) and the unblinded administration of sertraline in the combination-therapy group, the test of the adverse-event profile of sertraline focused on statistical comparisons between sertraline and placebo and sertraline and cognitive behavioral therapy.

Randomization and Masking
The randomization sequence in a 2:2:2:1 ratio was determined by a computer-generated algorithm and maintained by the central pharmacy, with stratification according to age, sex, and study center. Subjects were assigned to study groups after being deemed eligible and undergoing verbal reconsent with a study investigator. Subjects in the sertraline and placebo groups did not know whether they were receiving active therapy, nor did their clinicians. However, subjects who received combination therapy knew they were receiving active sertraline. The study protocol called for independent evaluators who completed assessments to be unaware of all treatment assignments.

Statistical Analysis
On the basis of previous studies,_10_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R10) ,_11_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R11) ,_12_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R12)
,_13_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R13) ,_14_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R14) ,_15_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R15)
we hypothesized that 80% of children in the combination-therapy group, 60% in either the sertraline group
or the cognitive-behavioral-therapy group, and 30% in the placebo group would be considered to have had a response to treatment at week 12. We determined that we needed to enroll 136 subjects in each active-treatment group and 70 subjects in the placebo group for the study to have a power of 80% to detect a minimum difference of 17% between any two study groups in the rate of response, assuming an alpha of 0.05 and a two-tailed test with no adjustment for multiple comparisons.

Analyses were performed with the use of SAS software, version 9.1.3 (SAS Institute). For categorical outcomes (including data regarding adverse events), treatments were compared with the use of Pearson’s chi-square test, Fisher’s exact test, or logistic regression, as appropriate. Logistic-regression models included the study center as a covariate. For dimensional outcomes, linear mixed-effects models (implemented with the use of PROC MIXED) were used to determine predicted mean values at each assessment point (weeks 4, 8, and 12)
and to test the study hypotheses with respect to between-group differences at week 12.

In each linear mixed-effects model, time and study group were included as fixed effects, with linear and quadratic time and time-by-treatment group interaction terms. Each model also began with a limited number of covariates (e.g., age, sex, and race), followed by backward stepping to identify thebest-fitting and most parsimonious model. In all models, random effects included intercept and linear slope terms, and an unstructured covariance was used to account for within-subject correlation over time. All comparisons were planned and tests were two-sided. A P value of less than 0.05 was considered to indicate statistical significance. The sequential Dunnett test was used to control the overall (familywise) error rate._24_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R24)

We analyzed data from all subjects according to study group. Sensitivity analyses were performed with the last observation carried forward (LOCF) and multiple imputation assuming missingness at random. Results were similar for the two missing-data methods. We report the results of the LOCF analysis because the
response rates were lower and hence provide a more conservative estimate of outcomes.

Results
Subjects
A total of 3066 potentially eligible subjects were screened by telephone
(_Figure 1_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#F1) ). Of these subjects, 761 signed consent forms and completed the inclusion and exclusion evaluation, 524 were deemed to be eligible and completed the baseline assessment, and 488 underwent randomization. Eleven subjects (2.3%) stopped
treatment but were included in the assessment (treatment withdrawals); 46 subjects (9.4%) stopped both treatment and assessment (study withdrawals).

On the basis of logistic-regression analyses, pairwise comparisons indicated that subjects in the cognitive-behavioral-therapy group were significantly less likely to withdraw from treatment than were those in the sertraline group (odds ratio, 0.33; 95% confidence interval [CI], 0.13 to 0.87; P=0.03) or the placebo
group (odds ratio, 0.24; 95% CI; 0.09 to 0.67; P=0.006). Of the 488 subjects who underwent randomization, 459 (94.1%) completed at least one postbaseline assessment, 396 (81.1%) completed all four assessments, and 440 (90.2%) completed the assessment at week 12. Subjects were recruited primarily through advertisements (52.2%) or clinical referrals (44.1%).
(http://content.nejm.org/cgi/content/full/NEJMoa0804633v2/F1)
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Figure 1. Enrollment and Outcomes.

Subjects who are shown as having withdrawn from treatment discontinued their assigned therapy but continued to undergo study assessment. Subjects who are shown as having withdrawn from the study discontinued both therapy and assessment. CBT denotes cognitive behavioral therapy.

Of 14 possible sessions of cognitive behavioral therapy, the mean (±SD) number of sessions completed was 12.7±2.8 in the combination-therapy group and 13.2±2.0 in the cognitive-behavioral-therapy group. The mean dose of sertraline at the final visit was 133.7±59.8 mg per day (range, 25 to 200) in the combination-therapy group, 146.0±60.8 mg per day (range, 25 to 200) in the sertraline group, and 175.8±43.7 mg per day (range, 50 to 200) in the placebo group.

Demographic and Clinical Characteristics
There were no significant differences among study groups with respect to baseline demographic and clinical characteristics (_Table 1_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#T1) ). The mean age of participants was 10.7±2.8 years, with 74.2% under the age of 13 years.

There were nearly equal numbers of male and female subjects. Most subjects were white (78.9%), with
other racial and ethnic groups represented. Subjects came from predominantly middle-class and upper-middle-class families (74.6%) and lived with both biologic parents (70.3%). Most subjects had received the diagnosis of two or more primary anxiety disorders (78.7%) and one or more secondary disorders
(55.3%). At baseline, subjects had moderate-to-severe anxiety and impairment (_Table
2_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#T2) ).

Given the geographic diversity among study centers, there were significant differences among sites on several baseline demographic variables (e.g., race and socioeconomic status). Overall, these variables were equally distributed among study groups within each center; however, three centers had one instance each of
unequal distribution for sex, race, or socioeconomic status.

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Table 1. Baseline Characteristics of the Subjects and Recruitment According
to Study Center.

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Table 2. Key Outcomes at 12 Weeks.

Clinical Response
In the intention-to-treat analysis, the percentages of children who were rated as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression–Improvement scale at 12 weeks were 80.7% (95% CI, 73.3 to 86.4) in the combination-therapy group, 59.7% (95% CI, 51.4 to 67.5) in the cognitive-behavioral-therapy group, 54.9% (95% CI, 46.4 to 63.1) in the sertraline group, and
23.7% (95% CI, 15.5 to 34.5) in the placebo group (_Table 2_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#T2) ).

With the study center as a covariate, planned pairwise comparisons from a logistic-regression model showed
that each active treatment was superior to placebo as follows: combination therapy versus placebo, P<0.001 (odds ratio, 13.6; 95% CI, 6.9 to 26.8); cognitive behavioral therapy versus placebo, P<0.001 (odds ratio, 4.8; 95% CI, 2.6 to 9.0); and sertraline versus placebo, P<0.001 (odds ratio, 3.9; 95% CI, 2.1 to 7.4). Similar pairwise comparisons revealed that combination therapy was superior to either sertraline alone (odds ratio, 3.4; 95% CI, 2.0 to 5.9; P<0.001) or cognitive behavioral therapy alone (odds ratio, 2.8; 95% CI, 1.6 to 4.8; P=0.001). However, there was no significant difference between sertraline and cognitive behavioral therapy (P=0.41).

There was no main effect for center (P=0.69); however, a comparison among centers according to study group revealed a significant difference in response to combination therapy but no differences with respect to the response to sertraline alone (P=0.15) or cognitive behavioral therapy alone (P=0.25).

Further evaluation of response rates revealed that the average response rate for combination therapy at one center was significantly lower than at the other centers (P=0.002). A sensitivity analysis of site response rates showed that when data from the one site were removed, the average response rate of the other sites was consistent with that of the full sample.

The mixed-effects model for the Pediatric Anxiety Rating Scale revealed a significant quadratic effect for time (P<0.001) and a significant quadratic time-by-treatment interaction for cognitive behavioral therapy versus placebo (P=0.01) but not for either combination therapy or sertraline versus placebo. In other words, as compared with placebo, cognitive behavioral therapy had a linear mean trajectory (_Figure 2_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#F2) ). Planned pairwise comparisons of the expected mean scores on the Pediatric Anxiety Rating Scale at week 12 revealed a similar ordering of
outcomes, with all active treatments superior to placebo, according to the following comparisons: combination therapy versus placebo, t=–5.94 (P<0.001); cognitive behavioral therapy versus placebo, t=–2.11 (P=0.04); and sertraline versus placebo, t=–3.15 (P=0.002). In addition, combination therapy was
superior to both sertraline alone (t=–3.26, P=0.001) and cognitive behavioral therapy alone (t=–4.73, P<0.001). No significant difference was found between sertraline and cognitive behavioral therapy (t=1.32, P=0.19). The same magnitude and pattern of outcome was found for the Clinical Global Impressio Severity
scale and the Children’s Global Assessment Scale.
(http://content.nejm.org/cgi/content/full/NEJMoa0804633v2/F2)
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Figure 2. Scores on the Pediatric Anxiety Rating Scale during the 12-Week
Study.

Scores on the Pediatric Anxiety Rating Scale range from 0 to 30, with scores higher than 13 consistent with moderate levels of anxiety and a diagnosis of an anxiety disorder. The expected mean score is the mean of the sampling distribution of the mean.

Estimates of the effect size (Hedges’ g) and the number needed to treatbetween the active-treatment groups and the placebo group were calculated. Effect sizes are based on the expected mean scores on the Pediatric Anxiety
Rating Scale, derived from the mixed-effects model. The number needed to treat is based on the dichotomized, end-of-treatment scores on the Clinical Global Impression–Improvement scale with the use of LOCF. The effect size was 0.86 (95% CI, 0.56 to 1.15) for combination therapy, 0.45 (95% CI, 0.17 to 0.74) for
sertraline, and 0.31 (95% CI, 0.02 to 0.59) for cognitive behavioral treatment.

The number needed to treat was 1.7 (95% CI, 1.7 to 1.9) for combination therapy, 3.2 (95% CI, 3.2 to 3.5) for sertraline, and 2.8 (95% CI, 2.7 to 3.0) for cognitive behavioral therapy. Treatment and Study Withdrawals
Most treatment and study withdrawals were attributed to reasons other than adverse events (43 of 57, 75.4%) (_Table 3_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#T3) ).

Of the 14 withdrawals that were attributed to an adverse event, 11 (78.6%) were in the groups receiving either sertraline alone or placebo and consisted of 3 physical events (headache, stomach pains, and tremor) and 8 psychiatric adverse events (worsening of symptoms, 3 subjects; agitation or disinhibition, 3; hyperactivity, 1; and nonsuicidal self-harm and homicidal ideation, 1).
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Table 3. Subjects Who Withdrew from Treatment or the Study.

Serious Adverse Events
Three subjects had serious adverse events during the study period. One child in the sertraline group had a worsening of behavior that was attributed to the parents’ increased limit setting on avoidance behavior; the event was considered to be possibly related to sertraline. A child in the combination-therapy
group had a worsening of preexisting oppositional defiant behavior that resulted in psychiatric hospitalization; this event was considered to be unrelated to a study treatment. The third subject was hospitalized for a tonsillectomy, which was also considered to be unrelated to a study treatment
(_Table
4_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#T4) ).
View this table:
_[in this window]_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633v2/T4)
_[in a new window]_
(http://content.nejm.org/cgi/content-nw/full/NEJMoa0804633v2/T4)
(http://content.nejm.org/cgi/powerpoint/NEJMoa0804633v2/T4)
Table 4. Moderate-to-Severe Adverse Events at 12 Weeks.

Adverse Events
Subjects in the combination-therapy group had a greater number of study visits and therefore significantly more opportunities for elicitation of adverse events than did those in the other study groups, with a mean of 12.8±4.0 opportunities (range, 1 to 22) in the combination-therapy group, as compared with 9.9±3.6 (range, 1 to 14) in the sertraline group, 10.6±2.0 (range, 1 to 14) in the cognitive-behavioral-therapy group, and 9.7±4.2 (range, 1 to 14) in the placebo group (P<0.001 for all comparisons). Rates of adverse events,
including suicidal and homicidal ideation, were not significantly greater in the sertraline group than in the placebo group. No child in the study attempted suicide. Among children in the cognitive-behavioral-therapy group, there were fewer reports of insomnia, fatigue, sedation, and restlessness or fidgeting than in the sertraline group (P<0.05 for all comparisons). For a list of mild adverse events that were not associated with functional impairment, as well as moderate and severe events, see the _Supplementary Appendix_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633/DC1) ,

available with the full text of this article at www.nejm.org.

Discussion
Our study examined therapies that many clinicians consider to be the most promising treatments for childhood anxiety disorders. Our findings indicate that as compared with placebo, the three active therapies combination therapy with both cognitive behavioral therapy and sertraline, cognitive behavioral therapy alone, and sertraline alone — are effective short-term treatments for children with separation and generalized anxiety disorders and social phobia, with combination treatment having superior response rates. No physical,psychiatric, or harm-related adverse events were reported more frequently in the sertraline group than in the placebo group, a finding similar to that for SSRIs, as identified in previous studies of anxious children._12_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R12) ,_13_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R13) ,_25_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R25)

Few withdrawals from either treatment or the study were attributed to adverse events. Suicidal ideation and homicidal ideation were uncommon. No child attempted suicide during the study period. Since they were recruited at multiple centers and locations, the study subjects were racially and ethnically diverse. However, despite intense outreach, the sample did not include the most socioeconomically disadvantaged children.
Subjects were predominantly younger children and included those with ADHD and other anxiety disorders, factors that allow for generalization of the results to these populations.

Conversely, the exclusion of children and teens with major depression and pervasive developmental disorders may have limited the generalizability of the results to these populations.The observed advantage of combination therapy over either cognitive behavioral therapy or sertraline alone during short-term treatment (an improvement of 21 to 25%) suggests that among these effective therapies, combination therapy
provides the best chance for a positive outcome. The superiority of combination therapy might be due to additive or synergistic effects of the two therapies. However, additional contact time in the combination-therapy group, which was unblinded, and expectancy effects on the part of both subjects and
clinicians cannot be ruled out as alternative explanations.

Nonetheless, the magnitude of the treatment effect in the combination-therapy group (with two
subjects as the number needed to treat to prevent one additional event) suggests that children with anxiety disorders who receive quality combination therapy can consistently expect a substantial reduction in the severity of anxiety. An increased number of visits in the combination-therapy group resulted in increased opportunities for elicitation of adverse events. Consequently, the potential for expectancies among subjects, parents, and clinicians regarding the side effects of medications in the context of more visits may have increased the rate of some adverse events in the combination-therapy group and may limit conclusions that can be drawn regarding the rates of adverse events in combination therapy.

The positive benefit of cognitive behavioral therapy, as compared with placebo, adds new information to the existing literature._26_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R26)
The number needed to treat for cognitive behavioral therapy in this study (three subjects) is the same as that
identified in a meta-analysis of studies comparing subjects who were assigned to cognitive behavioral therapy with those assigned to a waiting list for therapy or to sessions without active therapy._14_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R14)

Our study’s test of cognitive behavioral therapy included children with moderate-to-severe anxiety and addresses criticism of previous trials that included children with only mild-to-moderate
anxiety._14_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R14)
Before our study, cognitive behavioral therapy for childhood anxiety was considered to be
“probably efficacious.”_26_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R26)

This evaluation of cognitive behavioral therapy and other recent studies_27_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R27)
,_28_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R28) suggests that
such therapy for childhood anxiety is a well-established, evidenced-based treatment._29_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R29)

Given that the risk of some adverse events was lower in the behavioral-therapy group than in the sertraline group, some parents and their children may consider choosing cognitive behavioral therapy as their initial treatment.

The results of our study confirm the short-term efficacy of sertraline for children with generalized anxiety disorder_25_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R25) and show that
sertraline is effective for children with separation anxiety disorder and social phobia. The number needed
to treat for sertraline in our study (three subjects) was the same as that previously identified in a meta-analysis_15_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R15) of six
randomized, placebo-controlled trials of SSRIs for childhood anxiety disorders._12_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R12) ,_13_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R13) ,_25_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R25)
,_30_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R30) ,_31_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R31)

These studies and others_27_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R27)
suggest that SSRIs, as a class, are the medication of choice for these conditions. The titration schedule that we used, which emphasized upward dose adjustment in the absence of response and adverse events, suggests that the average end-point dose of sertraline in this study is the highest dose consistent with good outcome and tolerability. No adverse events were observed more frequently in the sertraline group than in the placebo group. In contrast to the apparent risk of suicidal ideation and behavior in studies of depression in children and
adolescents,_15_ (http://content.nejm.org/cgi/content/full/NEJMoa0804633#R15) our study did not demonstrate any increased risk for suicidal behavior in the sertraline group. Given the benefit of sertraline alone or in combination with cognitive behavioral therapy and the limited risk of adverse events associated with the drug in our study, the well-monitored use of sertraline and other SSRIs in the treatment of childhood anxiety disorders is indicated.

Cognitive behavioral therapy and sertraline either in combination or as monotherapies appear to be effective treatments for these commonly occurring childhood anxiety disorders. Results confirm those of previous studies of SSRIs and cognitive behavioral therapy and, most important, show that combination
therapy offers children the best chance for a positive outcome. Our findings indicate that all three of the treatment options may be recommended, taking into consideration the family’s treatment preferences, treatment availability, cost, and time burden. To inform more prescriptive selection of patients for
treatment, further analysis of predictors and moderators of treatment response may identify who is most likely to respond to which_32_
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#R32) of these
effective alternatives.
Supported by grants (U01 MH064089, to Dr. Walkup; U01 MH64092, to Dr.
Albano; U01 MH64003, to Dr. Birmaher; U01 MH63747, to Dr. Kendall; U01 MH64107,
to Dr. March; U01 MH64088, to Dr. Piacentini; and U01 MH064003, to Dr. Compton)
from the National Institute of Mental Health (NIMH).

Sertraline and matching placebo were supplied free of charge by Pfizer. Dr. Walkup reports receiving consulting fees from Eli Lilly and Jazz Pharmaceuticals and fees for legal consultation to defense counsel and
submission of written reports in litigation involving GlaxoSmithKline, receiving lecture fees from CMP Media, Medical Education Reviews, McMahon Group, and DiMedix, and receiving support in the form of free medication and matching placebo from Eli Lilly and free medication from Abbott for clinical trials funded by the NIMH; Dr. Albano, receiving royalties from Oxford University Press for the Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent Versions, but not for interviews used in this study, and royalties from the Guilford Press; Dr. Piacentini, receiving royalties from Oxford University Press for treatmentmanuals on childhood obsessive compulsive disorder and tic disorders and from the Guilford Press and APA Books for other books on child mental health and receiving lecture fees from Janssen-Cilag; Dr. Birmaher, receiving consulting fees from Jazz Pharmaceuticals, Solvay Pharmaceuticals, and Abcomm, lecture fees from Solvay, and royalties from Random House for a book on children with bipolar disorder; Dr. Rynn, receiving grant support from Neuropharm, BoehringerIngelheim Pharmaceuticals, and Wyeth Pharmaceuticals, consulting fees from Wyeth, and royalties from APPI for a book chapter on pediatric anxiety disorders; Dr. McCracken, receiving consulting fees from Sanofi-Aventis and Wyeth, lecture fees from Shire and UCB, and grant support from Aspect, Johnson & Johnson, Bristol-Myers Squibb, and Eli Lilly; Dr. Waslick, receiving grant support from Baystate Health, Somerset Pharmaceuticals, and GlaxoSmithKline; Dr. Iyengar, receiving consulting fees from Westinghouse for statistical consultation; Dr. March, receiving study medications from Eli Lilly for an NIMH-funded clinical trial and receiving royalties from Pearson for being the author of the Multidimensional Anxiety Scale for Children, receiving consulting fees from Eli Lilly, Pfizer, Wyeth, and GlaxoSmithKline, having an equity interest in MedAvante, and serving on an advisory board for AstraZeneca and Johnson & Johnson; and Dr. Kendall, receiving royalties from Workbook Publishing for anxiety-treatment materials.

No other potential conflict of interest relevant to this article was reported.

The views expressed in this article are those of the authors and do not necessarily represent the official views of the NIMH, the National Institutes of Health, or the Department of Health and Human Services.
We thank the children and their families who made this study possible; and J. Chisar, J. Fried, R. Klein, E. Menvielle, S. Olin, J. Severe, D. Almirall, and members of NIMH’s data and safety monitoring board.
* The study investigators are listed in the Appendix.
(http://content.nejm.org/cgi/content/full/NEJMoa0804633#RFN1)

Source Information
From the Johns Hopkins Medical Institutions, Baltimore (J.T.W., G.S.G.); New York State Psychiatric Institute–Columbia University Medical Center, New York (A.M.A., M.A.R.); the University of California at Los Angeles, Los Angeles (J.P., J.M.); Western Psychiatric Institute and Clinic University of Pittsburgh Medical Center, Pittsburgh (B.B., S.I.); Duke University Medical Center, Durham, NC (S.N.C., J.S.M.); the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD (J.T.S.); Baystate
Medical Center, Springfield, MA (B.W.); and Temple University, Philadelphia
(P.C.K.).

This article (10.1056/NEJMoa0804633) was published at www.nejm.org on
October 30, 2008. It will appear in the December 25 issue of the Journal.
Address reprint requests to Dr. Walkup at the Division of Child and
Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns
Hopkins Medical Institutions, 600 N. Wolfe St., Baltimore, MD 21287.
References
1. Benjamin RS, Costello EJ, Warren M. Anxiety disorders in a pediatric
sample. J Anxiety Disord 1990;4:293-316. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1016/0887-6185(90)90027-\
7&link_type=DOI)
_[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1990EJ54500002&link_type=I\
SI
)
2. Birmaher B, Yelovich AK, Renaud J. Pharmacologic treatment for
children and adolescents with anxiety disorders. Pediatr Clin North Am
1998;45:1187-1204. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1016/S0031-3955(05)70069\
-9&link_type=DOI) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=000076256400011&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=9884682&link_type=MED)
3. Achenbach TM, Howell CT, McConaughy SH, et al. Six-year predictors
of problems in a national sample of children and youth: I. Cross-informant
syndromes. J Am Acad Child Adolesc Psychiatry 1995;34:336-347. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1097/00004583-199503000-\
0002

0&link_type=DOI) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1995QK02500020&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=7896676&link_type=MED)
4. Ferdinand RF, Verhulst FC. Psychopathology from adolescence into
young adulthood: an 8-year follow-up study. Am J Psychiatry 1995;152:1586-1594.
_<NOBR Full Text]_
(http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=ajp&resid=152/11/1\
586
)
5. Pine DS, Cohen P, Gurley D, Brook J, Ma Y. The risk for
early-adulthood anxiety and depressive disorders in adolescents with anxiety
and
depressive disorders. Arch Gen Psychiatry 1998;55:56-64. _<NOBR Full Text]_
(http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=archpsyc&resid=55/\
1/56
)
6. Pine DS. Child-adult anxiety disorders. J Am Acad Child Adolesc
Psychiatry 1994;33:280-281. _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1994MT23000019&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=8150802&link_type=MED)
7. Gurley D, Cohen P, Pine DS, Brook J. Discriminating depression and
anxiety in youth: a role for diagnostic criteria. J Affect Disord
1996;39:191-200. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1016/0165-0327(96)00020-\
1&link_type=DOI) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1996VA95900004&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=8856423&link_type=MED)
8. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview
Schedule for Children Version 2.3 (DISC-2.3): description, acceptability,
prevalence rates, and performance in the MECA study. J Am Acad Child Adolesc
Psychiatry 1996;35:865-877. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1097/00004583-199607000-\
00012&link_type=DOI
) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1996UT65000012&link_type=I\
SI
)
_[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=8768346&link_type=MED)
9. Klein R. Anxiety disorders. In: Rutter M, Taylor E, Hersov L, eds.
Child and adolescent psychiatry: modern approaches. 3rd ed. London: Blackwell
Scientific, 1995:351-74.
10. Kendall PC, Treating anxiety disorders in children: results of a
randomized clinical trial. J Consult Clin Psychol 1994;62:100-111. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1037/0022-006X.62.1.100&
link_type=DOI) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1994MW67500015&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=8034812&link_type=MED)
11. Kendall PC, Flannery-Schroeder E, Panichelli-Mindel SM,
Southam-Gerow M, Henin A, Warman M. Therapy for youths with anxiety disorders:
a second
randomized clinical trial. J Consult Clin Psychol 1997;65:366-380. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1037/0022-006X.65.3.36
6&link_type=DOI) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1997XA22300002&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=9170760&link_type=MED)
12. Birmaher B, Axelson DA, Monk K, et al. Fluoxetine for the treatment
of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry
2003;42:415-423. _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=000181706500007&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=12649628&link_type=MED)
13. The Research Unit on Pediatric Psychopharmacology Anxiety Study
Group. Fluvoxamine for the treatment of anxiety disorders in children and
adolescents. N Engl J Med 2001;344:1279-1285. _<NOBR Full Text]_
(http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=nejm&resid=344/17/\
1279
)
14. James A, Soler A, Weatherall R. Cognitive behavioural therapy for
anxiety disorders in children and adolescents. Cochrane Database Syst Rev
2005;4:CD004690-CD004690. _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=16235374&link_type=MED)
15. Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk
for reported suicidal ideation and suicide attempts in pediatric
antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA
2007;297:1683-1696. _<NOBR Full Text]_
(http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=jama&resid=297/15/\
1683
)
16. Diagnostic and statistical manual of mental disorders, 4th ed., text
rev.: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.
17. Kendall PC, Hedtke KA. Cognitive-behavioral therapy for anxious
children: therapist manual. 3rd ed. Ardmore, PA: Workbook Publishing, 2006.
18. Idem. Coping Cat workbook. 2nd ed.. Ardmore, PA: Workbook
Publishing, 2006.
19. Kendall PC, Gosch E, Furr JM, Sood E. Flexibility within fidelity. J
Am Acad Child Adolesc Psychiatry 2008;47:987-993. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1097/CHI.0b013e31817eed2\
f&link_type=D

OI) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=18714195&link_type=MED)
20. Albano AM, Silverman WK. The anxiety disorders interview schedule
for DSM-IV, child version: clinician manual. New York: Oxford University Press,
1996.
21. Guy W, Bonato R, eds. CGI: Clinical Global Impressions. Chevy Chase,
MD: National Institute of Mental Health, 1970.
22. The Pediatric Anxiety Rating Scale (PARS): development and
psychometric properties. J Am Acad Child Adolesc Psychiatry 2002;41:1061-1069.
_[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1097/00004583-200209000-\
00006&link_type=DOI
) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=000177597000006&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=12218427&link_type=MED)
23. Shaffer D, Gould MS, Brasic J, et al. A Children’s Global Assessment
Scale (CGAS). Arch Gen Psychiatry 1983;40:1228-1231. _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A1983RP17500010&link_type=I\
SI
)
_[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=6639293&link_type=MED)

24. Miller RG. Simultaneous statistical inference. New York:
McGraw-Hill, 1966.
25. Rynn MA, Siqueland L, Rickels K. Placebo-controlled trial of
sertraline in the treatment of children with generalized anxiety disorder. Am J
Psychiatry 2001;158:2008-2014. _<NOBR Full Text]_
(http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=ajp&resid=158/12/2\
008
)
26. Silverman WK, Pina AA, Viswesvaran C. Evidence-based psychosocial
treatments for phobic and anxiety disorders in children and adolescents. J Clin
Child Adolesc Psychol 2008;37:105-130. _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=18814641&link_type=MED)
27. Beidel DC, Turner SM, Sallee FR, Ammerman RT, Crosby LA, Pathak S.
SET-C versus fluoxetine in the treatment of childhood social phobia. J Am Acad
Child Adolesc Psychiatry 2007;46:1622-1632. _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=000251141800011&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=18030084&link_type=MED)
28. Kendall PC, Hudson JL, Gosch E, Flannery-Schroeder E, Suveg C.
Cognitive-behavioral therapy for anxiety disordered youth: a randomized
clinical
trial evaluating child and family modalities. J Consult Clin Psychol
2008;76:282-297. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1037/0022-006X.76.2.282&\
link_type=DOI
) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=000254539400010&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=18377124&link_type=MED)
29. Chambless DL, Hollon SD. Defining empirically supported therapies. J
Consult Clin Psychol 1998;66:7-18. _[CrossRef]_ (http://content
.nejm.org/cgi/external_ref?access_num=10.1037/0022-006X.66.1.7&link_type=DOI)
_[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=000071929800002&link_type=I\
SI
)
_[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=9489259&link_type=MED)
30. Wagner KD, Berard R, Stein MB, et al. A multicenter, randomized,
double-blind, placebo-controlled trial of paroxetine in children and
adolescents
with social anxiety disorder. Arch Gen Psychiatry 2004;61:1153-1162. _<NOBR
Full Text]_
(http://content.nejm.org/cgi/ijlink?linkType=ABST&journalCode=archpsyc&resid=61/\
11/1153
)
31. March JS, Entusah AR, Rynn M, Albano AM, Tourian KA. A randomized
controlled trial of venlafaxine ER versus placebo in pediatric social anxiety
disorder. Biol Psychiatry 2007;62:1149-1154. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1016/j.biopsych.2007.02.\
025&link_type=DOI
)
_[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=000250905800012&link_type=I\
SI
) _[Medline]_
(http://content.nejm.org/cgi/external_ref?access_num=17553467&link_type=MED)
32. Kiesler DJ. Some myths of psychotherapy research and the search for
a paradigm. Psychol Bull 1966;65:110-136. _[CrossRef]_
(http://content.nejm.org/cgi/external_ref?access_num=10.1037/h0022911&link_type=\
DOI
) _[ISI]_
(http://content.nejm.org/cgi/external_ref?access_num=A19667673600005&link_type=I\
SI
)
Appendix
The following investigators participated in this study: Steering Committee:
J. Walkup (chair), A. Albano (cochair); Statistics–Experimental Design: S.
Compton, S. Iyengar, J. March; Cognitive Behavioral Therapy: P. Kendall, G.
Ginsburg; Pharmacotherapy: M. Rynn, J. McCracken; Assessment: J. Piacentini,
A. Albano; Study Coordinators: C. Keeton, H. Koo, S. Aschenbrand, L. Bardsley,
R. Beidas, J. Catena, K. Dever, K. Drake, R. Dublin, E. Fontaine, J. Furr, A.
Gonzalez, K. Hedtke, L. Hunt, M. Keller, J. Kingery, A. Krain, K. Miller, J.
Podell, P. Rentas, M. Rozenmann, C. Suveg, C. Weiner, M. Wilson, T. Zoulas;
Data Center: M. Fletcher, K. Sullivan; Cognitive Behavior Therapists: E.
Gosch, C. Alfano, A. Angelosante, S. Aschenbrand, A. Barmish, L. Bergman, S.
Best, J. Comer, S. Compton, W. Copeland, M. Cwik, M. Desari, K. Drake, E.
Fontaine, J. Furr, P. Gammon, C. Gaze, R. Grover, H. Harmon, A. Hughes, K.
Hutchinson, J. Jones, C. Keeton, H. Kepley, J. Kingery, A. Krain, A. Langley,
J. Lee, J. Levitt, J. Manetti-Cusa, E. Martin, C. Mauro, K. McKnight, T. Peris, K.
Poling, L. Preuss, A. Puliafico, J. Robin, T. Roblek, J. Samson, M.
Schlossberg, M. Sweeney, C. Suveg, O. Velting, T. Verduin; Pharmacotherapists:
M. Rynn, J. McCracken, A. Adegbola, P. Ambrosini, D. Axelson, S. Barnett, A. Baskina,
B. Birmaher, C. Cagande, A. Chrisman, B. Chung, H. Courvoisie, B. Dave, A.
Desai, K. Dever, M. Gazzola, E. Harris, G. Hirsh, V. Howells, L. Hsu, I.
Hypolite, F. Kampmeier, S. Khalid-Khan, B. Kim, D. Kondo, L. Kotler, M.
Krushelnycky, J. Larson, J. Lee, P. Lee, C. Lopez, L. Maayan, J. McCracken, R.
Means,L. Miller, A. Parr, C. Pataki, C. Peterson, P. Pilania, R. Pizarro, H. Ravi,
S. Reinblatt, M. Riddle, M. Rodowski, D. Sakolsky, A. Scharko, R. Suddath, C.
Suarez, J. Walkup, B. Waslick; Independent Evaluators: A. Albano, G.
Ginsburg, B. Asche, A. Barmish, M. Beaudry, S. Chang, M. Choudhury, B. Chu, S.
Crawley, J. Curry, G. Danner, N. Deily, R. Dingfelder, D. Fitzgerald, P.
Gammon, S. Hofflich, E. Kastelic, J. Keener, T. Lipani, K. Lukin, M. Masarik, T.
Peris, T. Piacentini, S. Pimentel, A. Puliafico, T. Roblek, M. Schlossberg, E.
Sood, S. Tiwari, J. Trachtenberg, P. van de Velde; Pharmacy: K. Truelove, H.
Kim; Research Assistants: S. Allard, S. Avny, D. Beckmann, C. Brice, B.
Buzzella, E. Capelli, A. Chiu, M. Coles, J. Freeman, M. Gringle, S. Hefton, D.
Hood, M. Jacoby, J. King, A. Kolos, B. Lourea-Wadell, L. Lu, J. Lusky, R. Maid, C.
Merolli, Y. Ojo, A. Pearlman, J. Regan, S. Rock, M. Rooney, N. Simone, S.
Tiwari, S. Yeager.

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Prozac Prescribed Immediately

“Within a few weeks (of taking Prozac), I began having nightmares of murdering people.”

Hi, I work shiftwork and I listen to Art Bell (for entertainment purposes only…ha ha) and I heard your interview with Barbara Simpson. I just wanted to write you and tell you my experience with Prozac.

About 8 years ago, I went to see a psychiatrist about my depression, and he immediately put me on Prozac, without saying five words to me. Within a few weeks, I began having nightmares of murdering people. They were so awful, I couldn’t sleep. I immediately went back to the doctor to tell him about my problem, and he said not to worry about it, it was COMPLETELY NORMAL ! !

I immediately stopped taking the drug and went to see a psychologist, instead. I have been depression free ever since, because of the therapy given to me by the psychologist. Oh, and by the way, the nightmares stopped immediately after I stopped taking the Prozac.

I guess the real reason I am writing is in response to the Andrea Yates trial in Houston. I don’t know her, but it was reported on the news that she was on four different anti-depressants at the same time. If this is true, it is no wonder she did what she did. It is her doctor and the drug companies that should be on trial for the murder of her children. Something has to be done about this and I hope you could use your knowledge of the subject to inform everyone about the dangers of these drugs. I have written all the local news agencies in Houston and sent them Links to your website and the drug awareness website.

Thanks, Gary

Gary Johnston gary_johnston@swbell.net

 

12/8/2001

This is Survivor Story number 33.
Total number of stories in current database is 34

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4/30/2001 – Brain Death in Carbon Dioxide Treatment for Depression

Every time I think it can’t get much worse, it does! And every time I think I
have finally heard it all, I hear something like this case reported in the NY
Post as brain dead from carbon dioxide treatment.

ANYONE should know that depriving the brain of oxygen kills brain cells. So,
why would one think, especially one who calls himself a doctor, that would be
beneficial to someone suffering emotional trauma of any kind to give them
carbon dioxide? Will we hear next that they will be holding patient’s heads
under water for 10 minutes to see of what benefit it might be?

Even more alarming is the fact that this man pawned himself off as one who
specializes in environmental medicine and homeopathy. You would think that
someone who is suppose to know anything about environmental medicine would be
well aware of the damage caused by carbon dioxide – one of the greatest
concerns of environmental medicine. And since when did homeopathy include
anything like treating someone with carbon dioxide? Perhaps the problem here
was that the good doc had spent too much time in the same room where he was
treating his patients with the carbon dioxide? 🙂

Ann Blake-Tracy, Executive Director,
International Coalition For Drug Awareness
www.drugawareness.org and author of
Prozac: Panacea or Pandora? ()

CIRCARE:
Citizens for Responsible Care & Research
A Human Rights Organization
Tel-212-595-8974 FAX: 212-595-9086
veracare@…

FYI
According to The NY Post, a licensed psychiatrist, James Watt, used carbon
dioxide as a “treatment” for depression. Result: patient is brain dead in a
coma at Bellevue Hospital.

Could it be that James Watt is related to the notorious neurosurgeon, James
Watt, who teamed up with neurologist Walter Freeman, performing 40,000
lobotomies (by 1955) on American men, women, and children ??
[see excerpt, below, from the book Medical Blunders, by Robert Youngson and
Ian Schott.]

The National Institutive of Mental Health sponsors Carbon dioxide
“challenge’ experiments that are being conducted on patients–including
adolescents–who have been diagnosed with panic disorder. Is it ethical to
induce panic attacks (with carbon dioxide or other such non-therapeutic,
dangerous procedures) in order to study panic disorder? Or, do these
experiments demonstrate current “medical blunders” ?

~~~~~~~~~~~~~~~~~~~~~~~~

New York Post
Friday April 27, 2001, page 8

GEAR SEIZED FROM COMA WOMAN’S DOC

By MURRAY WEISS and DAVID K. LI

April 27, 2001 — Authorities seized equipment from the office of a
Manhattan psychiatrist yesterday – after one of his patients wound up brain
dead following a session, cops said.

Leah Grove, 38, is in intensive care at Bellevue Hospital, where she was
taken April 19 after something went wrong during “carbon dioxide” therapy at
Dr. James Watt’s office on East 46th Street.

Watt was treating the Queens woman for depression with a combination of
gases, including carbon dioxide, cops said.

Investigators said it was unlikely charges would filed.
_________________________________________________________________

New York Post
Sunday April 29, 2001

CO2-THERAPY VICTIM’S SHATTERED DREAMS

By DAVID K. LI, ANGELA C. ALLEN, MURRY WEISS and DAN MANGAN

April 28, 2001 — The woman left brain-dead after a psychiatric session
involving an unusual gas therapy had been looking forward to a new job in
California, her landlady said yesterday.

Leah Grove, 38, already had moved out of the Sunnyside, Queens,
apartment she had been sharing with a friend in anticipation of her move
west, said landlady Edith Giron.

Grove, a computer saleswoman, remained in a coma yesterday at Bellevue
Hospital with her grief-stricken mother at her bedside.

“Everything is about as can be expected,” said her mother, Lynn Grove,
who was so upset she could barely speak.

Grove was taken to the hospital April 19 after a mishap during
“carbon-dioxide therapy” at Dr. James Watt’s Manhattan office, police said.
She was being treated for stress and mild depression, cops said.

Watt has not been charged, but police and prosecutors searched his East
46th Street office and seized equipment Thursday.

Questions remained yesterday about the nature and purpose of the
therapy by Watt, who could not be reached for comment. Carbon dioxide can
suffocate a person.

Watt, 73, is a licensed psychiatrist whose business card says
he specializes in homeopathic care, including “environmental
detoxification, hormonal replacement, intravenous nutritional
infusions, and anti-aging therapy.”

Originally from New York, he spent time in California, and
returned to New York several years ago, police said.

In addition to carbon dioxide, police said Watt was giving a
mixture including oxygen and nitrous oxide – laughing gas – to Grove as
treatment.

Carbon-dioxide therapy was used in the 1940s and 1950s to
trigger near-death experiences.
_________________________________________________________________

http://www.scc.net/~lkcmn/lobotomy/lobo/brief.html

“the “Freeman-Watts standard lobotomy”; or, as they called it, the
“precision method”. After hand-drilling holes on either side of the head
which were widened by manually breaking away further bits of the skull, the
way would be paved for the knife by the preliminary insertion of a 6 inch
cannula, the tubing from a heavy-gauge hypodermic needle. Put in one hole,
this would be aimed at the other, on the opposite side of the head. Then the
blunt knife would be inserted in the path initially carved by the cannula.
Once inside the brain, the blade would be swung in two cutting arcs,
destroying the targeted nerve matter. “It goes through just like soft
butter,” said Watts. The operation was repeated on the other side of the
head.

Because the technique was “blind” — they could not see what they were
doing — it required both men. Watts manipulated the cannula and blade while
Freeman crouched in front of the patient, like a baseball catcher, using his
knowledge of the internal map of the brain to give Watts instructions such
as “up a bit”, “down a fraction”, or “straight ahead”. Watts enjoyed “flying
on instruments only”, as he put it, and became so expert that, as a special
trick, he could insert a cannula through a 2 millimeter hole in one side of
a patient’s head and thread it through the brain and out of the opposing
hole like a shoelace. “That’s pretty damn dramatic, you know,” he once said.
“And of course it always impressed spectators.”

The best was yet to come. Having observed that the optimum results were
achieved when the lobotomy induced drowsiness and disorientation, Freeman
and Watts decided to see if they could use this information to judge how an
operation was proceeding; they began to perform lobotomies under local
anesthetic. Now they could speak to the patient while cutting the lobe
connections and gauge whether they were being successful. They asked
patients to sing a song, or to perform arithmetic, and if they could see no
signs of disorientation, they chopped away some more until they could.

Initial professional reaction to the 1936 operations was not promising.
Although, privately, the technique aroused great interest, it drew outraged
responses from psychoanalysts and many psychiatrists, though, in keeping
with the medical tradition of discretion, these reservations were not voiced
to the public at the time. Ten years later, everybody would declare that
they had always opposed the lobotomy.” …………..

“As early as 1951, even the Soviet Union, where psychiatric abuse was rife,
had stopped performing the lobotomy on ideological grounds: it produced
unresponsive people who were fixed and unchangeable.”

~~~~~~~
The preceding text was adapted from the book Medical Blunders, by Robert
Youngson and Ian Schott. All reprinted materials are copyrighted by the
original authors; unauthorized reproduction is strictly prohibited. The
information presented at this site is intended for educational purposes
only, consult a professional for additional information. The maintainer of
this site and the original authors assume no responsibility of the misuse of
this information. Suggestions, comments, or questions should be sent to:
vestc@…. Last modification: 11 October 1997.

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4/19/2001 – Ann Blake-Tracy on the air with Columbine victims

* Before I give you this information on the Columbine shooting victims, you
should know that it was announced today in San Diego that Jason Hoffman, the
school shooter in El Cajon, had taken two different antidepressants.

Now for a little over a month I have been working with the victims of
Columbine shot by Eric Harris, and the Harris family attorney, as they have
prepared their lawsuits against Solvay, the makers of Luvox. We have been
invited by the largest talk radio station in Utah, KSL, to do a show with
Doug Wright. It will air Friday, April 20, (the anniversary of the Columbine
tragedy) at 10:00AM Mountain Time.

Another show will air Monday morning on KIQ 1010 in Salt Lake City with Joe
Jackson at 8:00AM Mountain time.

You can find the particulars on how to listen to these shows online or you
can find information on any other upcoming shows by going to:
http://members.aol.com/atracyphd/appear.htm

Check this site regularly for upcoming shows you can listen to online. If you
would like a show in your area contact your local station and tell them to
log on to www.drugawareness.org and let us know when they would like us on
the air.

Ann Blake-Tracy, Executive Director,
International Coalition For Drug Awareness
www.drugawareness.org

629 total views, 1 views today