9/1/2003 • A Systematic Chart Review of the Nature of Psychiatric Adverse Events in

9/1/2003 • A Systematic Chart Review of the Nature of Psychiatric Adverse Events in Children and Adolescents Treated with Selective Serotonin Reuptake Inhibitors

Timothy E. Wilens MD ; Joseph Biederman MD ; Anne Kwon MS ; Rhea Chase BA ; Laura Greenberg BA ; Eric Mick ScD ; Thomas J. Spencer MD

Journal of Child and Adolescent Psychopharmacology Volume: 13 Number: 2 Page: 143 — 152

Conclusion: Based on the retrospective review of medical charts, youth receiving SSRI appear to be at risk for treatment emergent PAE and recurrence with re-exposure to an SSRI. Prospective longer term studies evaluating the course and prognosis of youths manifesting PAE to SSRI are necessary.

A Systematic Chart Review of the Nature of Psychiatric Adverse Events in Children and Adolescents Treated with Selective Serotonin Reuptake Inhibitors

Timothy E. Wilens MD ; Joseph Biederman MD ; Anne Kwon MS ; Rhea Chase BA ; Laura Greenberg BA ; Eric Mick ScD ; Thomas J. Spencer MD

Journal of Child and Adolescent Psychopharmacology Volume: 13 Number: 2 Page: 143 — 152

Conclusion: Based on the retrospective review of medical charts, youth receiving SSRI appear to be at risk for treatment emergent PAE and recurrence with re-exposure to an SSRI. Prospective longer term studies evaluating the course and prognosis of youths manifesting PAE to SSRI are necessary.

A report in the Journal of Child and Adolescent Psychopharmacology (abstract below) Dr. Timothy Wilens, Dr. Joseph Biederman, et al, child psychiatrists at Harvard’s teaching hospital, Massachusetts General, found that 22% of children and adolescents who had been prescribed any one of the selective serotonin reuptake inhibitor (SSRI) antidepressants suffered drug-induced psychiatric adverse effects within three months. Furthermore, the authors, who have long advocated prescribing psychotropic drugs for children, reported: “Overall, 74% if children and adolescents experienced [i.e., suffered] an adverse event to an SSRI over the course of their treatment.”

The SSRI drugs prescribed for these children were: Prozac, Paxil (Seroxat), Zoloft, Luvox and Celexa. Proof that the adverse effects were drug-induced is borne out by the fact that after the drugs were withdrawn and the children were re-exposed to an SSRI, 44% suffered another psychiatric adverse effect.

This report validates what critics—who are not receiving financial support from drug companies—have been pointing out for some time: Antidepression drugs are not the solution for troubled children. The documented evidence consistently shows that the drugs are causing children mental distress that can only aggravate their problems.

Of particular concern: According to the authors, the most frequent adverse effects induced by SSRI drugs are sleep disturbance (35%) and agitation. That combination is a prescription for violent outbursts—such as, self injury, suicide attempts, and / or violent outbursts toward others.

It is scandalous that the National Institute of Mental Health has remained absolutely silent about mounting evidence that these drugs pose hazards for children’s health and lives. NIMH officials disregard the evidence of suicidal acts by children in clinical trials. The same evidence led the medical authorities in Great Britain to ban the use of an SSRI in children under 18. See documents at: http://www.ahrp.org/index.html

Despite evidence of harm, NIMH continues to promote the use of SSRIs and sponsors clinical trials that expose little children and adolescents to the hazards of these drugs. See: http://www.nimh.nih.gov/ncdeu/abstracts2002/ncdeu2062.cfm http://www.nimh.nih.gov/ncdeu/abstracts2002/ncdeu2061.cfm http://www.nimh.nih.gov/ncdeu/abstracts2002/ncdeu3016.cfm

For additional documentation about the harm being done to children who are inappropriately and indiscriminately prescribed psychotropic drugs, visit the AHRP website at: www.ahrp.org

Abstract: Objective: Despite a rapidly growing literature on the efficacy of the selective serotonin reuptake inhibitors (SSRI) in the treatment of juvenile psychiatric disorders, relatively little is described about emotional, behavioral, and cognitive adverse effects associated with their use. To this end we completed a retrospective analysis of medical charts to determine the incidence, nature, and clinical correlates of treatment emergent adverse effects in the behavioral, cognitive, and emotional domains.

Methods: We systematically evaluated the medical charts of children treated with SSRI for depressive or obsessive-compulsive disorders for a mean (±SD) of 26.9 ± 20.8 months to determine the incidence, nature, and clinical correlates of treatment emergent psychiatric adverse events (PAE). Charts were reviewed for diagnoses, type and dose of SSRI and adjunct medication, specific type of PAE, and time to onset and offset of PAE.

Results: In total, 82 charts of children and adolescents (mean age 12.2 ± 3.2 years) were examined. PAE occurred in 22% of children and were most commonly related to disturbances in mood. PAE were not associated with psychiatric diagnosis(es), age, sex, concurrent medications, doses or specific serotonin reuptake inhibitors. The onset of PAE was observed typically 3 months after SSRI exposure (median = 91 days). Although PAE diminished with SSRI discontinuation, those that emerged early in treatment diminished significantly more rapidly than those that emerged later (median offset was 10 and 49 days, respectively). Re-exposure to an SSRI resulted in another PAE in 44% (n = 18) of the group.

Copyright © by Mary Ann Liebert, Inc. 2003 Reference Links: 17 (View Links)

11/5/2002 • Adolescent Drug Use Creates Long-Term Imbalance

11/5/2002 • Adolescent Drug Use Creates Long-Term Imbalance
Even commonly prescribed amphetamines may lead to addictive behavior.

By Ross Grant
Health ScoutNews Reporter

Thomas Jefferson University
Philadelphia

Here is more evidence that there is significant brain alteration within brain cells in response to synthetic chemicals that change brain function in many unknown ways. Could these abnormal proteins that form in response to foreign chemicals that cross the blood brain barrier, be part of the mysterious amyloid deposits that are markers for Alzheimers Disease? An educated guess, from some observers who have noted a relationship between Alzheimer’s and people who have taken a lot of brain-altering drugs during their lifetimes, says yes. Has anybody else noticed such a connection? Until we have a long term study on that very question, the drug companies have to be up front and say that they don’t know if their particular synthetic chemical can cause Alzheimers or not. In the meantime, we should avoid taking their drugs until they can prove that they don’t have such long term adverse effects.

Adolescent Drug Use Creates Long-Term Imbalance
Even commonly prescribed amphetamines may lead to addictive behavior.

http://www.healthscout.com/template.asp?ap=43&page=newsDetail&id=510032

By Ross Grant
Health ScoutNews Reporter

Thomas Jefferson University
Philadelphia

Here is more evidence that there is significant brain alteration within brain cells in response to synthetic chemicals that change brain function in many unknown ways. Could these abnormal proteins that form in response to foreign chemicals that cross the blood brain barrier, be part of the mysterious amyloid deposits that are markers for Alzheimers Disease? An educated guess, from some observers who have noted a relationship between Alzheimer’s and people who have taken a lot of brain-altering drugs during their lifetimes, says yes. Has anybody else noticed such a connection? Until we have a long term study on that very question, the drug companies have to be up front and say that they don’t know if their particular synthetic chemical can cause Alzheimers or not. In the meantime, we should avoid taking their drugs until they can prove that they don’t have such long term adverse effects.

Drug use during adolescence, including such commonly prescribed drugs as Ritalin, may upset brain chemistry more than any other time in a person’s life, new research says.

The findings should help scientists better understand why addictions generally begin during adolescence, and what the long-term risks result.

“This is a major public health question,” says the lead researcher, Dr. Michelle Ehrlich, a neurology professor at Thomas Jefferson University in Philadelphia. “The adolescent brain appears to be more sensitive to certain effects of these psycho-stimulant drugs. We need to see whether this sensitivity leads to permanent brain changes and behavior changes.”

In the study, which just appeared in the Journal of Neuroscience, the researcher gave cocaine and amphetamine to groups of adult, adolescent and baby mice every day for a week. Then they compared the chemistry in two sections of the mice brains against that of a control group. Because mice have many of the same brain functions as humans, scientists believe the results should shed light on our brains, Ehrlich says. After taking the drugs, all the mice had elevated levels of an addiction-marking protein in the part of the brain that controls movement and hyperactivity. But adolescent mice also had high levels of the protein in the part of the brain that controls the “reward” mechanism.

Because of that chemical imbalance, adolescents may depend on drugs to stimulate their reward mechanism, leading to addictive behavior, Ehrlich says. Meanwhile, other studies have shown that the protein, called DeltaFosB, stimulates other chemical responses in the brain months after drug use has stopped, which may contribute to drug cravings.

“The implications are that there is an increased adaptation in the younger brain than in the older brain to these psycho-stimulants,” Ehrlich says. But Ehrlich isn’t worried only about the effects of illegal drugs. The same long-term changes in brain chemistry may also occur after adolescents take prescribed amphetamine.

“Amphetamine is one of the most commonly used drugs for attention deficit disorder. Ritalin is one of the most well-known ones,” Ehrlich says. “I prescribe these drugs. I work with children on these drugs. I’m not saying we shouldn’t use them, but we should know about their long-term effects.”

In some cases, the risks of prescribing amphetamine drugs are worthwhile, says Dr. Eric Nestler, chairman of the psychiatry department at the University of Texas Southwestern Medical Center. But Nestler, who was one of the first researchers to discover Delta FosB, says such drugs are prescribed too often, when the risks aren’t worthwhile.

“There has to be a concern,” he says. “Kids with attention deficit disorder are really impaired. A drug like Ritalin works well with those conditions, and to deny it to a kid who really need it is a disservice. The problem comes when the diagnosis of attention deficit disorder is made too frequently.”

So far, though, no one has studied whether Ritalin and other prescribed drugs raise the level of Delta FosB like cocaine and amphetamine, Nestler says. “That would be an interesting study,” he says.

Nestler says he is surprised that Erlich’s team didn’t see higher Delta FosB levels in both parts of the adult mouse brain. In his research, he found that both adolescent and adult mice have elevated levels, although he thinks he used a more sensitive method of detecting Delta FosB.

Still, if Ehrlich’s research shows that adolescents have a higher level of Delta FosB than do adults, it reveals key evidence about the addiction process, he says.

“This is the first finding to suggest that the adolescent brain is more sensitive. That is very interesting,” Nestler says. What To Do

To learn more about these drugs, visit this site at the California State University at San Marcos. Or for more information about how amphetamine is prescribed to treat attention deficit/hyperactivity disorder, try the National Center for Birth Defects and Developmental Disabilities. Copyright © 2002 ScoutNews, LLC. All rights reserved. Last updated 11/5/2002