| nomdaplume1000@yahoo.com 2004-09-21, 3:08 am |
| Drug Warning Label Idea Prompts Caution
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By DIEDTRA HENDERSON, AP Science Writer
WASHINGTON - Alarmed at a recommendation that antidepressants for children carry
a strict new warning label, some parents are not letting their kids take the
drugs as part of a clinical trial for young people who have attempted suicide.
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Government health advisers said last week the labels on these drugs should have
bold warnings surrounded by a black box to draw attention and say that, in some
cases, the medication increases suicidal thoughts and behavior.
A study financed by the National Institute of Mental Health is designed to
determine whether treatment — medication or behavioral therapy, alone or
combined — can prevent future suicide attempts.
Children enrolled in the small pilot study have attempted suicide previously,
which normally would exclude them from such scientific trials.
Dr. Graham Emslie, principal investigator at one of the study's five sites, said
only 15 percent of children diagnosed as depressed take medication.
"We're trying to increase the number who are treated," said Emslie, who works in
Dallas, and the black box warning "is definitely not going to help."
The Food and Drug Administration (news - web sites) said it generally supports
the recommendation from the advisory panel that labels on antidepressants have
warnings about increased risk of suicidal thoughts and behavior.
For every 100 children taking antidepressants in controlled clinical trials, an
additional two to three experienced increased suicidal tendencies.
In the trial, the parents of a child who had attempted suicide within the
previous 45 days — a requirement to participate in the study — refused to let
researchers use an antidepressant as planned.
In a second instance, divorced parents could not agree whether their suicidal
child should take the medication.
Emslie said two refusals by parents in a single week, each citing the advisory
panel's comments, mark the beginning of a worrisome trend. "I don't think it was
isolated. I think it will continue," Emslie said.
On Capitol Hill, lawmakers are pushing for greater disclosure of the results
from drug clinical trials.
The FDA (news - web sites) said last week it has begun to adopt more strident
warning labels for all antidepressants, not only those involved in pediatric
clinical trials: Celexa, Effexor, Luvox, Paxil, Prozac, Remeron, Serzone,
Wellbutrin and Zoloft.
The agency has not yet said whether that will be a black-box warning as the
advisory panel recommended.
Last week's public hearings on the issue have led to changes already in how
antidepressants are prescribed.
For psychiatrists like Dan Medeiros, the push to ensure that doctors first
discuss the medication's risks and benefits simply reinforces what he has done
for 14 years.
Medeiros runs a day treatment program for New York teenagers who skip school or
fail because of depression. Medeiros' warnings already include the risk that an
antidepressant can boost energy.
"People can be so depressed they don't even have the energy to get out of bed.
If the medication starts improving energy level ... you then have the means to
commit suicide," he said.
John March, chief of child and adolescent psychiatry at Duke university Medical
Center, said he's inclined to prescribe Prozac first among the new generation of
antidepressants. The federal recommendations won't change that since three
studies, including one led by March, point to Prozac's effectiveness.
Kathy Bruce's husband, Marty, killed himself in 1993, and her 10-year-old
daughter, McLain, was diagnosed as bipolar in May.
For the past month, the girl has taken Zoloft, which is linked to increased
suicidal thoughts among children. When prescribing the drug, McLain's doctor
mentioned a "small risk" associated with the antidepressant, Kathy Bruce said.
"It was a risk I was willing to take," Bruce said from her home near Atlanta.
"She's coming home every day happy and loving school."
Dr. Phillip Kennedy said he limited antidepressant prescriptions after the FDA
in March sent a warning letter to doctors.
A black box warning would make prescribing physicians and drug companies
"liability targets," Kennedy said.
His strategy has been to tell slightly depressed adolescents and their parents
that a drug could help, but that he would prefer that a psychiatrist prescribe
it. "You get resistance from the mother and child. It's a weekly occurrence, if
not more," Kennedy said.
Dr. Elissa Benedek, past president of the American Psychiatric Association, said
referrals to mental health specialists are likely to increase.
"If it makes some people more careful and more thoughtful about what they do,
it's not a bad thing," said Benedek, a child psychiatrist in Ann Arbor, Mich.
In Augusta, Ga., where Kennedy runs a family practice, he said youths can face a
three-month delay before seeing a psychiatrist.
___
On the Net:
Food and Drug Administration: http://www.fda.gov/
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Why, yes, in fact, I am a rocket scientist.
Guide to Medications for Mental Illness:
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