Friday, October 23, 2009

Psych Drugs may kill brain cells in preschoolers’ developing brain: animal study evidence

Psych Drugs may kill brain cells in preschoolers’ developing brain: animal study evidence

“Psychiatric Meds for Infants Linked to Later Behavior Problems
Researchers found drugs used to treat mood disorders, pain and epilepsy raised risk”

Do no harm: Don’t give psych drugs to preschoolers until we know what we are doing!!

This finding is being presented at a current research conference…
(here is my blog about research conferences…

Apparently, these researchers took a range of psych drugs and gave them to very young rats. Or mice. Or guinea pigs. Or whatever non-human animal. They found that certain drugs seem to kill brain cells.

Sure, this SOUNDS like the kind of study that we believe should be done BEFORE we go and test these drugs with preschoolers.

But no: psychiatrists, and ANY other physicians, are perfectly able to GUESS whether any commercially available psychiatric drug might work for some preschooler’s problem, and go prescribe it and see what happens.

Professionally / clinically, there are systems in place for these practitioners to communicate their experiences – articles can be published, ranging from a case study with one patient, to studies with greater sample sizes; Studies might be presented at research conferences, or in “continuing medical education” courses.

What cannot be done is the pharmaceutical companies cannot market, advertise, or otherwise promote a drug for a problem or a population unless they have gotten FDA approval. Docs are not limited in that way. So, docs are basically free to go try antipsychotics on preschoolers. And they do.

But this is not the best style of treatment for detecting possible long-term effects. Data are not systematically gathered at long-term outcomes. FDA approval of a drug requires short-term efficacy, and similar pre-market safety info, PLUS Voluntary post-marketing surveillance. If any clinical setting happens to be gathering long-term data, it is a challenge unless a project is strongly devoted to quality data -- A patient may drop out of care for any of many reasons – parents switch providers, parents move, parents change phone number, etc – if ANYONE were making the most feeble attempt to detect long-term harm from the use of psychiatric meds in preschoolers, they would have a great challenge gathering data.

This is partly why a non-human animal study is valuable: we can't really depend on FDA post-marketing surveillance since it is totally voluntary; there is no identified long-term systematic effort to gather long-term outcomes / safety data for preschoolers, or anyone esle, on these psych drugs.

With non-human animals, we can see what MIGHT be happening to us. Non-human animals are more acceptable as sacrifices for the sake of knowledge, and their lifespans are quicker: a mouse reaches adolescence and adulthood a lot quicker. So, you can see if a drug given in infancy has a bad effect at adulthood – well within a year, versus the two decades it would take with a human.

The limit is that, obviously, a mouse is not a human. Mice do not answer psychiatric interview questions, and their facial expressions are more difficult to read. But hey we do what we can. [not me – I haven’t done any animal studies like this. just observing monkey social behavior.] what can we do? We can sacrifice the mouse and look at his brain cells.

So, the presenter, Forcelli, and colleagues apparently have detected harm from some psych drugs. We will have to wait until they publish the full study for us to get a full report.

But the news does not look good.

"That is of particular concern because some of the drugs may predispose to psychiatric disorders later in life," study author Patrick Forcelli, a graduate student at Georgetown University Medical Center, said in a school news release.

This next part really bothers me:

"At the same time, our studies identify specific drugs that cause little or no long-term behavioral impairment."

This sounds like they have conclusively learned that, for some psych drugs, there is NO long-term harm from preschool use.

----How do they know about long-term harm? Scientifically speaking, and honestly speaking, that cannot declare this. Sad that this was a WELL-CRAFTED PRESS RELEASE, not a spontaneous comment to a reporter, where maybe a statement comes out the wrong way.

Here is what they should have said: “…our studies failed to detect indicators of harm from a range of other psych drugs.”

OK – why the big deal about this? Because a range of psych meds are increasingly being prescribed for preschool-age children. For their “behavioral problems.”

My opinion? Nearly ALL of the cases of preschool kids being prescribed psych meds are cases where meds should not be used at all. Significant parenting interventions should be used. I look at these studies, and I know: they rarely include a family evaluation to adequately rule out family chaos, instability, poor parenting, inconsistent parenting, abuse, etc. as a cause of this behavior.

Yet I know, from a range of psych work experiences, this is almost always the case.

If you believe these problems are “brain disorders,” then you are gonna prescribe drugs. If you believe that kids have tantrums, act oddly, are extremely anxious, etc., because of their social circumstance, then you are gonna do a parenting intervention.

We are in a time of indulgent, and/ or lazy, neglectful parenting. This is the problem with kids these days. I believe it is terrible to lay the blame on the kids. Preschool kids.

Where were these “severely disturbed” preschoolers when WE were young? Before the 80s, the style of parenting was NOT like it is today, and families were not producing these problems. Sure, there were kids with problems, and poor-parenting families. But not as a sport.

To figure out whether a FAMILY is not doing its job, and the kid’s problems are resulting from improper parenting, you need to do a full assessment like this:

Parent Interview. Major Developmental Domains. Lots of history. Psychosocial Functioning. Child Rating Scales. Assessment of Marital Discord. “Parental Stress:” –And I would prefer to include a profile of the family’s FINANCIAL picture: do both parents work? How much debt (house pmt, car pmt, credit card pmt, how much in savings, etc.). Household money management: is there a written budget? Do mother and father have money arguments? Single Parent Issues. Blended Family Issues. Non-resident parent issues. Support from Extended Family.

All of that sets the context for loving, consistent parental involvement. No matter what the child’s problems, loving, attentive, consistent parenting is a must.

Rarely is this properly done. Because Big Pharma and NAMI are triyng to convince all of us that we have “brain disorders” and pills are the answer.

Even for preschoolers. Toddlers. Infants.

Here is an example of the issue of preschool prescription of psych meds: keep in mind that the pharmaceutical industry has absolutely NO systematic long-term study to assess long-term risks. None. No patient registry, etc.

Luby JL, Tandon M, Belden A. “Preschool bipolar disorder.” In: Child Adolesc Psychiatr Clin N Am. 2009 Apr;18(2):391-403, ix.

“Although some empirical work has now been added to the larger body of case material, preschool bipolar disorder (BPD) remains a highly ambiguous diagnostic area. This is notable in the context of the significant progress that has been made in many other areas of psychopathology in the preschool period. While there is a need for well controlled empirical investigations in this area, a small but
growing body of empirical literature suggests that some form of the disorder may arise as early as age 3. The need for large scale and focused studies of this issue is underscored by the high and increasing rates of prescriptions of atypical antipsychotics and other mood stabilizing agents for preschool children with presumptive clinical diagnosis of BPD or a related variant. Clarifying the nosology of preschool BPD may also be important to better understand of the developmental psychopathology of the disorder during childhood. Data elucidating this developmental trajectory could then inform the design of earlier potentially preventive interventions that may have implications for the disorder across the lifespan.

--See? These people totally believe the toddlers have bipolar disorder. They totally believe BOTH depression and MANIA are seen in their clients.

And what about my wild accusations that these people WANT to sell PATENTED (i.e., money-making, no-generic-available) drugs to an ever-younger set of customers?

Well, Dr. Luby has been on the payroll of a few pharmaceutical companies: Janssen, AstraZeneca, Shire, and who knows which other psych med companies.

Who knows. Because she has not been consistent regarding sharing information regarding whether her views on prescribing preschoolers meds might be influenced by her financial sponsors…

In a 2006 article

[Luby J, Mrakotsky C, Stalets MM, Belden A, Heffelfinger A, Williams M, Spitznagel E. J Child Adolesc Psychopharmacol. 2006 Oct;16(5):575-87. Risperidone in preschool children with autistic spectrum disorders: an investigation of safety and efficacy],

she declared: "Drs. Luby, [et al.] have no conflicts of interest or financial relationships to disclose."

At the same time, here article here:

Luby JL, Sullivan J, Belden A, Stalets M, Blankenship S, Spitznagel E. An observational analysis of behavior in depressed preschoolers: further
validation of early-onset depression. J Am Acad Child Adolesc Psychiatry. 2006 Feb;45(2):203-12.

…declares: “Disclosure: Dr. Luby has received grant/research support from Janssen, has given occasional talks sponsored by AstraZeneca, and has served as a consultant for Shire Pharmaceutical.”

So: bottom line: this recently presented non-human animal study reveals that adding some, but maybe not other, psych meds to young, developing brains, at least in these non-human animals, leads to brain cell death and later problems.

AND: We simply do not have a research knowledge base with humans to answer such questions.

AND: the scholarly promoters of Rx preschoolers are often funded by Big Pharma

AND: the scholarly promoters have not been forthcoming about their financial relationships with their sugar daddy pharmaceutical company sponsors.

AND: these drug studies rarely conduct an adequate social / parenting assessment to rule out child problems secondary to situational or parenting problems.


You do the math. Meds vs. therapy: looks like more evidence on the therapy side with this recent science news.

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