Dec. 3, 2012 By Brenda Goodman, MA — Most teens with mental illnesses don’t take medications for their conditions, a new survey finds.
The study contradicts reports of widespread and indiscriminate pill-popping in high schoolers. If anything, researchers say, many kids may not be getting enough help for real problems that are affecting their lives.
“The one thing that we heard over and over when we started this study was that parents are getting their kids prescriptions for stimulants so they can do better on the SATs,” says researcher Kathleen Merikangas, PhD, chief of the genetic epidemiology branch in the intramural research program at the National Institute of Mental Health in Bethesda, Md.
But researchers, who questioned teens for the study, say they found no evidence of that trend.
“I was surprised that the rates were as low as they were. I thought the frequency of medication use was lower than we would have expected,” Merikangas says.
She points out that not treating mental health problems in teens can often lead to serious problems. They include failing grades, disruptive or criminal behavior, substance abuse, and suicide.
“As a society, we need to think about access to care before all of these bad outcomes occur,” Merikangas says.
Psychiatric Medications in Teens
Previous studies have relied on insurance claims to estimate rates of medication use in children and teens. Those studies have found sharp rises with psychiatrists prescribing to kids, especially poor children.
One 2006 study found that prescriptions of psychotropic drugs written to teens had shot up 250% between 1994 and 2001. It’s not always clear from claims data why the drugs are prescribed or even if they’re taken.
The new study, published in the Archives of Pediatric and Adolescent Medicine, took a different approach.
Researchers surveyed more than 10,000 teens in the U.S. who were between the ages of 13 and 18. The teens were carefully selected to reflect the makeup of the general population.
Researchers interviewed the teens at home and asked about any symptoms of mental problems in the past year that had been severe enough to affect their day-to-day functioning. When they reported taking medications, researchers had them produce the pill bottle so they could write down the drug name.
About half the teens in the study met the criteria for a mental disorder, and 22% were classified as being severely affected by their problems.
Despite that, only 14.1% of kids had taken any kind of psychotropic drug. The highest rates of medication use were in kids who met the criteria for attention deficit hyperactivity disorder (ADHD). Nearly 1 in 3 kids with ADHD reported taking a psychotropic medication. About 1 in 5 had been prescribed stimulants to help manage their condition.
In contrast, teens who were anxious, depressed, or bipolar were less likely to be prescribed a drug that could help. About 11% of teens diagnosed with an anxiety disorder were prescribed medications. About 20% of kids with depression or bipolar disorder were taking a mood-altering medication.
The study also found that the majority of kids who had been prescribed a psychotropic drug had a mental disorder severe enough to disrupt their day-to-day lives.
Many Kids Need Better Mental Health Care
“Not only were they not overprescribed, one could say that this group was inadequately treated,” says Victor Fornari, MD, director of the division of child and adolescent psychiatry at North Shore-LIJ Health System in New Hyde Park, N.Y.
Fornari, who wasn’t involved in the research, praised the study for its careful methods. He says it reflects attitudes he often sees in his own practice.
“There’s enormous resistance. Many families, maybe 50%, refuse treatment, even when they are told their child has a psychiatric disorder,” Fornari tells WebMD.
Health coverage may be another factor behind the lower-than-expected rates of medication use seen in teens.
In an editorial on the study, David Rubin, MD, a pediatrician at the Children’s Hospital of Philadelphia, points out that many middle-class families simply can’t afford mental health care. These teens are often covered on their parents’ private insurance plans, which rarely cover mental health visits.
“The take-home message is that as a country it should bother us that many children do not have access to the appropriate services they need, and that rates of medication use (whether high or low) are really a symptom of a mental health system that does not meet the standard of what any parent — whether rich or poor — would hope for their children if they were in crisis,” Rubin says.
By Kaitlin Bell Barnett
I’ve argued before that declaring American kids and teens to be “overmedicated” is something of a cop-out.
How can people say what constitutes overmedication when they can’t – or won’t – specify what would constitute an acceptable number or percentage of kids taking psychiatric meds?
Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems.
A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all – key measurements of youth medication use.
Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.
Among Kids With Diagnosable Disorders, Low Rates of Recent Medication Use
The study, which was published online in the Archives of Pediatrics and Adolescent Medicine, surveyed a large, nationally representative sample of more than 10,000 teens ages 13 to 18.
It found that about 14 percent of kids with DSM-IV psychiatric diagnoses had been treated with medication in the past year.
The percentage ranged widely, however, depending on the condition. Thirty-one percent of teens with diagnosable ADHD reported having taken medication for that condition in the past 12 months, compared to just 11 percent of those with anxiety disorders.
Researchers Find ‘No Compelling Evidence’ For Overmedication
The research team – which includes several major figures in this field – considered these percentages to be reasonable, especially considering the amount of distress and dysfunction involved in the kids they surveyed. “There was no compelling evidence for either misuse or overuse of psychotropic medications,” they wrote.
“The majority who had been prescribed medications, particularly those who received treatment in specialty mental health settings,” they added, “had a mental disorder with severe consequences… functional impairment, suicidality, or associated behavioral and developmental difficulties.”
The study also found that most kids were taking a medication commonly prescribed for their diagnosis, such as antidepressants for depression, or stimulants for ADHD.
Antipsychotic use, which has been growing dramatically in recent years and is the subject of much debate about alleged overprescribing, was very low overall, ranging from 0.1 percent of those with anxiety as their primary diagnosis to 2 percent of those with developmental disorders as their primary problem.
Moreover, just 2.5 percent of kids who didn’t qualify for a psychiatric diagnosis reported having taken meds in the past year.
But even this small percentage of kids who didn’t meet the formal criteria sufficient for a diagnosis at the time they were surveyed weren’t necessarily inappropriately mediated: 78 percent reported having a prior mental or developmental disorder (like autism) that caused distress or impairment.
What’s Missing From The Study
It’s important to note that this study collected data between 2001 and 2004, so it’s possible medication use in teens – or at least the use of certain medications, like antipsychotics – has expanded since then.
And an important measurement was missing from the article that would provide key context about under- or over-treatment. Although researchers queried teens and families about where they received mental health services (in school, from a general practitioner, a mental health specialist, etc.), the text of the article didn’t indicate what percentage of the medicated kids were also receiving other services, such as psychotherapy. It also didn’t indicate what percentage of the unmedicated kids were receiving other services.
That’s crucial, because medication isn’t the only treatment out there. Other therapies have been shown to be effective, and a number of studies have found combined therapy and medication to be superior to either treatment alone.
Therefore, the issue isn’t so much what percentage of kids are taking medications – or even what percentage of kids with a bona fide diagnosis are taking them, the focus of this study.
Rather, the more salient questions are whether kids with troubling emotional and behavioral problems have appropriate and sufficient access to treatment, and whether they and their families consider that treatment – and those who administer it – adequate and effective.
An editorial accompanying the article made that point convincingly.
The editorial also pointed out that this study included a relatively high percentage of well-off kids with private insurance, which might account for the low rates of medication use. Previous studies have shown that kids with public insurance, especially foster children, are far more likely to be medicated at higher rates.
So What Do We Still Need To Know?
Although this study provides valuable information showing that relatively few teens take medication for their psychiatric disorders, we need a study that examines how common psychiatric diagnoses, medication use and other treatment modalities are in youngsters from diverse backgrounds.
And that same study should also measure kids and families’ opinions about access to and effectiveness of different kinds of treatment, as well as their level of satisfaction with the medical and with mental health professionals who administer it.
By Katherine Lee Hypoactive sexual desire disorder is the most common form of female sexual dysfunction. It’s defined as a chronic lack of interest in sexual activity that causes a woman distress — if a woman doesn’t view the lack of sexual interest as a problem, then it isn’t one.
Many physiological factors can dampen the libido’s fire. Menopause or a chronic medical condition can lead to physical changes that can affect a woman’s sex drive or lead to discomfort or decreased pleasure during sex.
And so can some drugs.
Drugs (and an Herb) That Affect Libido
Certain medications can interfere with the balance of hormones and transmission of chemical messengers in the brain, causing problems with libido and a woman’s ability to achieve orgasm. A few common medications can cause hypoactive sexual desire disorder. These include:
Antidepressants. Medications used to treat depression and anxiety symptoms are the most common drugs that can lead to hypoactive sexual desire disorder and other types of sexual dysfunction.
As an example, some commonly used antidepressants that can decrease sexual desire include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). These drugs are SSRIs (selective serotonin reuptake inhibitors), which means they work by making the “feel-good” hormone serotonin more available in the brain, thus improving mood. The problem: “Serotonin has a positive effect on mood but can have a negative effect on libido and orgasm,” says Jennifer Berman, MD, a urologist, a specialist in female sexual medicine, and the director of Berman Women’s Wellness Center in Los Angeles.
Birth control pills. As many as 30 percent to 40 percent of women who take birth control pills, such as Loestrin, can experience hypoactive sexual desire disorder, says Dr. Berman. “Birth control pills lower testosterone, which can lower libido,” says Berman.
Antihypertensives. Some medications commonly prescribed for high blood pressure like diuretics (such as furosemide or Lasix) and beta blockers (such as metoprolol) can lead to hypoactive sexual desire disorder. These drugs can dampen libido and cause difficulty reaching orgasm.
Chemotherapy, anti-cancer drugs. Drugs used to treat cancer are also associated with a reduced lack of sexual interest and hypoactive sexual desire disorder. For example, tamoxifen, a breast cancer drug, can lower estrogen levels, which can lower libido, says Berman. Cyclophosphamide, a chemotherapy drug, can cause vaginal dryness, reduced libido, and difficulty reaching orgasm.
Acne medications. Spironolactone is a drug that is usually prescribed to treat acne. It is also a diuretic that can be used to treat blood pressure or heart failure. It can have a negative effect on libido and lead to hypoactive sexual desire disorder.
Saw palmetto. This herbal remedy may lower testosterone and can play a role in hypoactive sexual desire disorder.
Women and Sexual Dysfunction: Replacing Medications
Women who experience hypoactive sexual desire disorder due to medications can try switching medications or finding alternative treatments. If the problem stems from oral contraceptives, the woman can consider switching to other forms of birth control such as an intrauterine device, says Berman.
If antidepressants are the cause, you may want to discuss with your doctor the possibility of reducing your dose or even consider looking for other causes of your mood disorder. (One often-overlooked cause of depression is hormonal imbalance, says Berman.) You can also consider switching to a more dopamine-driven drug, which is less likely to cause hypoactive sexual desire disorder.
As an alternative to hypertensive drugs that may cause hypoactive sexual desire disorder, you may want to consider calcium channel blockers or ACE inhibitors. “These drugs are less likely to have a negative impact on libido,” says Berman.
If you have hypoactive sexual desire disorder, discuss your options with your doctor. If medications are causing your hypoactive sexual desire disorder, you have options that can help you achieve a more satisfactory sex life.
Learn more in the Everyday Health Sexual Health Center.
Pharmacologist Michael Klein, Ph.D., is director of the Food and Drug Administration (FDA) Controlled Substance Staff.
During more than 30 years of federal service, he has amassed extensive experience with issues related to drug regulation, abuse, misuse, and addiction. Prior to joining FDA 20 years ago, Dr. Klein worked as a senior scientist with the Drug Enforcement Administration (DEA).
Q: What is misuse and abuse of prescription drugs?
A: When a person takes a legal prescription medication for a purpose other than the reason it was prescribed, or when that person takes a drug not prescribed to him or her, that is misuse of a drug. Misuse can include taking a drug in a manner or at a dose that was not recommended by a health care professional. This can happen when the person hopes to get a bigger or faster therapeutic response from medications such as sleeping or weight loss pills. It can also happen when the person wants to “get high,” which is an example of prescription drug abuse.
Q: What’s the difference between misuse and abuse?
A: It mostly has to do with the individual’s intentions or motivations. For example, let’s say that a person knows that he will get a pleasant or euphoric feeling by taking the drug, especially at higher doses than prescribed. That is an example of drug abuse because the person is specifically looking for that euphoric response.
In contrast, if a person isn’t able to fall asleep after taking a single sleeping pill, they may take another pill an hour later, thinking, “That will do the job.” Or a person may offer his headache medication to a friend who is in pain. Those are examples of drug misuse because, even though these people did not follow medical instructions, they were not looking to “get high” from the drugs. They were treating themselves, but not according to the directions of their health care providers.
However, no matter the intention of the person, both misuse and abuse of prescription drugs can be harmful and even life-threatening to the individual. This is because taking a drug other than the way it is prescribed can lead to dangerous outcomes that the person may not anticipate.
Q: What are the dangers linked to misuse and abuse of prescription drugs?
A: It’s important to note that all drugs can produce adverse events (side effects), but the risks associated with prescription drugs are managed by a health care professional. Thus, the benefits outweigh the risks when the drug is taken as directed.
However, when a person misuses or abuses a prescription drug, there is no medical oversight of the risks. A person can die from respiratory depression from misusing or abusing prescription painkillers; for example, opioids. Prescription sedatives like benzodiazepines can cause withdrawal seizures. Prescription stimulants such as medications for attention deficit hyperactivity disorder (ADHD) can lead to dangerous increases in blood pressure. The risks from these drugs are worse when they are combined with other drugs, or alcohol.
Additionally, when a person misuses a prescription drug, even on a single occasion, that individual might enjoy the experience so much that they begin to seek out the drug more often. Thus, drug abuse and drug dependence are serious risks of misusing prescription drugs.
Q: Why do people misuse and abuse prescription drugs?
A: Prescription drugs are often readily accessible in the home, so it’s easy to take more of them than recommended for a therapeutic reason, or to sneak a few from someone else’s bottle to see if you can “get high.”
One feature of prescription drug abuse is when a person continues to take the drug after it’s no longer needed, medically. This is usually because the drug produces euphoric responses. Prescription drugs are often preferred for abuse because of the mistaken belief that the drugs provide a “safe high.” But as I mentioned before, all drugs carry risks, and if these risks are not being managed by a health care professional, people can get into serious trouble.
Q: How big is this problem?
A: The prevalence of misuse and abuse of prescription medications is concerning. The Substance Abuse and Mental Health Services Administration (SAMHSA), a federal health agency, reports that in 2008, 52 million persons in the United States age 12 or older had used prescription drugs nonmedically at least once in their lifetime, and 6.2 million had used them in the past month. SAMHSA also reported that between 1998 and 2008, there was a 400 percent increase in substance abuse treatment admissions for opioid prescription pain relievers.
A recent Centers for Disease Control and Prevention (CDC) survey found that one in five high school students had taken a prescription drug without a doctor’s prescription. According to SAMHSA, the majority of these teenagers are obtaining the drugs from friends or relatives for free. Most concerning, the perception of risk of prescription drug abuse declined 20 percent from 1992 to 2008, based on data from a National Institute on Drug Abuse survey.
Q: What prescription drugs are being misused and abused?
A: SAMHSA reports that in 2008, nonmedical use of psychotherapeutic prescription drugs fell into four major classes: pain relievers, tranquilizers, stimulants, and sedatives.
Nearly 35 million Americans reported that they had nonmedical use of prescription pain relievers—including opioid-containing drugs such as hydrocodone (Vicodin), oxycodone (OxyContin, Percodan, Percocet), and fentanyl (Duragesic)—at least once during their lifetime.
Approximately 21.5 million Americans have used prescription tranquilizers for nonmedical purposes at least once. These include drugs prescribed for anxiety or insomnia, such as benzodiazepines—including diazepam (Valium), alprazolam (Xanax) and clonazepam (Klonapin)—and non-benzodiazepines such as zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta).
Similarly, about 21.2 million Americans have used prescription stimulants nonmedically at least once. These include drugs prescribed for ADHD such as amphetamine (Adderall), methylphenidate (Ritalin, Concerta, and Daytrana), and methamphetamine. Notably, almost 13 million people reported they had used prescription methamphetamine at least once during their lifetime.
Finally, nearly 9 million Americans have used prescription sedatives nonmedically at least once. These sedatives include barbiturates such as amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal).
Q: Who is misusing and abusing these medications?
A: Prescription drugs are being misused and abused by a wide variety of people. According to SAMHSA, about 26 million Americans between the ages of 26 and 50 report they have used prescription drugs non-medically at some point in their life. Other age groups have lower lifetime incidents: 13 million who are age 50 or older, 9 million who are age 18 to 25, and 3 million who are 12 to 17 years of age.
There also appears to be regional differences across the U.S. For example, SAMHSA reports that the highest past-year rates of nonmedical use of prescription pain relievers occur in Arkansas, Kentucky, Nevada, Oklahoma, Oregon, Tennessee, and Wisconsin.
Q. Should a person’s health care professional tell them about the risks associated with a medication with abuse potential?
A: Yes. The health care professional should talk to a patient about all of the warnings and precautions listed in the drug label for the medication being prescribed. In addition, if a medication guide is available, it will explain the risks of the drug in plain language. The pharmacy will provide the medication guide when a person picks up the prescription.
FDA also recommends that patients be vigilant when it comes to matters of their health. Reading information and asking questions are good practices, though they are only the first steps. For instance, individuals may not realize they are developing a drug abuse problem with a prescription drug, especially if they were initially using the drug as directed when they were patients.
Health care professionals should encourage patients to be aware of early signs of drug abuse, which can include using the prescription more frequently or at higher doses, but without medical direction to do so. Using the drug compulsively or not being able to carry out normal daily activities because of drug misuse are also signs of abuse.
Finally, health care professionals and pharmacists have a responsibility to remind patients not to share their medications with friends or family. Not only is this a dangerous practice health-wise, it is also illegal.
Q: How does FDA help prevent misuse and abuse of prescription medicines?
A: FDA works hard to meet the challenges of preventing misuse and abuse of prescription drugs, while making sure that medically appropriate drugs are available for the patients who need them.
The primary way FDA works to prevent misuse and abuse is through educating patients, caregivers, and health care professionals. This often occurs through the information FDA provides to each of these groups, such as in drug labels, medication guides, and alerts.
But long before a patient can obtain a prescription, FDA has already evaluated whether the drug is safe and effective for a particular medical condition. FDA only approves those drug applications that have been shown to be safe and effective for a specific indication, and the data from this review is then used to create informational materials.
FDA is also part of the wider national strategy involving other government agencies, the pharmaceutical industry, medical organizations, and community groups, among other entities. This combined effort addresses improved treatment, prevention, enforcement, and emerging drugs of abuse.
Q: How is a prescription medication classified as having potential for abuse?
A: During FDA’s drug review process, certain data can give indications that a drug has abuse potential. The chemical structure may be similar to a known drug of abuse. When the drug is given to animals, it may produce behaviors that are like those produced by abusable drugs. In humans, the drug may produce a high rate of euphoria.
FDA considers these and all abuse-related data to make a determination regarding abuse potential, which is a part of the safety evaluation of a drug. If a drug is deemed to have abuse potential, DEA is informed and they may add the drug to the list of substances covered by the Controlled Substances Act (CSA).
In addition, FDA can become aware that a drug has abuse potential through other means. For example, there may be epidemiological reports of abuse that only became evident after the drug was marketed. Also, DEA informs us that there is an increase in law enforcement actions related to a specific drug. In both cases, FDA reviews all available data and makes a scientific and medical assessment of whether the drug has abuse potential. If it does, DEA is informed and may schedule the drug under the CSA.
Q: What are the keys to preventing abuse of prescription medicines?
A: Be informed about the effects of prescription drugs and be vigilant. Know what medications your loved ones are taking and watch for signs of changes in behavior. For instance, have you noticed negative changes in your child’s behavior or grades? Is your spouse evasive about how much medication he or she is taking? Do you have friends that you suspect might be pilfering prescription drugs from your medicine cabinet?
SAMHSA has a great website on signs of prescription drug abuse.
If you are taking medications that have abuse potential, use the drugs only as directed. Don’t share them, and store them in a safe, secure place. Count the pills regularly to make sure no one else is using them. If you are having a house party or an open house, make sure the medications are properly secured.
Finally, all drugs should be disposed of properly after they are no longer needed. If no specific disposal directions are given with the medication, discard the drugs by mixing with undesirable substances, sealing them in a container, and placing them in the trash. You can also call your local DEA office for advice on alternative disposal methods.
Q: What can I do if I find that someone I know is abusing prescription drugs, or if I find myself becoming dependent on them?
A: SAMHSA has a website (www.samhsa.gov) and a telephone hotline (800–662–HELP ) to aid in finding treatment facilities in different areas of the country. I recommend contacting them and a health care professional, as no single type of treatment is appropriate for everyone who is abusing prescription drugs.
Medications used to treat mental disorders continue to enjoy the best sales they’ve had ever. Meanwhile, psychotherapy usage continues to decline.
We started tracking the top 25 psychiatric medications prescribed in the U.S. back in 2005, with the help of IMS Health and their innovative Xponent service, which tracks the vast majority of prescriptions dispensed in the U.S.
The top 5 are below, while the rest of the list follows.
Xanax (alprazolam) – 47,792,000
Celexa (citalopram) – 37,728,000
Zoloft (sertraline) – 37,208,000
Ativan (lorazepam) – 27,172,000
Prozac (fluoxetine HCL) – 24,507,000
To put the percent changes below into perspective, the U.S. total population rose approximately 1.6 percent from 2009 to 2011. That suggests that anything above 1.6 percent change was driven by other factors — more people seeking treatment, more pharmaceutical advertising and marketing, or some other factor.
The biggest movers and shakers on the list were Celexa — moving up 15 spots to grab the second most-prescribed psychiatric drug in 2011 — and Wellbutrin XL, moving from 22 to 13.
Drugs used to treat attention deficit hyperactivity disorder (ADHD) — generic amphetamine salts and methylphenidate — enjoyed big gains as well. The rise of generics is not surprising, since once a medication goes off-patent, it becomes cheaper to purchase. Cheaper meds makes them available to more people who can now afford them.
Check out the Top 25 Psychiatric Medication Prescriptions for 2011 now.
By Traci PedersenAssociate News Editor
A fear of the dark may trigger some insomnia, according to researchers at Ryerson University. The findings will be presented at Sleep 2012, the annual meeting of the Associated Professional Sleep Societies, in Boston.
In the small study of 93 college-aged men and women, researchers found that more poor sleepers than good sleepers confessed a fear of the dark. “I think the most surprising part of the study is that people told us,” says researcher Colleen Carney, Ph.D., associate professor of psychology at Ryerson University, Toronto. Fear of the dark was confirmed through sleep lab experiments.
Carney and her research team decided to pursue the fear of the dark notion after she heard many people with insomnia, over the years, talk about sleeping with a light or TV on. All participants (average age 22) completed questionnaires regarding their sleep habits. One particular questionnaire is called the Insomnia Severity Index that helps classify people as good or poor sleepers. Participants were then assigned into either the poor-sleeper group or the good-sleeper group—there were 42 poor sleepers and 51 good sleepers.
Interestingly, of the 42 poor sleepers, almost half said they were afraid of the dark. Of the 51 good sleepers, only about one-quarter were afraid of the dark. In the sleep lab, Carney tried to confirm the fear of the dark. Four different times, she exposed both the good and poor sleepers to a burst of white noise. “If you are nervous, you are going to flinch,” said Carney.
Researchers observed participants’ responses, such as blinking speed and other reactions to measure the level of fear. They were measured twice in a simulated bedroom setting that was lit and twice in the same setting while dark. “We measured the blinks, the size, and how fast,” Carney said. ”The poor sleepers tended to blink fast in the dark in response to the unexpected noise.”
The poor sleepers had greater ”startle” responses only in the dark, she found, while the good sleepers tended to get used to the burst of white noise. “That’s what you do when you aren’t afraid,” she said. “The poor sleepers actually became more afraid.”
Carney believes that, for the poor sleepers, a fear of the dark may contribute to increased arousal once the lights are turned off. To lessen insomnia, Carney says those who have a fear of the dark should work directly on the fear, or phobia.
Adolescents who receive prozac for the treatment of major depression are significantly less likely to abuse drugs in the future, say researchers. However, the medication did not reduce the chances of alcohol abuse. The 5-year study, conducted by John Curry, a professor of psychology and neuroscience at Duke University, involved nearly 200 adolescents at 11 sites across the United States.
The researchers found that of the 192 teenagers whose depression receded after 12 weeks of treatment, only 10% abused drugs later on vs. 25% of adolescents who didn’t respond to treatment. Curry explained: “It turned out that whatever they responded to – cognitive behavioral therapy, Prozac, both treatments, or a placebo – if they did respond within 12 weeks they were less likely to develop a drug-use disorder.” The team followed nearly half of the 439 participants from the “Treatment for Adolescents with Depression Study” (TADS). The study was conducted from 2000 to 2003 and was led by Dr. John March, chief of Child and Adolescent Psychiatry at Duke University Medical Center.
At the end of Curry’s 5-year follow up, participants were aged 17 to 23 and had no previous problems with drug or alcohol abuse. In the “Onset of Alcohol or Substance Use Disorders Following Treatment for Adolescent Depression” (2004-2005), researchers found that 76% of study participants used marijuana. Other drugs included opiates, hallucinogens, and cocaine.
Before study participants received treatment, they must have had at least 5 symptoms for a length of time in order to be diagnosed with major depression. Symptoms included:
Loss of interest
Disruptions in appetite
Loss of sleep or energy
Suicidal thought of behavior
According to the researchers, medications or skills learned in cognitive-behavior therapy, in addition to education and support that all participants received, may have played vital roles in keeping the adolescents away from drugs. However, the team found no differences in alcohol abuse. Curry believes that this may partially be due to the prevalence of alcohol use among individuals aged 17 to 23.
Curry explained: “It does point out that alcohol use disorders are very prevalent during that particular age period and there’s a need for a lot of prevention and education for college students to avoid getting into heavy drinking and then the beginnings of an alcohol disorder. I think that is definitely a take-home message.” The team also found that participants who consumed alcohol were more likely to have repeat bouts with depression.
Curry said: “When the teenagers got over the depression, about half of them stayed well for the whole five-year period, but almost half of them had a second episode of depression. And what we found out was that, for those who had both alcohol disorder and another depression, the alcohol disorder almost always came first.”
According to Curry and co-author Susan Silva, associate professor and statistician in the Duke School of Nursing, further studies are required as the number of individuals who developed drug or alcohol disorders was fairly small. Furthermore, the team were unable to determine whether the rates of subsequent drug or alcohol abuse were higher among teenagers who didn’t receive treatment for depression as this study had no comparison group of non-depressed patients.
By Traci PedersenAssociate News Editor
A certain marijuana compound known as cannabidiol (CBD) can treat schizophrenia as well as antipsychotic drugs, with far fewer side effects, according to a preliminary clinical trial.
The research team, led by Markus Leweke of the University of Cologne in Germany, studied 39 people with schizophrenia who were hospitalized for a psychotic episode. Nineteen patients were treated with amisulpride, an antipsychotic medication that is not approved in the U.S., but is similar to other approved drugs. The remaining 20 patients were given CBD, a substance found in marijuana that is considered responsible for the mellowing or anxiety-reducing effects. Unlike the main ingredient in marijuana, THC, which can trigger psychotic episodes and worsen schizophrenia, CBD has antipsychotic effects, according to prior research in both animals and humans.
Neither the patients nor the scientists knew who was receiving which drug. At the end of the four-week trial, both groups made significant clinical improvements in their schizophrenic symptoms, and there was no difference between those getting CBD or amisulpride. “The results were amazing,” said Daniel Piomelli, Ph.D., professor of pharmacology at the University of California-Irvine and a co-author of the study. “Not only was [CBD] as effective as standard antipsychotics, but it was also essentially free of the typical side effects seen with antipsychotic drugs.”
Antipsychotic drugs may cause devastating and sometimes permanent movement disorders; they can also lower a patient’s motivation and pleasure. The new generation of these drugs can also lead to weight gain and increase the risk for diabetes. These side effects are well known as a major hindrance during treatment. In the German study, weight gain and movement problems were observed in patients taking amisulpride, but not CBD.
“These exciting findings should stimulate a great deal of research,” said Dr. John Krystal, chair of psychiatry at Yale University School of Medicine, who was not associated with the research. He notes that CBD not only had fewer side effects, but also seemed to work better on schizophrenia’s so-called “negative symptoms,” which are notoriously hard to treat. Negative symptoms of schizophrenia include social withdrawal, a lowered sense of pleasure and a lack of motivation. However, since current antipsychotic medications can actually cause these negative symptoms, it wasn’t clear whether CBD was better than amisulpride at getting rid of these symptoms, or whether CBD simply caused fewer side effects to begin with.
If replicated, the results suggest that CBD may be at least as effective as current medications for the treatment of schizophrenia, without the severe side effects that make patients reluctant to take medication.
“The real problem with CBD is that it’s hard to develop for a variety of silly reasons,” said Piomelli. Since it comes from marijuana, there are obvious political issues surrounding its use. Extracting it from the plant is also expensive.
But the biggest obstacle may be that CBD is a natural compound, and therefore can’t be patented the way new drugs are. So although CBD could outsell the current blockbuster antipsychotic drugs, pharmaceutical companies aren’t likely to develop it. Researchers are working to develop synthetic versions of CBD that would avoid such hurdles. “We have one and are hoping to move forward in the near future,” Piomelli said.
The study is published online in the journal Translational Psychiatry.
By Madeline Vann, MPH If you’re depressed, antidepressants can help you minimize those feelings of sadness and hopelessness — but will the drugs also undermine your ability to feel joy?
Emotional blunting — an overall unfeeling or numbness — is a common complaint of depression patients prescribed to certain antidepressants. This diminished capacity to have feel-good emotions during positive moments can be a significant side effect for some people taking selective serotonin reuptake inhibitors, or SSRIs.
And when research supporting the idea was first discussed at a national conference in 2002, mental health professionals nodded in agreement over the existence of this unwanted side effect, recalls psychiatrist Heidi Combs, MD, an assistant professor of psychiatry at the University of Washington in Seattle.
However, emotional blunting is largely based on what doctors hear from their patients, as opposed to results from clinical research. So what can be done about it?
Who Experiences Emotional Blunting?
SSRIs are a class of antidepressants that affect the way the brain uses the neurotransmitter serotonin. Their effect is intended to relieve the symptoms of depression — and they’re often successful in doing so. Unfortunately, explains Dr. Combs, the drugs also act on the reward pathways in the brain — the pathways that bring us pleasure. For some people, this means that they experience emotional blunting, or the sensation that all their emotional responses are dulled.
“If something positive is going on, these patients might not have the full response,” Combs says. Though there are many case studies, the lack of large clinical studies makes it difficult to predict which people will experience this side effect — and which ones won’t.
Part of the problem is the very nature of depression. People struggling with depression often complain that they have lost some of their ability to respond emotionally to events and people around them. So for a long time, emotional blunting caused by antidepressants was written off a as symptom of hard-to-treat depression.
However, says Combs, it’s fairly easy now for physicians to tease apart the symptoms of depression itself and this antidepressant side effect. If the depression symptoms have improved, but emotional blunting persists, it’s likely due to the antidepressant. If, on the other hand, the emotional blunting continues alongside unrelieved sadness, weepiness, and other depression symptoms, then it’s more apt to be part of the original disorder, she explains.
Get Your Glee Back: What to Do About Emotional Blunting
To regain your pleasure response, Combs recommends these solutions:
Switch antidepressants. It may be a good idea to move to another class of antidepressants entirely because someone who responds to one SSRI drug with emotional blunting may respond the same way to another one. Add a second medication. If switching to another class of drugs just leaves you with more troublesome symptoms (which can happen if you’re dealing with anxiety), ask your doctor about adding just a small amount of another antidepressant to free the reward pathways. Talk it out. If you’re feeling an overall loss of emotional response, working through the problems that are causing stress and depression in the first place (including solving practical problems like those related to housing or income) may help.If you find that your depression medication is edging out all your emotions, talk to your doctor. This is a real effect, emphasizes Combs, but the good news is that it has real solutions.
By Rick Nauert PhDSenior News Editor
A provocative new study suggests women who take antidepressants during pregnancy are at higher risk of giving birth prematurely, but that depression itself does not increase that risk. The latter finding contradicts some earlier research.
The results, reported by Yale researchers in the online journal Epidemiology, are good news for women who worry that their depression will harm their baby.
Researchers also stress that women who take antidepressants during pregnancy should not be overly alarmed.
“Women did not ask to be depressed and yet they worry that their depression may affect their baby,” said Dr. Kimberly Yonkers, professor of psychiatry and of obstetrics, gynecology, and reproductive sciences.
“This study tells them they should not worry that they are somehow compromising their pregnancy because they are depressed. And when considering whether to take medication for depression, women should understand that the risk of preterm birth is only one of many factors they should weigh.”
The study found that taking serotonin reuptake inhibitors (SRIs) during pregnancy significantly increased risk of what is called a late preterm birth.
Late preterm birth is defined as at least 34 weeks after gestation but before 37 weeks. Antidepressant use is not associated with early preterm birth, which is much more dangerous to the baby.
Findings from the Yale study contrast with several previous studies that suggested depression itself might lead to premature birth.
In the new research, the Yale team studied almost 3,000 pregnant women, including those who were diagnosed as depressed during their pregnancy. After controlling for numerous variables such as health history, age, drug use, and socioeconomic status, they found no association between depression and premature birth.
They did find a significant risk of preterm birth among women who were taking antidepressants. So should depressed women not take antidepressants?
“A woman should always consult with her doctor, but if she is symptomatic and suffering, the use of antidepressants may be indicated,” Yonkers said.
By Diana Rodriguez ADHD is a behavioral disorder affecting millions of children and adults. However, ADHD can be successfully managed with a combination of therapy and ADHD drugs. There are several types of ADHD drugs that are useful, and several medications within each type. There are standards of treatment that often provide the greatest success, but they don’t work for everyone.
ADHD Drugs: Medication Classes Prescribed
The types of ADHD drugs used most often are stimulants, non-stimulant drugs including antidepressants, and high blood pressure medications. The first line of treatment and the most commonly prescribed ADHD drugs are typically the stimulants, because they often work the best.
F. Allen Walker, MD, a psychiatrist who has ADHD and who runs his own practice specializing in ADHD in Louisville, Ky., feels the stimulant class of ADHD drugs is superior to other classes in treating ADHD. “When treating patients, if you combine therapy and education with medication and you take the time to individualize the medication and dosage, that is the most effective way to treat ADHD,” says Dr. Walker. Stimulants primarily focus on increasing the neurotransmitter dopamine in the brain, particularly in the prefrontal cortex. “The theory is people with ADHD have a brain that’s a little bit thirsty for dopamine,” says Walker, and increasing dopamine levels allows an ADHD brain to function better.
Non-stimulant drugs can also be used to treat ADHD. Non-stimulant medications such as various antidepressants affect not only dopamine, but also other neurotransmitters such as norepinephrine and serotonin. Antidepressants are sometimes used in patients who are not able to tolerate stimulant medications. High blood pressure medications can help manage associated ADHD symptoms like irritability, impulsivity, restlessness, and tics, though they aren’t very successful in managing inattention.
The Most Common ADHD Drugs
Here is a list of the most commonly prescribed ADHD drugs and information about each one:
Ritalin, Mehylin, Metadate, Concerta, Daytrana (methylphenidate). This stimulant can effectively manage all of the primary symptoms of ADHD — impulsivity, hyperactivity, and inattention. Studies show that methylphenidate offers the most significant and quick reduction of ADHD symptoms and doesn’t increase tics. Potential side effects include depression, dizziness, headaches, appetite loss, insomnia, and nausea. Studies have shown that Ritalin might have a negative impact on the healthy development of the brain in children and teenagers. Concerta is an extended-release form of methylphenidate. Daytrana contains the same medication in a patch that is applied to the skin daily.
Adderall (dextroamphetamine and amphetamine). This stimulant can effectively manage all of the primary symptoms of ADHD, with all the potential side effects of Ritalin. Studies have shown a rare side effect of heart attacks, which can be fatal, particularly if mixed with alcohol use.
Dexedrine (dextroamphetamine). This stimulant can effectively manage all of the primary symptoms of ADHD, with all the potential side effects of other stimulants. Studies show some evidence that dextroamphetamine may increase tics after long periods of time when given in greater-than-normal doses and should not be administered at such levels.
Vyvanse (lisdexamfetamine dimesylate).This stimulant is known as a prodrug, meaning it is inactive until metabolized in the body. Vyvanse may prevent the potential for drug abuse that has been reported with Adderall.
Focalin (dexmethylphenidate). This stimulant comes in a capsule, which can be opened and sprinkled on foods for those who have trouble swallowing pills. Though it is known to have fewer side effects than Ritalin, this medicine may stop working earlier than needed in some individuals.
Strattera (atomoxetine). This non-stimulant drug offers the benefit of 24-hour effects, which is longer than stimulants. It can also help battle depression and is a good choice for people dealing with ADHD and depression or anxiety, but it’s not as effective against symptoms of hyperactivity as stimulant drugs. Side effects can include fatigue, irritability, stomachache, headache, nausea, and vomiting. Studies show that atomoxetine is as effective as stimulants with some additional benefits and at a lower cost than some other drugs. Atomoxetine also doesn’t have the risk of abuse and dependence that stimulant drugs do. However, it’s been found to potentially increase the risk of suicide.
Aplezin, Wellbutrin, Zyban (buproprion). This antidepressant affects the chemicals dopamine and norepinephrine in the brain and can be a very effective treatment in people who have both ADHD and depression. Buproprion can effectively manage symptoms of hyperactivity and inattention in people who don’t find relief from stimulants or who can’t tolerate their side effects. However, antidepressants have not been found to be effective at managing impulsivity. Side effects can include blurry vision, drowsiness, dryness of the mouth, and constipation. Studies have shown that some antidepressants can increase the risk of suicide. Antidepressants are not approved by the U.S. Food and Drug Administration (FDA) for the treatment of ADHD.
Intuniv, Tenex (guanfacine). Intuniv, a long-acting form of the blood pressure medication Tenex, was approved for the treatment of ADHD by the FDA in September 2009. This once-a-day treatment for kids ages 6 to 17 is a non-stimulant medication thought to engage receptors in the area of the brain linked to ADHD. In 2011, the FDA said that Intuniv could be used along with a stimulant to help children who are not responding well to a stimulant alone. Guanfacine can strengthen memory, reduce distraction, and improve attention and impulse control. Side effects can include tiredness, abdominal pain, dizziness, a drop in blood pressure, dry mouth, and constipation.
Catapres (clonidine). This high blood pressure medication can manage ADHD symptoms of aggressive behavior, impulsions, hyperactivity, and tics, but it’s not very effective against inattention. Side effects can include drowsiness, dryness of the mouth, blurry vision, heart problems, and constipation. Studies have shown that this high blood pressure medication is becoming more popular and is a safe and successful treatment for ADHD in addition to or instead of stimulant medications, but it is not FDA-approved for this use.
With patience and a knowledgeable medical professional, you can find the right medication at the right dose to help manage ADHD symptoms.
Potential ADHD Treatment Side Effects By Marie Suszynski
Here are 10 side effects associated with stimulant ADHD meds and what you can do about them:
1. Anxiety. Your child may feel anxious for the first day or two after starting the stimulant, Allan says, but this is a side effect that should go away.
2. An upset stomach. Thankfully, an upset stomach that’s caused by the medication usually doesn’t last long, Allan says. Eating a high protein breakfast can help, but you may also want to talk to your child’s doctor about treating the stomach upset with another medication, she says.
3. Difficulty sleeping. Some kids will have a harder time sleeping when they first begin stimulants, though others are better able to organize and get themselves to bed on time. “I’ve seen instances of both of those things happening,” Allan says. If your child is having trouble sleeping, switching to a shorter-acting medication (one that wears off more quickly than a long-acting one) can help to get your child to sleep on time.
4. Daytime drowsiness. In addition to having trouble falling asleep, stimulants may also cause your child to spend more time in non-REM (rapid eye movement) sleep, which is a lighter stage of sleep. That can lead to drowsiness during the day.
5. Mood changes. Initially, you may notice your child being more irritable on the new medication, Allan says. This has been the biggest side effect for Kara Wiemert’s 16-year-old sister, who has been taking ADHD meds since she was about 7 years old.
“Before she pretty much had one mood of constantly happy and overly energetic,” Boston-based Wiemert says. “She now has mood swings to the extreme where she’s almost unbearable to be around.” Unfortunately, the mood swings haven’t gone away for her sister, but her family has learned to be more understanding. Wiemert also has noticed that her sister is less moody since she found other friends with ADHD who she can relate to.