antidepressants in children.
http://www.guardian.co.uk/society/2010/sep/18/children-depression-antidepressants
"
"We're getting clear evidence that the onset of depression is happening
earlier and earlier," says Marjorie Wallace
<http://en.wikipedia.org/wiki/Marjorie_Wallace_%28SANE%29>, chief
executive of the mental health
<http://www.guardian.co.uk/society/mental-health> charity Sane
<http://www.sane.org.uk/>. "In previous generations, people would be
overwhelmed by depression in their 20s. Now the peak age for onset is
13-15: the numbers of teenagers calling us for help suggest the rates of
depression in the under-14s have doubled in the last four years, and in
the 15-24 age group it has increased by one-third."
"
What her definition of clear evidence and what mine is may be totally
different. I'm not going to dismiss her point that children depression
may be happening earlier in the UK? The earlier post on what depression
actually means is important to answer the question, i.e. is it
biological depression happening earlier or is it something else,
something that society or culture is doing to children to make them
unhappy earlier? Or are doctors being forced to diagnose children? Or
are they overdiagnosing them?
Looking at prescription data or call volume by age band may show a
change in behaviour, for example more children being willing to contact
emotional support services or doctors being more ready to prescribe
antidepressants to children. Prescription dta would offer a very large
sample size compared to the call volumes the SANE helpline receives.
Elsewhere in the article it notes 113,000 prescriptions were given out
to under-16s. That's a lot. Prozac was only recently licensed. There's a
lot of off-label use of medication in children, i.e. use without or
against guidelines or clinical approval.
I'd guess the figures for 2008, 2009 and 2010 would show a steep and
inreasing trend.
I'm looking at the BNF for children. There is detail on 13 approved
antipsychotics, 2 formulations of lithium and 5 other antimania drugs, 8
antidepressants and 4 ADHD drugs. No listing of St John's Wort though....
Anyway, it then goes on to pharmcological treatments for obesity in
children. The treatment of obesity is one of those interesting things
about medicine. It no longer treats diseases. Obesity is not a disease
but it is a risk factor associated with other illnesses, just like
smoking. Doctors didn't believe it was a disease so wouldn't diagnose
it. Treatments were produced though including gastic bypasses and lipase
inhibitors toreduce the absorption of fat. Upon creation of a treatment
the idea of illness became more valid and doctors would be more likely
to diagnose it.
The same is true but through a different mechanism for parents. They can
become more likely to diagnose a mental illness through learning and
change in perception passed through the media and social networks. Few
parents worry about whether childhood depression is really an illness or
just an unwanted facet of the human experience (the removal of which
could be detrimental to the child). When they see a media report
describing something that's similar to how their child behaves many
parents may take their child to a doctor and tell them they think
they're ill. Teachers may also tell parents they think their child is
mentally ill when in fact they're bored or going through a horrible
childhood process that no one should go through but is part of their
personal and individual development.
So what I'm saying is potentially childhood depression isn't increasing
but the diagnosis by doctors, parents and teachers (and other people
involved in care) is increasing. This is the spreading and widening of
the definition of mental disorder that the chair of the DSM-IV task
force is campaigning against in America.
The biggest problem is people, in general, don't understand depression.
For example studies show that depression is often cyclical in a person's
life and the cycle has become quicker since the introduction of
antidepressant treatments.
Hmm....actually, the biggest problem is the use of medication when there
could be the option for preventative stuff like trying to keep a check
on a child's well being and equipping them to deal with emotional
suffering then offering therapeutic interventions when necessary. These
could take many forms, from mentoring or coaching to psychological
therapies or an adventure holiday at PGL. It could take meeting J K Rowling.
This takes a shift in thinking though. This takes the shift to call it
childhood misery instead of childhood depression. Demedicalising it
changes how it's treated. For a start it means doctors don't necessarily
have the answer - and there's pretty good evidence to support that
statement. It means drugs are not the first choice.
The change in thinking would also need to be associated with a large
increase in funding for childhood mental health and social care.
Medication is cheap and convenient, and it produces changes reliably.
I just don't believe in drugging children. There are other options.
My childhood was marred by many a bleak patch. Long, deep and intense
depressions. I survived it with a typical male epistomology of mental
health, and I shed many a tear alone. I know that abyss well. I learned
to survive on my own and without friendship. It's a mistake I keep
making to this day.
It's making me sad to think of the sadness in my childhood and this
ramble is hard to thinking about. I was trying to look at my childhood
experience and see what stuff worked for me, what made me happy and
brought me out of the inky black. I was thinking solutions could be
derieved from that sort of process: people reflecting on how they do
through bad shit when they were young so that young people today could
have that instead of be given drugs for their misery.
But it's made me feel quite sad and alone. So I'm going to stop writing
now and have a spliff.
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