Childhood Depression

Depression is often associated with adults, but children are also victims. New data has surfaced to refute claims that antidepressants increase the risk of suicide in teens. I, however, always recommend cognitive behavioral therapy as a starting point before medication.  If the case of depression is severe and/or the child is already suicidal, do consult with a psychiatrist immediately about medication options and/or in-patient care if a facility is available. Monitor your child closely over the next few weeks.

Alix Spiegel writes for SHOTS:

A Fresh Look At Antidepressants Finds Low Risk Of Youth Suicide

In 2004, after an extensive review, the Food and Drug Administration issued a strong warning to doctors who prescribed antidepressants to teens and children.

Antidepressants, the FDA said, appeared to increase suicide among kids and teens. Doctors needed to be careful. The FDA even mandated that a "black-box warning," the strongest type, be placed on antidepressant packaging.

This warning and worries that giving antidepressants to children might cause them to kill themselves was front-page news for weeks and appeared to changed the prescribing behavior of doctors.

Fewer doctors used antidepressant medications with their young patients and, according to at least one study, the number of suicides among kids and teens began to rise.

This week the Archives of General Psychiatry published an analysis that finds no increase in suicide among young people taking Prozac. The findings put a new wrinkle in the long-running debate over the safety of the medicines when used to treat depressed young people.

The study reviewed detailed data from over 9,000 patients — including 700 youths — who took the antidepressant Prozac and found that the drug didn't increase suicidality in children at all. It also looked at data for adults taking Effexor.

 

Now, the main author of the study is Robert Gibbons, a statistician at the University of Chicago's medical school. Gibbons sat on the panel of experts that advised FDA to issue the warnings, but he always felt ambivalent about the panel's decision.

"I worried that what we might end up with was a real epidemic of suicide," Gibbons told Shots. "And the data suggests that that is exactly what happened. Rather than the black-box warning leading to decreases in child suicide rates, they were followed by some of the largest increases in child suicide rates both here in America and around the world."

So why did the new study come to such a different conclusion about the risks of suicide in kids?

According to Gibbons, the FDA's findings and his findings are similar in some respects. Both found that when doctors asked their patients about suicidal thoughts and behavior in the context of regularly scheduled checkups there was no difference between the medications and placebos.

But when it came to what are called adverse event reports, there was a difference between his study and the review done by the FDA.

Adverse event reports occur when patients spontaneously contact their doctors with problems associated with taking a medication. When the FDA looked at these patient reports, they found that patients on antidepressant medications reported 80 percent more suicidal thoughts and behavior than patients on placebos.

Gibbons didn't look at these spontaneous reports in the same way. He only considered them when patients acted on their suicidal thoughts with a suicide attempt. He found that the small number of people who acted on their suicidal thoughts did not affect the overall risk of suicide.

The original FDA study also included all antidepressants — not just Prozac. That might account for some of the differences found.

Gibbons, who has become a vocal opponent of the black-box warnings since his stint on the committee that advised FDA, says that he hopes this study will reassure clinicians about the safety of the drugs. It's not clear whether other researchers will agree with him that the new study's findings present a fundamental challenge to the FDA's previous conclusions.

The FDA was contacted for this report, but a spokeswoman emailed that the agency doesn't respond to every report or study.

The Gibbons study was funded by the National Institute of Mental Health and the federal Agency for Healthcare Research and Quality. Gibbons has been an expert witness for the Justice Department and Pfizer in cases related to antidepressants, anticonvulsants and suicide.

Teenage tantrums...Healthy?

I just read an informative entry in Shots blog, which discusses very interesting finding of a study done by researchers at the University of Virginia.  The findings were published in the journal of Child Development, and they focused on the importance and benefits of children's arguments.  Th study reported that children who fight and argue with their parents were more assertive and independent in the future.  Those children were also able to confidently stand by their ideals and morals, but (and that's a big but), only if parents direct them well during these arguments.

Joseph P. Allen, the lead psychologist in this study, explained that parents should consider these arguments not as a nuisance but as a "critical training ground".  Here is a small synopsis of the blog entry by Patti Neighmond:

Teens should be rewarded when arguing calmly and persuasively and not when they indulge in yelling, whining, threats or insults, he says.

In Allen's study, 157 13-year-olds were videotaped describing their biggest disagreement with their parents. The most common arguments were over grades, chores, money and friends. The tape was then played for both parent and teen.

"Parents reacted in a whole variety of ways. Some of them laughed uncomfortably; some rolled their eyes; and a number of them dove right in and said, 'OK, let's talk about this,'" he says.

It was the parents who said wanted to talk who were on the right track, says Allen. "We found that what a teen learned in handling these kinds of disagreements with their parents was exactly what they took into their peer world," with all its pressures to conform to risky behavior like drugs and alcohol.

Allen interviewed the teens again at ages 15 and 16. "The teens who learned to be calm and confident and persuasive with their parents acted the same way when they were with their peers," he says. They were able to confidently disagree, saying 'no' when offered alcohol or drugs. In fact, they were 40 percent more likely to say 'no' than kids who didn't argue with their parents.

From my own perspective I can completely understand and agree with these findings.  As some of you followers might have already have read, I commonly say "every opportunity is a learning opportunity".  These arguments are bound to happen, and it is your choice as a parent to use your strength and power to instill fear or instill respect.  Fear will only last for a short period of time, and then encourage lying and escapist behavior; respect will be lifelong with the added benefit of building your child's character. 

Follow the link for the full blog entry.

Marriage Survival 101

 A new post to share by Jennifer Ludden from the SHOTS blog...

To Keep Marriage Healthy When Baby Comes, Share House Work 

As many couples can attest — and lots of research backs this up — marital happiness plummets with the arrival of a baby. Sleepless nights, seemingly endless diaper changes and the avalanche of new chores that come with a newborn leave little time for the intimacies of marriage. It's a situation ripe for mental stress and marital discord.

In fact, the strain is so well documented that, as the Wall Street Journal reported earlier this year, a growing number of mental-health professionals now advise pre-emptive relationship counseling for expectant parents.

But in a survey of 2,870 married couples, the National Marriage Project of the University of Virginia found that more than a third of them buck the trend, managing to stay happy through the emotional, physical and financial strains of new parenthood. So, how do they do it?

Not surprisingly, the report finds sexual satisfaction and a sense of commitment top the list of traits that lead husbands and wives to say they are "very happy" in marriage. No. 3 is "generosity," defined as:


"the virtue of giving good things to [one's spouse] freely and abundantly," and encompasses small acts of service (e.g., making coffee for one's spouse in the morning), the expression of affection, displays of respect, and a willingness to "forgive him/her for mistakes and failings."

Further down the list: shared housework. That's right, both mothers and fathers are more likely to report they are "very happy" when housework is "shared equally." So presumably, asking your husband to do the laundry (or your wife to change the light bulb) can be good for your marriage. Though harking back to generosity, perhaps it's better if each volunteers to take on the task.

The survey is a joint project of the National Marriage Project and the Institute for American Values, conservative groups that promote marriage. Their report also finds — as many surveys have shown — that more devoutly religious people often rank themselves happier. Another recent study attributes this effect to the social networks that religion can foster.

Strikingly, the National Marriage Project finds a big jump in marital happiness among couples with four or more children (which, as the researchers note, is likely a pretty self-selecting group.)

Or, there's a simpler strategy: patience. Contrary to popular perception, evidence suggests marital bliss rebounds with the empty nest.

Another Shot

Sharing another interesting article from SHOTS entitled : 

Now Children Need Cholesterol Tests, Too

By Nancy Shute

Children today are growing up fast — so fast that they're now being told to have their cholesterol tested before they hit puberty.

The new recommendation to test all children for cholesterol at ages 9 to 11 comes from the National Heart, Lung, and Blood Institute. The goal is to reduce the risk of heart disease in adulthood. But the new recommendation runs counter to the advice of another federally-funded independent panel, which says routine screening isn't needed before age 20.

"The more we learn the more we realize that the atherosclerosis process really begins early in life," says Steven Daniels, chair of the panel that wrote the new guidelines, and a pediatric cardiologist who chairs the department of pediatrics at the University of Colorado School of Medicine. The earlier in life cholesterol risk can be identified, the premise goes, the easier to keep it under control.

Pediatricians were already supposed to be doing cholesterol tests in children who are obese, have diabetes or have a family history of heart disease. But after studies found that those screening tools weren't catching some grade-schoolers with high cholesterol, the notion of universal screening gained traction.

Kids won't like it, because it requires a blood draw, and that means a needle. But the test won't require a special visit; it will be part of regular well child visits. The new guidelines are endorsed by the American Academy of Pediatrics is publishing them Monday in the journal Pediatrics.

But the new recommendation isn't universally endorsed. Some doctors think the call for universal screening is overkill, since only about half of children with high cholesterol will go on to have that problem as adults. And researchers at the Centers for Disease Control and Prevention reported last year that in many children, high levels of LDL cholesterol corrected themselves by the next office visit.

A 2007 recommendation from the U.S. Preventive Services Task Force, a federally-funded group that sets practice guidelines, says there's not enough evidence to recommend universal screening under age 20.

Daniels says that universal screening is intended to find children with very high LDL cholsterol, the "bad" kind, is 190 milligrams of the stuff in each decliter oof blood. Overall, less than 1 percent of children would be candidates for treatment with statin drugs, he says. "I don't think it's likely that there will be overtreatment."

More likely is that Mom and Dad will need to get serious about exercise eating healthy. Daniel says: "It gives them a stronger rationale for working hard on making the home the healthiest environment that it could be."

Even though statins have an enviable safety record in adults, no studies have been done on the implications of putting children on statins for the rest of their lives. That's why today's recommendation gives some physicians pause.

Safe keeping...

Pill Or Candy? Can You Guess Which Of These Is Medicine?

Which tablet is a cold medicine and which ones are candy?

Credit: Melissa Forsyth and Alyson Hurt / NPR

Intrigued? 

Click on the link and read this interesting report.