What Your Doctor May Not Tell You About Depression

What Your Doctor May Not Tell You About Depression: The Breakthrough Integrative Approach for Effective Treatment
by Michael B. Schacter, M.D., with Deborah Mitchell
Published by Warner Wellness; November 2006.

Beware of books that advertise themselves as “the breakthrough treatment” for anything.

This is a book I really would like to recommend. There is a lot of good information in the book that would probably be useful for anyone suffering from or vulnerable to depression. But ultimately the book suffers from a thinly disguised anti-psychiatry bias and frequently weak or misleading evidence for alternative therapies. On the one hand, the author warns against the “debilitating side-effects” of conventional antidepressant medications; on the other, he recommends dubious procedures such as chelation to cure depression by ridding the body of “dangerous toxins” – but fails to mention that procedures such as chelation have their own risks and side-effects and are based on weak or no evidence to support their efficacy.

As just one example of what I found annoying about this book, in Chapter 3, Discover Your Biochemical Profile, Schacter presents a case study (which, by the way, he seems to prefer to systematic controlled efficacy studies as “evidence” for his recommendations) for one patient, Patricia. Dr. Schacter has this to say about his case study:

The table above [see book] shows the neurotransmitter test results of one patient, Patricia, who was treated with amino acid therapy for depression and fatigue. As you can see, all of her neurotransmitter levels were out of optimal range when she first came to be tested. After four months of amino acid therapy, all of her neurotransmitter levels had changed significantly and moved toward optimal levels. More important, she was feeling 100 percent better and, for the first time in five years, had the energy and motivation to initiate a career change.

Now let’s look at this for a moment. First, we are not told whether Patricia had been treated previously using conventional medications and/or psychotherapies. Could it be that the reason she felt better “for the first time in five years” was that this was the first time she had followed through on treatment recommendations at all? Note that there is no “Patricia control group” for comparison. Second, while he concludes that “all of her neurotransmitter levels had moved toward optimal levels”, he fails to point out that three of the five are still outside the optimal range, or that the two that made it into the optimal range after four months were not very far out of range to begin with. And, third, we have no way of knowing how this patient would have responded to four months of treatment with an SSRI, especially if combined with psychotherapy, (e.g., cognitive behavior therapy).

To be fair, there is a lot of excellent information on nutrition and lifestyle issues in this book. I wish they had been presented as adjuncts to conventional treatment rather than implying that it is one or the other.

Excerpt from the book:

Basics of a Healthful, Antidepression Diet
By Michael B. Schachter, MD, & Deborah Mitchell
What Your Doctor May Not Tell You About Depression

For some people, the phrase healthful diet is enough to send their mood tumbling. “Guess I’ll have to give up everything I enjoy, like chocolate and hamburgers and french fries,” sighed one patient. “That’s enough to make me even more depressed!” But healthful need not be equated with unappetizing or boring. Different, perhaps, and for some people a change to a more healthful diet requires big adjustments — in the foods they buy, where they eat out, and how they prepare their choices. The rewards, however, are many, including improved mood, more energy, enhanced immune system, better concentration, and invigorated sex drive, to name but a few. I’ve found that laying down a few basic but critical guidelines for a healthful diet, and then tweaking them for individual patients, works much better than expecting people to follow a complicated program that involves counting grams of carbohydrates or protein, weighing foods, referring to charts, or combining certain items in complicated ratios. That being said, here are my lists of Positive Foods and Foods to Avoid.

Positive Foods

  • Sweets. In moderation, natural sugars such as rice syrup, date sugar, pure Vermont syrup, unsulfured blackstrap molasses, and unfiltered honey are all acceptable. An herbal sweetener — that has nearly no calories — is stevia, which can be found in health food stores and increasingly in mainstream grocery stores.

  • Fats. Some fats are healthy and instrumental in maintaining mental health, especially omega-3 fatty acids. When you choose oil for cooking, your best choice is probably cold-pressed olive oil. Butter and other saturated fats (like coconut oil, but not margarine that contains transfatty acids) may be used in moderate amounts. I suggest you avoid fried foods (especially deep-fried).

  • Whole fruits and vegetables. Whenever possible, choose fresh, organic fruits and vegetables and eat at least five to seven servings daily. To derive the most benefit from these rich sources of vitamins, minerals, fiber, and carbohydrates, eat them in as pure a state as possible, preferably raw or lightly steamed. (Sorry, deep-fried potatoes and onion rings don’t count as servings of whole vegetables.) Fruit and vegetable juices are good as well, and if you have a juicer, please learn how to make your own fresh juices, remembering to drink the pulp as well!

  • Whole grains and cereals. Whole grains and cereals (organic if possible) are excellent sources of complex carbohydrates. These foods include whole grains, brown rice, and unprocessed cereals. Complex carbohydrates break down gradually and provide a more steady supply of glucose – brain fuel – thus helping maintain an even or calmer mood. Simple carbohydrates, however, such as those found in sugary foods or those made with white flour, metabolize rapidly, contributing to and causing mood swings and energy highs and lows. Also, be aware that some grains and even other whole-food starches may be problematic for some people.

  • Beans, legumes, nuts, and seeds. Choose organic foods in this important category as well. Foods in this group are excellent sources of protein, especially for people who want to reduce or eliminate animal protein. Beans, legumes, nuts, and seeds are also high in fiber and many nutrients. Also in this category are tofu and other forms of fermented soybeans (miso, tempeh) and flaxseed.

  • Eggs and dairy. Eggs and dairy foods — milk, cheese, butter, cream, and yogurt — are good sources of protein, calcium, and other important nutrients. They are also rich sources of saturated fat, which may be fine for many people. The major concern I have about eggs and dairy relates to whether hormones were used in raising the animals; whether or not they were given foods containing pesticides, antibiotics, toxic minerals, or other chemicals; and whether the animals were confined to inhumane cages. Soft-boiled eggs are best because heat is applied without exposure to oxygen, thus reducing free radical damage. I recommend organic eggs and dairy products and prefer nonhomogenized milk. Although pasteurization of milk products is the norm today in order to eliminate harmful bacteria, certified raw milk is preferred in areas where it is available, provided the cows are clean and hygienic principles are used in caring for them. If you are lactose-intolerant because of a deficiency of the enzyme lactase, or you choose not to consume dairy items, nondairy foods may be used. These include products made from soy, rice, or nuts, such as soy milk, rice milk, and almond milk; cheese made from these “milks”; and nondairy desserts. These “dairy” foods are also good sources of protein.

  • Organic meats and poultry. Despite a push for people to eat more fish, meat and poultry continue to be major sources of animal protein for many people. For patients who eat meat, I recommend organically raised products, which are virtually free of hormones, pesticides, antibiotics, and other unnatural additives, all of which can have a detrimental effect on mood and general health. Such meat and poultry choices are slowly becoming more accessible and typically are available in natural and whole-food stores. Meats and poultry are sources of methionine, which is critical for methylation; this amino acid is difficult to get from plant-based sources.

  • Fish and shellfish. Fish and shellfish can be excellent sources of protein and omega-3 fatty acids, if you make judicious choices. I’m calling for “judicious choices” because of the persistent and very real problem of mercury, pesticides, PCBs, and other contamination of the fish supply. Fish that I tend to recommend that are high in omega-3 fatty acids, but relatively low in mercury, are wild Alaskan salmon and sardines. I am wary about farm-raised fish because some studies indicate that they are high in PCBs and other contaminants. The smaller the fish (say, sardines), the less likely they are to accumulate mercury. But if you eat fish fairly frequently, I recommend that you have your blood mercury levels checked, because there is no way to guarantee the fish you eat regularly is not contaminated. Everyone whom I have checked for mercury who eats sushi more than once a week is quite high in it. Swordfish, king mackerel, shark, and most tuna tend to be quite high in mercury.

I would like you to consider two factors when choosing foods from this list. One, do you have any reactions to these foods that may be contributing to or causing your depression? Two, do you have any specific food preferences based on religious, ethical, and/or moral beliefs? If you are a vegetarian, for example, you will not select meat, poultry, or fish, so you will need to choose other protein-rich foods such as soy products, legumes, beans, seeds, and, depending on the type of vegetarian diet you follow, eggs and/or dairy.

Foods to Avoid

Most of the foods included in this list should come as no surprise to you. In most cases, foods on the Avoid list have been highly refined and processed. Fortunately, for every food you should avoid, there is a healthy alternative on the Positive Foods list. You may find that the Avoid list reads like your current grocery list; or you may discover that only one or two categories apply to you. Next time you’re in the grocery store, here are the items you want to skip:

  • Sugar. Avoid all foods that contain added sugar, such as soda, candy, cakes, ketchup, some breakfast cereals, and so on. Become a label reader. If sugar (or one of its companions, such as corn syrup) is one of the first few ingredients, put the item back on the shelf! Sugar can give you a burst of energy, but in the long run it can leave you depressed and tired.

  • White-flour products. Just say no to white bread, white pasta, and other products that use white flour, including many crackers, rolls and bagels, refrigerator biscuits, pizza dough, and baked goods. Also avoid white rice. These overly processed food products have been stripped of their nutritional value, and then they are “enriched” with some nutrients, along with synthetic additives.

  • Alcohol. This includes beer, wine, and liquor. People often forget that alcohol is a depressant, even though it provides an initial kick. Drinking alcohol can also disturb your sleep, which is a problem with many people who are depressed.

  • Caffeine. Avoid coffee, tea, colas, and chocolate. (Okay, you can have a limited amount of organic dark chocolate on occasion.) If you must have coffee, choose an organic coffee, since most coffees are high in pesticides. Decaffeinated coffee is fine for most people, provided that it is organic and does not use toxic chemicals in processing.

  • Hydrogenated fats. Hydrogenated fats are oils to which hydrogen atoms have been added in the factory in order to harden them and improve shelf life. These hydrogenated oils or fats contain high concentrations of trans-fatty acids, which have recently been clearly shown to disrupt fatty acid metabolism in the body and cause serious disease. Hydrogenated fats are found primarily in margarines, snack foods (potato chips, corn chips), crackers and cookies, baked products, and fast foods. When you read ingredient labels, look for the words hydrogenated, partially hydrogenated, margarine, or shortening, which indicate the presence of trans-fatty acids, or look at the nutritional panel for the percentage of trans-fat in the product. Beginning January 2006, food manufacturers were required to list trans-fat content on labels.

  • Chemical food additives. To avoid artificial preservatives, flavorings, colors, and sweeteners, you need to read labels. Not all labels list all the chemicals in the food item, but the general rule is: If the product has been processed, it probably contains chemicals. For example, artificial preservatives such as BHA, BHT, nitrites, monosodium glutamate, and nitrates are often seen in cereals, breads, frozen dinners, boxed meals, and crackers. All foods containing artificial colors (such as red dye 40) or artificial flavorings should be avoided. Artificial additives can cause various adverse reactions, including mood swings, depression, fatigue, headache, rash, aggression, irritability, and attention difficulties, among others. I believe all artificial sweeteners, including saccharine, aspartame, and sucralose, should be avoided. In particular, avoid diet sodas containing aspartame.

  • Fluoride. Do not drink fluoridated water or tap water (unless filtered) or use fluoridated toothpaste. Despite the popularity of fluoride dental treatments for both adults and children, I strongly recommend you not get them. Also, avoid fluoridated vitamins for children. There are a number of excellent books and websites that clearly document the lack of efficacy and dangers of fluoride ingestion and fluoride use. If you live in an area where the tap water is fluoridated and you want to drink the tap water but not the fluoride, you need to use a water filter with a reverse osmosis component; carbon filters will not remove fluoride.

  • Chloride. Do not drink chlorinated water (unless the chlorine has been filtered out), as chlorine is toxic. A simple carbon filter will remove chlorine from tap water. 

In the end, I would like to recommend this book for the useful information it contains. I cannot recommend it globally because of the overly-prejudicial way that information is presented. Had the author aimed more at a balanced view of conventional and alternative treatments, this could have been a much better resource. It is, I think, a worthwhile read for the practitioner with a critical eye, but not recommended for most patients.

Bad logic, bad science, and sensationalism

This is the kind of news release that angers me.

Brian Quinn, LCSW, PhD., Author Of A New Book On Bipolar Disorder, Discusses The Risks Of Antidepressants In Angry, Agitated Teens

It’s ill-conceived, illogical, and dangerous. It starts with the statement that “Dr. Quinn’s new book reviews the most up-to-date research on the use of antidepressants in bipolar disorder” and then proceeds to demonstrate that the author has little grasp of the most basic principles of logic, let alone the principles of research.  His statements are based neither in research nor in logic. They are self-serving and misleading. I get that he wants to sell his new book. I also get that using sensationalism and duplicity as a means to increase sales is perfectly acceptable to him. And that, in my view, is reprehensible.

“Eric Harris, one of the shooters at Columbine, was on an antidepressant when he and Dylan Klebold killed 12 students and then themselves. Jeff Weise, who killed nine people and then himself in Red Lake, Minnesota, was also on an antidepressant, and Kip Kinkel was on an antidepressant when he fatally shot his parents, two students and wounded dozens at a high school in Springfield, Oregon.”

Okay. And so? This tells us what? This is selective bigotry and stigmatization of mental illness at its very worst. “One of the shooters” at Columbine was on an antidepressant? And the implication is that caused him to kill people? What about the other shooter? What caused him to kill people? What about all the other historical and emotional characteristics of Eric Harris? Were those factors unrelated to the shootings? What about all of the other people who commit crimes, including mass or serial murder, every year who are not on any medication at all? What about the millions of people world-wide who are on antidepressants and other medications who will live their whole lives without ever killing anyone?

“Antidepressants have been linked to worsening hostility, suicidal behavior and psychosis in depressed children and teens and some people with bipolar disorder. While no one can say that antidepressants caused Harris, Weise, and Kinkel to commit mass murder, all these cases raise the question of who should be given antidepressants and who should not.”

No. This is false. Antidepressants have not been linked to hostility, suicidal behavior, or psychosis in children, teens, or anyone else, except by anecdotal evidence which is increasingly being exposed as hysteria. However, it is the case that hostility, suicidal behavior, and sometimes psychosis are among the symptoms of the illnesses and conditions that various classes of psychotropic medications, including antidepressants, are used to treat.

“‘These drugs tend to be handed out routinely to anyone with symptoms of depression and without a great deal of thought given to accurate diagnosis or the risks involved in using them, especially in young people with agitated depression,’ said Brian Quinn, LCSW, PhD., author of a new book, Wiley Concise Guides to Mental Health: Bipolar Disorder (John Wiley & Sons, 2007). ‘We don’t know what the diagnoses of these kids were, but we do know that they all had angry, agitated depressions — an indication they may have had bipolar disorder or could respond to antidepressants with a worsening of their symptoms. Caution should have dictated that they not be given antidepressants initially.'”

What absolute balderdash. These drugs are certainly NOT “handed out routinely to anyone with symptoms of depression and without a great deal of thought given to accurate diagnosis or the risks involved in using them”. The author is a social worker. He does not and cannot prescribe medications. What evidence is presented to back up the claim that physicians are ignoring diagnostic considerations in prescribing these medications?

“‘Psychiatrists, psychologists and social workers frequently misdiagnose those in the depressed phase of bipolar illness as having simple depression. This often results in them mistakenly being given antidepressants alone,” Quinn said.”

Okay. So people with bipolar disorder are often initially misdiagnosed with depression. Why is that, Mr. Quinn? I can tell you that it’s not a result of incompetence and it’s not a result of antidepressant medication. It’s a result of the nature of bipolar disorder – a fact you should understand as a self-styled expert on the subject. The majority of bipolar patients first present with depression, not hypomania, and the only way currently to accurately diagnose bipolar disorder is on the basis of longitudinal evidence showing recurrent cycles of depression coupled with evidence of at least one hypomanic or manic episode, evidence which is frequently not available when a patient is first being seen by a mental health professional. Given that, physicians do what they should be doing, viz., treating the symptoms of depression. That doesn’t mean that the possibility of bipolar disorder is ruled out. It simply means that physicians, like other men of science, follow the principle of Occam’s Razor: The simplest explanation is often the correct one and one does not proceed to a more complex explanation (diagnosis) of medical-psychiatric symptoms without first eliminating the simpler explanations (diagnoses).

This is the Dr. Phil phenomenon – the confusion of entertainment and marketing with science and professional practice. It is blatantly anti-science and anti-logic. And it worries me because of the potential damage it does to vulnerable people who need help and may be denied it if sensationalist propaganda such as this is believed.

We’re already seeing evidence of rising suicide rates among adolescents and children as a result of the fundamentally unfounded restrictions on the use of antidepressant medications among these age groups. We don’t need more biased sensationalism to make the situation worse.

antidepressants, bad logic, bad research, bad science, bipolar disorder, depression, sensationalism

Eating, Drinking, Overthinking

Eating, Drinking, Overthinking: The Toxic Triangle of Food, Alcohol, and Depression – and How Women Can Break Free
By Susan Nolen-Hoeksema, Ph.D.

Depression is a common and debilitating problem among women, though it rarely occurs in a vacuum. Instead, as Susan Nolen-Hoeksema has found, depression often coexists with disordered patterns of eating and drinking. Three core problems – overthinking, unhealthy eating habits, and heavy drinking – lead to and reinforce one another in a toxic triangle that wreaks havoc on women’s mental well-being, their physical health, their relationships, and their careers – so completely they often find it very difficult to break free.

Breaking free is possible, however, both for women who are already aware that they suffer from a serious problem and for the hundreds of thousands of others who dance around the edges with only occasional symptoms. As Eating, Drinking, Overthinking shows, women can free themselves by transforming the very traits that make them vulnerable into strengths. Nolen-Hoeksema provides the tools to harness the energy of women’s reflective and interpersonal skills, creating more effective and healthy ways to counter their tendency to turn inward.

Eating, Drinking, Overthinking raises an alarm by revealing that the intersection of depression, unhealthy eating, and heavy drinking is, though common, all but ignored by scientists and the lay public. This book gives hope to women whose lives are in grips of the toxic triangle, as well as to their family and friends, that freedom is within reach.

Author: Susan Nolen-Hoeksema, Ph.D. is a professor of psychology at Yale University, and the author of Women Who Think Too Much : How to Break Free of Overthinking and Reclaim Your Life.

eating disorder, depression, addiction, alcoholism

Making sense of medication side-effects

You’ve just come home from a visit to your doctor with a new prescription. If you are like many people today, one of the first things you will do is read the leaflet your pharmacist gave you and then go to the internet to look for more information. For many people, what they find there can be alarming.

Websites like www.RxList.com include tables of possible side-effects that patients in various research studies may have experienced. Sometimes, this can be quite a long list, but on closer inspection in most cases you will see that no individual side-effect is experienced by the majority of people taking the medication. You should also note that in most cases the information provided will include a group called “Placebo” — a group which is given a “sugar pill” instead of the actual drug — and often patients in this group will also report experiencing those side-effects.

So what does it all mean? How does one read these sometimes frightening data tables to make sense of them?

Read the fine print
Let’s look at a popular drug in the family of newer antidepressant/antianxiety medications: Effexor (venlafaxine). On this page from RxList, you will find a table (Table 2) with possible side-effects listed vertically down the left hand side and data from studies comparing Effexor XR (the extended release version of this medication) to placebo in three different patient groups: Major Depressive Disorder, General Anxiety Disorder, and Social Anxiety Disorder. In this table, virtually all of the listed side-effects are reported as occurring in less than 3% of patients who continued to take the medication over an 8- to 12-week period. However, it is important to note that the data presented in Table 2 are side effects experienced during discontinuation of the drug after taking it for 8 to 12 weeks.

Look at the Placebo Group
Now scroll down that page a bit until you find Table 3. The data here summarize reported side-effects for the three groups (Major Depressive Disorder, General Anxiety Disorder, and Social Anxiety Disorder) versus Placebo during the 8- to 12-week period the patients were actually taking the drug: This is probably more meaningful information for someone just beginning the medication.

Notice first that many of the listed side-effects are associated with numbers like 4 per cent, 3 per cent, 2 per cent, 1 per cent, or less than 1 per cent. That means that 96 per cent or more of the people taking this medication will not experience those symptoms, so they are not things you need worry greatly about.

Looking next at the bigger numbers, it seems that 31 per cent of people on Effexor complained of nausea. Two things to note about that: First, this means that almost 70 per cent did not experience this side effect so the odds are you may be one of the lucky ones; and, second, that 12 per cent of people in the placebo group also complained of nausea. The difference in this case (12 per cent vs. 31 per cent) is probably meaningful and I would probably consider this to be a significant side-effect for this medication. But it does raise the general question of whether a reported symptom is associated with the illness rather than the medication. A better example of this is seen a little further down the page: Some individuals taking Effexor complain of sleep disturbance. However, note that about equal numbers complain of somnolence (excessive sleepiness or drowsiness) and insomnia (17 per cent for each symptom). It is also noteworthy that for individuals taking the placebo 8 per cent complained of somnolence and 11 per cent complained of insomnia. Now, changes in sleep patterns are known symptoms of depression — there are suggestions in these data that Effexor may exacerbate that particular problem in some individuals but it is still worth noting that over 80 per cent of patients taking the drug do not report these side-effects.Then we come to a couple of side-effects that seem to be clearly caused by the medication: First, excessive sweating is reported by 14 per cent of patients taking Effexor but only 3 per cent of placebo patients. Second, abnormal (delayed) ejaculation in males is reported by 16 per cent taking the drug while less than 1 per cent of those in the placebo group complain of this side-effect. Again, it is worth noting that the vast majority (approximately 85 per cent) will not experience this side-effect but when it occurs it is probably safe to attribute it to the medication.

If you’re one of the unlucky ones…
Finally, with modern medications, there is now a considerable range of alternative medications to treat most illnesses. If you are experiencing one of the listed side-effects or even one that isn?t listed but that you think might be related to the medication, let your doctor know. In most cases, the problem can be solved by switching to one of the alternative drugs used to treat your condition.

adverse effects, anti-depressant, anxiety, depression, medications, psychiatric medication, psychotropic medication, side effects, SSRI

Advances in the treatment of depression

recent article in The News-Sentinel offers new hope to the “15-25 percent of the 19 million Americans with depression” who do not respond to treatment using medication, psychotherapy, or electroshock therapy (ECT). While that estimate seems a little high to me (I would estimate that at least 90% of depressed patients eventually respond to medication and/or psychotherapy, although it does sometimes take a bit of trial and error, with a small percentage requiring ECT), there is no doubt that some patients are resistant to these treatment options.

Vagus Nerve Stimulation therapy device for treating psychiatric disorder is undergoing FDA approval

Vagus Nerve Stimulation therapy, used since 1997 to reduce seizures in epilepsy patients who did not respond to medication, might give hope to people whose depression keeps them from working, caring for families and enjoying life… The first implant for treating a psychiatric disorder is on target for final approval by the Food and Drug Administration within 60 days. In mid-June, the electrical nerve stimulator was recommended by an FDA committee…

The concept for using the VNS for depression came serendipitously after epileptic patients noted improvements in their moods. The implant works like this: A small generator, similar to a cardiac pacemaker, is surgically implanted into the left side of the chest. Wires from the generator are wrapped around the left vagus nerve, which runs alongside the carotid artery. The vagus nerve sends messages to deep regions of the brain, stimulating and changing brain activity, particularly in areas regulating mood, Lisanby said. The generator delivers electrical pulses for 30 seconds, about once every five minutes, for people with depression.

The generator can be turned on and off using a hand-held magnetic wand. While epileptic patients with the VNS implant are taught how to control the stimulator according to seizure activity, for people with depression, the generator is on continuously…

As with research into treatments for many physical illnesses and medical conditions, to me what is significant about reports like this is not how many people can be helped or even whether or not this particular treatment proves to be effective – what is important is that it is a reminder that research into improved methods for treating these illnesses is ongoing. If you are among those who are currently struggling with depression, anxiety disorders, or major mental illness, and feeling frustrated by the treatments you have tried so far, do not give up hope. With a bit of patience and some trial-and-error, there is a very good possibility that you will either find an existing treatment that is beneficial to you, or you may be one of those who is helped by something currently under development.

As with research into treatments for many physical illnesses and medical conditions, to me what is significant about reports like this is not how many people can be helped or even whether or not this particular treatment proves to be effective – what is important is that it is a reminder that research into improved methods for treating these illnesses is ongoing. If you are among those who are currently struggling with depression, anxiety disorders, or major mental illness, and feeling frustrated by the treatments you have tried so far, do not give up hope. With a bit of patience and some trial-and-error, there is a very good possibility that you will either find an existing treatment that is beneficial to you, or you may be one of those who is helped by something currently under development.

depression, depression treatment, electrical stimulation

Medication in children: Controlling symptoms or controlling behavior?

This isn’t a new issue but it is one that emerges repeatedly, amid reports of increases in the rate of diagnosis of disorders like ADHD and corrsponding increases in the use of medications for treating those disorders. Are there really more children meeting the criteria for ADHD, childhood bipolar disorder, or obsessive-compulsive disorder than 10 or 20 years ago? Or are we relying too much on complaints from school teachers and stressed-out parents about difficult behavior?

Use of drugs to control kids worries specialists
by Carol Marbin Miller, Miami Herald

Troubled youngsters across the nation are being prescribed mood-altering drugs with increasing frequency, raising questions among psychiatrists and researchers specializing in the mental health needs of children. Supporters of the current trends in child psychiatry see the burgeoning use of often expensive new drugs as a sign that needy children are gaining access to a mental healthcare system that once often excluded them.Critics disparage the statistics as evidence that healthy but unruly children are being given drugs for the convenience of their caretakers, not because they need them.My suspicion is that physicians and psychologists really have become better at recognizing certain disorders and in understanding that children can and do exhibit symptoms of disorders such as bipolar disorder or obessive compulsive disorder, though such diagnoses in children were rare in the past. I also suspect that we will in time determine that some of the increase is due to environmental toxicity and fallout from substantial increases in stress levels in the lives of our children and their families, impacting directly and indirectly on the neurobiology of emotional and behavioral controls.

But I also believe that part of the problem is that schools, parents, and physicians without appropriate training in the diagnosis of such disorders are increasingly “diagnosing” these children based on superficially simple-to-complete behavior checklists, and physicians are then using these “diagnoses” to prescribe and administer medications that may well be not only unhelpful but potentially damaging to developing bodies and nervous systems.

Perhaps one solution is to require that a diagnosis be obtained from a professional with appropriate training in child psychology and psychopathology before any psychotropic medications can be prescribed.

pediatric psychology, child psychology, child psychiatry, ADHD, depression, OCD, bipolar disorder, psychiatric medication