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January 2004

U.S. FDA hears from parents who say antidepressants can trigger suicides in kids
(Laurean Neergaard) Parents pleaded with the Food and Drug Administration (news - web sites) on Monday to end the use of popular adult antidepressants in children, saying the drugs can increase youths' risk of suicide and violence.
"To die in this violent, unusual fashion without making a sound . . . Paxil must have put her over the edge," said Sara Bostock, describing how her daughter Cecily stabbed herself in the chest with a kitchen knife shortly after graduating from Stanford University and two weeks after starting the drug.
"You have an obligation today . . . from preventing this tragic story from being repeated over and over again," said Mark Miller of Kansas City, Mo., whose son Matt hanged himself from his bedroom closet after taking his seventh Zoloft tablet.
But facing those anguished complaints were a handful of families who say antidepressants changed their children's lives by alleviating serious depression.
"My children have had tremendous improvement with their illnesses," said Dr. Suzanne Vogel-Scieilia of the National Alliance for the Mentally Ill, who has two sons using the drugs. "I shudder to think of their plight if these medicines were not available."
The FDA opened hearings Monday on the emotionally charged controversy, months after British health authorities first sounded the alarm by saying an entire list of antidepressants were unsuitable for child use.
Here, no final answer is expected until late summer. Until then FDA has advised doctors to use great caution if they prescribe any antidepressants to anyone under age 18.
"The wrong answer in either direction . . . could have profound consequences," said Dr. Russell Katz, FDA's director of neurologic drugs, in explaining the lengthy deliberation.
Katz acknowledged divisions of opinion even within the FDA, where some scientists believe there is a link between some antidepressants and youth suicide behaviour and attempts.
Preliminary data from studies suggest that suicidal behaviour and attempts, while infrequent, might be at least twice as frequent among some antidepressant users. Britain put the risk at around 3.2 per cent of children given the drugs, compared with 1.5 per cent of those given dummy pills.
But problems with that data led FDA's leaders to conclude that they can't yet answer the question.
Depression occurs in about 10 per cent of youth and can lead to suicide, especially if untreated. Some 1,883 10- to 19-year-olds killed themselves in the U.S. in 2001, and specialists say there are 10 to 20 attempts for every suicide. For adults, antidepressants clearly alleviate major depression, the FDA stresses.
But medicines can work differently in children. The agency has approved only one treatment - Prozac, the best known of a family of popular antidepressants called SSRIs — to alleviate pediatric depression, saying its benefits outweigh side effects.
Still, it is legal for doctors to prescribe adult medicines to children even if the FDA has not formally approved pediatric use, and child antidepressant prescriptions rose dramatically in the 1990s. The FDA ordered other manufacturers to submit research on how their drugs affect children and teenagers.
Last summer, British health authorities acted on the first of those findings, declaring that no depressed child or teen should use the SSRI drug Paxil, sold in Britain under the name Seroxat.
The FDA still is analysing the studies.
Source

'Recovering was about liking myself'
As the National Institute for Clinical Excellence launches guidelines on the treatment of eating disorders, BBC News Online talks to one woman about her experience.
Ann now makes sure she eats healthily Ann Cox remembers starting to over-eat when she was aged 11, something she believes was triggered by her anxiety about moving to secondary school.
"We had a walk-in pantry. I was an only child, so I had to be very deceitful, and I couldn't blame anyone else if food went missing.
"I can remember being terrified of being discovered by my parents. But I was compelled to do it. I was addicted." Ann over-ate throughout her teens — but was never discovered because she was naturally thin. "As an only child, I felt everyone knew everything about me.
"Over-eating was something I was addicted to. But it was also something that was my secret, something I had control over."

Hospitalised
But after a bout of illness at college in her twenties, Ann developed anorexia nervosa. "I had been in bed with tonsillitis, and after I'd recovered, I caught sight of myself in the mirror. "I liked what I saw — I had a flat stomach. That became my focus. "I wasn't nervous about classes any more. I wasn't nervous about fitting in. "At the age of 23, I was four and a half stone."
Ann, from Hastings, says she was hospitalised many times, sometimes because her weight had plummeted to dangerously low levels, and sometimes because doctors felt she needed to be sectioned.
At 30, she developed bulimia: "If you starve yourself for long enough, you either binge or die.
"I would spend £60 at the supermarket, then go home and eat it all before making myself sick into a washing up bowl in my room.
"Over the next eight years, my life was hell. Bulimia was linked to so much disgust — sometimes I would have sick dripping off my elbow. "By 38 I had lost my job and I had withdrawn from my friends.

'It was about liking myself'
"Eventually I asked to go to a psychiatric hospital in Brighton. I thought that they would know what to do."
The hospital helped her eat, but Ann says doctors failed to address her underlying psychological problems.
One day, she escaped from the hospital, planning to jump in front of a train — but two policemen at the station prevented her from killing herself. "It was then that I realised recovery was about feeling safe within myself and liking myself. "I realised that I had to do the work."
Now 53, Ann has been free of her eating disorder for 13 years. She now counsels people who are affected.
"I recognised that an eating disorder is symptomatic of a greater problem. It's like alcoholism — you've got to address the addiction to alcohol itself as well as why people are drinking.
"I set up a counselling service to address both the eating disorder and the underlying problem.
"The new NICE guidelines should be embraced. They will help people feel less isolated."
Source

Half of all people with anorexia are teenage girls
New guidelines aimed at improving the care of people with eating disorders have been issued by an NHS watchdog. The National Institute for Clinical Excellence, (NICE), set out treatment plans for patients with anorexia, bulimia and binge eating disorders.
It made specific recommendations for the care of teenagers, because of the rising numbers hit by the disease.
NICE also stressed the importance of psychological treatments and called for increased awareness among GPs. Experts said the guidance raised awareness of eating disorders, but did not come with any extra resources. In the UK, around 1.1 million people — including children as young as eight and some over 65s — are estimated to have an eating disorder.
However 50% of people with anorexia nervosa are teenage girls aged between 13 and 19. And the average age for developing bulimia nervosa is between 17 and 21.

'Important step'
The NICE guidelines set out specific treatment plans for each eating disorder. And they say that, where the patient is a child or adolescent, treatment should be tailored to their age and should involve carers and family members. The guidelines will be sent out to GPs and mental health specialists, and an information booklet will also be produced for patients and families.
Andrea Sutcliffe, who led the development of the guidance for NICE, said: "The availability of NHS services for people with eating disorders varies across England and Wales.
"With about one in 250 females and one in 2,000 males experiencing anorexia in adolescence or young adulthood and about five times that number suffering from bulimia, this guideline is an important step in standardising the care available to people with eating disorders.

'Devastating impact'
A spokesman for the Eating Disorders Association told BBC News Online: "These guidelines are very good, but we are concerned that the NHS doesn't have the infrastructure to deliver them.
"Two years ago, the Royal College of Psychiatrists reviewed eating disorder services and found there were 25 specialist services, which represented around 50% of what there should have been."
He added eating disorders could have a particularly devastating impact on teenagers. "It's very difficult for them to develop to their full potential. Their education can be disrupted, so for example, they might not go on to get their university place they are could easily have gained."
Jane Nodder, patient representative on the eating disorders guideline development group, said: "I welcome this guideline as a way of introducing a benchmark for the management and treatment of people with eating disorders."I am particularly pleased to see that it highlights the importance of patients, carers and health professionals working together to make treatment decisions and to provide good quality information to patients and their families."
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Acne myths
(KidsHealth.org) According to the American Academy of Dermatology (AAD), almost 100% of kids and teens between the ages of 12 and 17 get whiteheads, blackheads, or pimples at one time or another. And 17 million people in the United States - including adults, teens, and preteens - have acne, which is considered a common part of puberty.
But dispelling the many myths about acne is half the battle in the quest for clear skin. Help your child separate acne fact from acne fiction.

Myth: Getting a tan helps to clear up skin.
Fact: Even though a tan may temporarily cover the redness of acne, there's no evidence that having tanned skin helps to clear up acne. People who tan in the sun or in tanning booths or beds run the risk of developing dry, irritated, or even burned skin. They're also at increased risk of premature aging and developing skin cancer.

Encourage your child to keep skin safe by wearing protective clothing, hats, and sunglasses when outdoors. Your child should also wear a sunscreen with a sun protection factor (or SPF) of at least 15 that's labeled "noncomedogenic" or "nonacnegenic," which means the product won't clog pores. Discourage the use of tanning beds or booths, even for special occasions such as proms or vacations. Ask your child's doctor whether a sunless tanning product would be a better alternative.
If your child is using prescription acne medications (including oral contraceptives, which are often prescribed to help clear up acne), it's especially important to stay out of the sun and away from tanning beds. These drugs can make skin extremely sensitive to sunlight and the rays from ultraviolet tanning booths.

Myth: Eating greasy, fried foods or chocolate can cause acne.
Fact: Numerous scientific studies have come to the same conclusion: There's no connection between diet and acne. Although you may be tempted to use this myth to encourage your child to eat more fruits and vegetables, blaming zits on pizza, soda, french fries, and candy bars just isn't accurate.

Myth: The more you wash your face, the fewer breakouts you'll have.
Fact: Hygiene isn't related to the development of acne, either. Washing the face each day gets rid of dead skin cells, excess oil, and surface dirt, but too much cleansing or washing too vigorously can lead to dryness and irritation — which can actually make acne worse.
Dermatologists usually recommend gently washing - not scrubbing or rubbing — the face no more than twice a day with a mild cleanser and patting the skin dry. Your child should steer clear of harsh exfoliants or scrubs, which can actually irritate blemishes. In addition, toners containing high concentrations of alcohol can dry out the skin and should be avoided.

Myth: Popping pimples will help them go away faster.
Fact: Though popping a pimple may make it seem less noticeable temporarily, popping can cause the zit to stay around longer. Popping a pimple pushes bacteria from the zit further into the skin, making the area around the acne even more reddened and inflamed. Pimple-popping devices — such as "blackhead extractors" advertised in magazines - aren't any safer. Sometimes, popping a pimple will cause a brown or red scar to form that could last months; and scars, in the form of dents and pits, can last forever.
If your child is bummed because a huge zit arrived just in time for a special event, a cortisone injection given by a dermatologist may help to reduce redness and inflammation and speed healing. A dermatologist may also be able to recommend treatments for a teen with severe scarring.

Myth: You can't wear makeup or shave if you want clear skin.
Fact: Your child doesn't have to forego cosmetics as long the products used are labeled noncomedogenic or nonacnegenic, which means they won't cause breakouts. Some concealers now contain benzoyl peroxide or salicylic acid, which help to fight acne. Tinted acne-fighting creams may also help to fight pimples while hiding them.
However, if any product seems to be irritating your child's skin or seems to be causing breakouts, have your child stop using the product and call your child's dermatologist.
Cosmetics labeled "organic," "all natural," or those containing herbs have gained popularity, but they may contribute to clogged pores and acne, so it's best for kids who are prone to breakouts to steer clear of them.
Teen boys who have acne and shave can use either safety or electric razors, but should shave lightly around blemishes to avoid nicking the skin and causing irritation and infection.
Source

Parents of ADHD kids need treatment, too
Treatment for many young children with Attention Deficit/Hyperactivity Disorder should also include treatment for their parents, according to new research from the University of Maryland's ADHD Program.
In one of the first studies of preschool children with ADHD, the research team found that parents of children with the condition are 24 times more likely to have the disorder themselves, as compared with the parents of children without ADHD.
The study also showed that, when ADHD preschoolers also suffer from other serious behavioral problems, the parents are two to five times more likely to suffer from a wide range of mental health problems, including depression, anxiety and drug addictions.
"The evidence is dramatic and the message clear: We need to treat the whole family, not just the child," says University of Maryland psychologist Andrea Chronis, the study's lead author and director of the Maryland ADHD program.
The research is published in the December 2003 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Source

Alcoholism: Is it Inherited?
Genetic Component Not Yet Identified
There is a growing body of scientific evidence that alcoholism has a genetic component, but the actual gene that may cause it has yet to be identified. Studies of laboratory animals as well as human test subjects indicate that genetic factors play a major role in the development of alcoholism, but just how much a factor remains undetermined.
Children of alcoholics are four times more likely than other children to become alcoholics, according to the American Academy of Child & Adolescent Psychiatry, but environmental factors could be a factor in many of those cases.
Family, twin and adoption studies have shown that alcoholism definitely has a genetic component. In 1990, Blum et al. proposed an association between the A1 allele of the DRD2 gene and alcoholism. The DRD2 gene is the first candidate gene that has shown promise of an association with alcoholism (Gordis et al., 1990).

Less Sensitive to Alcohol
In another study scientist selectively bred two strains of mice: those that are not genetically sensitive to alcohol, and those that are acutely genetically sensitive to it. The two strains show markedly different behavior when exposed to identical amounts of alcohol.
The sensitive mice tend to lose their inhibitions and pass out rather quickly, earning them the nickname "long sleepers." "Short sleepers" are mice that are genetically less sensitive to alcohol. They seem to lose fewer inhibitions, and tolerate the alcohol for longer before they pass out.
"Alcohol consumption is influenced by a combination of environmental and genetic factors," said Gene Erwin, PhD, professor of pharmaceutic sciences at the CU School of Pharmacy, "This study indicated that genetic factors play more of a role, and we're trying to understand the power of those genetic factors."
If alcoholism can be traced to a particular gene or combination of genes, how can the information be used?
"These genes are for risk, not for destiny," stressed Dr. Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism. He added that the research could help in identifying youngsters at risk of becoming alcoholics and could lead to early prevention efforts.
Source

Social network key to teen suicide risk
By Randy Dotinga HealthDay Reporter — When it comes to preventing teen suicide, understanding the social world of adolescent girls may provide a key to predicting potential risk, says a new study.
Researchers found girls were twice as likely to think about suicide if they had few friends. The risk of suicide attempts also rose among girls whose social life was fragmented among different groups of friends.
While one suicide expert says the research offers nothing new, study co-author Peter Bearman contends the findings should help guide communities as they try to prevent suicide. For teens, especially girls, "what is important is having social identity, friendships and feeling integrated," says Bearman, a professor of sociology at Columbia University.
Suicide is the third leading cause of death among children aged 10 to 14 in the United States, and continues to be a major killer among young and middle-aged people, according to 2001 federal statistics.
In the new study, researchers looked at 13,565 students in grades 7 to 12 who answered federal questionnaires in 1994 and 1995. The researchers report their findings in the January issue of the American Journal of Public Health.
Teens were 1.4 to 2.7 times more likely to think about suicide if someone they knew — a family member or friend — had killed himself or herself. Students of both genders were about 1.5 times more likely to think about suicide if they acknowledged homosexual feelings, and girls were nearly twice as likely to consider killing themselves if they'd been sexually assaulted.
The likelihood of considering suicide doubled among girls who had few friends. They were also more likely to be at risk if their friends were not friends with each other, Bearman says.
But the risk of suicidal thoughts actually dropped among boys with few friends. The researchers wrote that adolescent boys are "more impervious" to their social worlds than girls.
The study points to a link between social lives and mental health, Bearman says, adding it reveals how difficult it is to predict which suicidal students will move from thoughts to action.
However, one suicide expert is skeptical about whether the findings shed any new light on teen suicide. Researchers already knew that teens are prone to imitate each other and at higher risk if their friends committed suicide, says Daniel Romer, a suicide expert and research director for the University of Pennsylvania's Institute for Adolescent Risk Communication.
"The findings about the social networks of suicidal youth are interesting, but we really don't know what they mean," says Romer. "Measuring a person's social network characteristics is very hard, and the study really does not take us much further along [beyond] what we knew already."

More information
Get details about the warning signs of teen suicide from the American Academy of Pediatrics. You can also try the American Foundation for Suicide Prevention or the National Center for Injury Prevention and Control.
(SOURCES: Peter Bearman, Ph.D., professor and chairman, Department of Sociology, Columbia University, New York City; Daniel Romer, Ph.D., research director, Institute for Adolescent Risk Communication, University of Pennsylvania, Philadelphia; January 2004 American Journal of Public Health)
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A devastating question: Does suicide discourse help or hurt teens?
By G. Jeffrey MacDonald The Christian Science Monitor
The unthinkable happened in Clark County, Wash., at the start of the 2000-01 school year: A 16-year-old boy committed suicide. Few in this rural region near the Oregon border dared even speak about it publicly.
Over the course of the school year, however, the deaths eerily kept coming. Five more students took their own lives in what experts term a teen suicide cluster. As panic set in, pressure mounted for a solution, but every option seemed to risk doing more harm than good.
"The ongoing concern all along has been whether to say anything at all," says Karyl Ramsey, then coordinator of the county's suicide-prevention campaign. "The fear was that talking about it might exacerbate the problem." After convening a task force and weighing the risks, Clark County officials gambled that new public-service announcements and school programs addressing suicide might create a safer youth climate.
But across the nation, the same questions remain: What, if anything, can prevent youth suicide? Does education on the topic lead depressed students to get help? Or do discussions instead run the risk of pushing some students closer to attempting suicide?
Nearly 5,000 people between ages 15 and 24 take their own lives in the United States each year. Only motor-vehicle accidents and homicides account for more deaths in this age group.
Although youth suicide rates have been dropping since 1994, researchers remain concerned as today's teen rates continue to be three times as high as those of the 1950s.
Yet because experts generally say they aren't sure what's causing rates to drop, prevention efforts keep emerging in all shapes and sizes, with intense debates never far behind.
Example: The TeenScreen program from Columbia University in New York. In it, high-school students in 95 communities don headphones, answer questions about their thoughts and feelings, and wait to see if evaluators encourage a meeting with a counselor.
The theory is simple: Screening for risk factors might save lives, while education about suicide might backfire.
"It's difficult to do direct education with youth that is safe and effective," says Laurie Flynn, director of the Carmel Hill Center at Columbia. "Just talking to kids about 'Don't do something' isn't terribly effective, since adolescents aren't especially responsive to adult admonition. Just having an assembly on suicide carries with it a possibility of stirring up those few young people who are very depressed and at risk. We just don't know enough yet about how to do (suicide education) well."
But officials for the state of Wisconsin strongly disagree. For them, education is a must. Since the mid-1980s, state law has required that every Wisconsin public school student receive instruction in suicide prevention.
"These kids are just suffering in silence," said Nic Dibble, a consultant to Wisconsin's Department of Public Instruction. "We can't guarantee there won't be a student who reacts negatively (to suicide-prevention classes). But on balance, we'd be doing more harm by not doing anything."
The roots of youth suicide remain mysterious. But social alienation in large schools and unrooted families, coupled with more substance abuse at younger ages and easier access to guns, have all been cited as factors in rising teen suicide rates in recent decades, says Lucy Davidson, director of education and prevention practice at the American Foundation for Suicide Prevention in New York.
Warning signs, such as loss of interest in activities and muffled cries for help, are almost always present in teen suicides, say experts. The challenge with youth is to identify those most at risk and get them promptly into treatment. But the question is: What type of treatment?
"Just raising general awareness can be dangerous because it tends to normalize the idea of suicide," says Davidson. "Awareness tends to disproportionately impact the population most at risk. It makes troubled youth aware of (suicide) as an option."
The volatile disposition of suicidal teens calls for education on the subject to be far more nuanced than efforts to raise awareness of health issues, such as smoking or pregnancy, according to Davidson. She believes educators have inherited a delicate task. They must reinforce the cultural taboo on suicide; that is, to say it's never OK. At the same time, though, they must remove the imbedded cultural stigma associated with getting help for mental illness.
In regions plagued by high rates of youth suicide, leaders on the prevention front are doing all they can to spark fresh public discussion. Virginia and Maine — two rural states where scant counseling resources have been connected to higher-than-average youth suicide rates — are concentrating new prevention efforts on training a cross-section of people to recognize warning signs and to persuade youth to seek help.
With help from a three-year, $900,000 grant from the Centers for Disease Control and Prevention, Maine is developing one of the nation's most comprehensive approaches. School staff are trained to spot suicidal behavior, students in a series of health classes learn how to cope with depression, and counselors take calls to a 24-hour crisis hotline.
Adults in Maine are also encouraged to broach the subject with students who show warning signs. But adults everywhere are apt to bristle at being nudged to raise a topic they fear might be harmful, say experts. Those delivering prevention programs to rural Virginia, where youth suicide rates are nearly three times the national average, say the group most opposed to discussing suicide are parents.
"A lot of parents, when you bring [a child's risk factors] to their attention, say, 'Oh, that's nothing. They've always been like that,' " says Calvin Nunnally, suicide prevention training coordinator at the Virginia Department of Health. "Most think kids are going through a phase when these things could be warning signs of suicide. Parents are pretty much in denial."
"Most parents tell me, 'Don't talk about it,' " says Kathleen Wakefield, a Virginia Beach mother who lost a 21-year-old son to suicide in 2001 and now talks to schools and parents about prevention. "It's that same backward idea that if you try to educate kids about drugs or sex then they'll start using drugs and having sex."
Most prevention efforts developed since the crisis peaked in the mid-1990s are too new or too unstudied for any consensus to have developed as to what works. Nevertheless, early studies have their tentative supporters.
Flynn at TeenScreen, for instance, finds encouragement in a 2003 Columbia University study suggesting that access to antidepressant medication might account for declining suicide rates since the mid-1990s. Conversely, she says, surveys suggest hotlines don't work because suicidal teens seldom obtain help or treatment on their own. Studies are being done of the programs in place in Maine and Virginia to determine if either is demonstrably effective or worthy of replication in other states. But prevention leaders say the potential for more suicides looms too large to sit back and wait for conclusive results.
"People still have a hesitancy to call it suicide when that's exactly what it is," said Nunnally, noting that many local newspapers don't report suicides as such. "It's better to put it on the table and deal with it than to push it under the rug and keep losing lives."
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