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Medication Nation

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By Judy Lin

Published Oct 1, 2007 8:00 AM


The Undecided

And then there are those who claim that our rush to medicate is premature. They point to the fact that some meds have been red-flagged by the FDA. Earlier this year, the FDA warned of a potential link between ADHD meds and the risk of sudden death among users 18 and younger with a history of heart defects.

Drugs for depression have also raised concerns. In 2004, the FDA required "black box" labeling on antidepressants, warning consumers of an increased risk of suicidal thinking among school-age users. A second warning was issued this year for young adults 18 to 24.

In fact, researchers found that while antidepressant sales dropped following the FDA's 2004 warning, youth suicides actually increased. Gail Griffith, who had served as patient representative to the FDA advisory committee that recommended the labeling, was quoted in a statement by the American Psychiatric Association, "I hoped the FDA could help to inform patients, but it seems many parents have simply become fearful of antidepressants, which so often are the life jacket preventing us from being sucked under by depression's powerful undertow."

Yet the truth is that few scientific studies have been conducted on drugs prescribed to children. Most of the drugs prescribed to kids are done so by doctors extrapolating from information about drugs approved for use in adults.

"Children aren't small adults," says Edward McCabe, physician-in-chief at Mattel Children's Hospital. "Their metabolism is different and they react differently to drugs than adults do."

Opinions

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Hence, he adds, "We don't [prescribe medication] lightly. There's a tension between applying the therapeutic technology that's available versus being sure that one is practicing safe pediatrics."

McCabe played a role in advocating for the Best Pharmaceuticals for Children Act, passed by Congress in 2002, which aims to enlist the pharmaceutical industry in testing whether drugs already approved for use in adults also work in children. It also mandates that all new drugs for kids be directly tested on kids, which, not too surprisingly, has drawn some fire. But McCabe poses the question, "Is it better to place [children] at risk in a controlled setting than in an uncontrolled environment?" He opts for the former, so much so that he has established a clinical trials program in his pediatrics department to expand research.

"The last 10 or 15 years have been nothing short of a revolution," says psychiatric researcher McCracken. "We've taken the scientific method and applied it to research on what treatments work and are safe for children with serious psychiatric disorders. We're at an exciting time where we're beginning to think about what a truly comprehensive treatment approach can and should be."

One promising piece of research is being led by depression expert Leuchter, addressing a problem common with antidepressants: For two-thirds of patients, the first drug prescribed doesn't work, and it can take months or even a year or more of trial and error to determine the most effective antidepressant for a particular patient. Leuchter's multi-university study, Biomarkers for Rapid Identification of Treatment Effectiveness in Major Depression (BRITE-MD), is aimed a developing a simple test: applying five electroencephalogram (EEG) sensors on a patient's forehead to measure brain patterns that might predict whether or not a particular medication is working. Initial findings suggest that this biomarker is highly predictive of antidepressant success.

The Drug-Free Promise

Even if the drugs do work, there are many who feel that approaches like therapy and changes in discipline at school and at home can do the job just as well. UCLA researchers couldn't agree more.

"We are very interested in developing educational or cognitive therapies — non-medical therapies — that could augment medication," says McCracken, who notes that ADHD medication fails to materially improve the lives of about four in 10 kids who take it. Similarly, psychotherapy used in tandem with medication has been clearly established as the best treatment for depression, says psychiatrist Leuchter.

McCracken and Piacentini are conducting multifaceted studies comparing medication, cognitive behavior therapy and other non-drug treatments, alone and in combination.

To learn how to best treat the social, generalized and separation anxiety disorders common among children and adolescents, these researchers are teaming up with their peers at other universities in the Child/Adolescent Anxiety Multimodal Treatment Study of 490 children. Their research will try to isolate which kind of child benefits most from which kind of treatment.

Another promising new approach is Mindful Awareness Practices. UCLA psychiatrist Lidia Zylowska, with Smalley's lab, is researching the use of this meditation-like training to help children and teens with ADHD. In a pilot study, teens reported improved ADHD symptoms, decreased anxiety and depression and improved ability to pay attention. Mindfulness also helps ADHD individuals better accept themselves and their struggles, Zylowska adds.

These forms of treatment may even help strengthen brain functioning, thanks to the brain's "neuroplasticity." Research on meditation, for instance, shows evidence of changes in EEG patterns and in the cerebral cortex, including areas involved in attention.

"There may be very powerful results when you learn self-regulatory tools like meditation or exercises like attention and memory training," says Smalley. "They may really change normal growth and gene expression. I think that we are at the tip of the iceberg, that what we learn for the next 50 years is going to radically alter what we know about how to 'self-regulate' our biology, including gene expression." But she cautions that, right now, "we tend to put more research into medication and fine-tuning medication and not as much in the psychosocial and alternative approach, including examining the culture in which we raise our children. For the 21st century, what we really need to be working on is prevention."

And as the science develops, the Millers, and millions of other parents, hope for more clarity, more reassurance and more reliable help for their kids. Kate has talked to other moms about their experiences and continues to search for more information.

"We're now looking for a new psychiatrist to do additional testing," she says. "We haven't committed to a drug plan. The therapist agrees. The pediatrician says yes, I'm willing to prescribe, but I want to look at all the information. One psychiatrist said, 'Oh, it's the common cold of kids these days. Your pediatrician is used to prescribing them.' That was not a good thing to hear, not really."

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