November
28, 2006
MHANYS DECEMBER 13TH HUDSON RIVER REGIONAL MENTAL HEALTH
POLICY DISCUSSION CANCELLED DUE TO LEGISLATURE'S RETURN TO ALBANY-
4 REGIONAL MENTAL HEALTH POLICY FORUMS WILL GO ON: Due
to the NYS Legislature’s anticipated return to Albany on December
13TH (read more in “NYS LEGISLATURE TO RETURN TO ALBANY ON
DECEMBER 13TH FOR “SPECIAL SESSION” TO ADDRESS CIVIL
COMMITMENT OF SEXUAL OFFENDERS,” below), the MHANYS Public
Policy Discussion scheduled for that day in Kingston, NY is being
canceled.
However,
4 other Mental Health Association affiliates will still be hosting
discussions about mental health policy issues in New York State
in December, which will include updates and a dialog with MHANYS
staff and members of the MHANYS Board of Directors. These discussions
will include updates on the status of mental health policy issues
currently pending in Albany and insight into what changes can be
expected with the Spitzer Administration. Most importantly, this
discussion will provide an open forum in which issues related to
mental health can be raised and discussed for possible inclusion
in the mental health policy agenda in Albany for 2007.
All
discussions are completely open to the public, and all individuals
interested in mental health policy in New York State should participate.
Most discussions will include lunch or refreshments.
4
Opportunities to Participate:
•
Binghamton – December 4th hosted by the Mental Health Association
of the Southern Tier
• Batavia – December 5th hosted by the Genesee County
Mental Health Association
• Buffalo – December 6th hosted by the Mental Health
Association of Erie County
• Glens Falls – December 14th hosted by the Warren/Washington
Association for Mental Health
Location
information for each event, as well as RSVP information is available
at http://mhanys.org/policy/Forum-Dates2006.htm
or by contacting Michael Seereiter at mseereiter@mhanys.org
or 518-434-0439 x221.
NYS
LEGISLATURE TO RETURN TO ALBANY ON DECEMBER 13TH FOR “SPECIAL
SESSION” TO ADDRESS CIVIL COMMITMENT OF SEXUAL OFFENDERS:
As was indicated in the most recent edition of the Mental Health
Update, Governor Pataki is calling the NYS Legislature back to Albany
for a "Special Session" on December 13th to take up legislation
aimed at civilly confining sexual offenders in state psychiatric
centers. The Governor's action is in response to the NYS Court of
Appeal's decision last week which found the Pataki Administration's
use of Mental Hygiene Law to “civilly confine” sexual
offenders in state psychiatric centers illegal.
This
solidifies questions about the Assembly and/or Senate’s return
to Albany, however what they will accomplish remains to been seen.
Great speculation about possible Legislative pay raises (partially
in response to the NYC Council’s recent pay raise) have been
mentioned in nearly every newspaper around the state in recent days.
Mental health advocates have been pushing for the Assembly’s
return to Albany ever since the NYS Senate passed the agreed upon
version of Timothy’s Law in September, so that this legislation
could be passed in the Assembly and delivered to Governor Pataki
for his consideration before the end of the year when he leaves
office. However, at this point, it appears that nothing has been
decided about any of these issues, including what the Assembly and
Senate will do with regard to the Governor's legislation to civilly
commit of sexual offenders.
MHANYS
and other mental health advocates have consistently opposed the
bills to civilly confine sexual offenders in state psychiatric centers
after their release from prison. Specifically, from our point of
view in the mental health community, (1) civil commitment would
place vulnerable individuals in psychiatric centers at a safety
risk; (2) cost the mental health system hundreds of millions of
dollars to contain only a tiny percentage of sexual offenders; (3)
and undo efforts made in the mental health community to erase the
common misconception that those with psychiatric disabilities are
violent and dangerous.
MHANYS
and others continue to contend that a more comprehensive approach
to sexual offender management is needed in NYS. Rather than a knee-jerk
reaction approach which simply tries to keep offenders off the street
after they have served their sentence, we join with the experts
in sex offender management in calling for a more effective and less
costly approach aimed at preventing sexual offense. This approach
would also include establishing longer periods of supervision and
monitoring for those who do offend and creating a state office entirely
responsible for overseeing all facets of sex offender management
(including education and prevention programs, investigation, prosecution,
incarceration, community supervision and treatment).
IN THE NEWS:
Speaker
Silver Needs to Change His Mind
Troy Record Editorial
By: The Star-Gazette of Elmira 11/24/06
For
those who have lost track, this law is named after 12-year-old Timothy
O'Clair, a Schenectady boy who committed suicide after his parents
fought for years to get him adequate mental health care. The family's
insurance coverage was limited, and the last-minute desperate attempt
to get Timothy care by relinquishing custody to the state proved
too late.
No
family - no one - should find themselves in such a position.
But
years of negative stereotypes about mental illness still cling to
us, and insurance companies have been reluctant to alter that norm.
If a person is diagnosed with a heart ailment rooted in a physical
imperfection, treatment is generally undertaken and continues until
full recovery or a long-term maintenance plan is set.
If
someone is diagnosed with bipolar disorder, an ailment rooted in
a physical imperfection in the brain, treatment is too often refused
or limited, regardless of the health impact of that policy. Old
notions that mental health issues are a defect in character, rather
than a flaw in brain function, have long buried that health care
disparity under a cloak of shame.
With
its passage of Timothy's Law, the Senate tried to help change that.
The law sets minimum outpatient and inpatient visit insurance standards
for everyone. In addition to assisting small businesses in meeting
any potential added costs, it broadens the scope of coverage large
employers must provide to adults and at-risk children - including
health issues such as major depression and panic disorders, illnesses
long dismissed as an indulgence to the weak willed.
It
is far from a perfect package. Too little is done to address addictive
disorders such as alcoholism and substance abuse. An earlier Assembly-backed
version of the bill included this coverage, but this version does
not.
This
Timothy's Law is an important first step, and the Assembly should
return before year's end to add its approval. A spokesman for Sheldon
Silver, D-Manhattan, said the speaker has no plans to call a special
session. We urge the speaker to change his mind.
Without
Assembly approval this year, the measure would die. Don't let that
happen without a vote, Mr. Silver.
Breaking
down this barrier is essential and long overdue.
Sex Offender Bill Considered. By The Associated
Press
Newsday, November 28, 2006
ALBANY
- The State Legislature will return to Albany Dec. 13 to consider
laws that would allow confining sex offenders in psychiatric facilities
after they have finished serving prison sentences.
Negotiations
will also heat up on other issues that could be enacted in the closing
days of Gov. George Pataki's 12 years in office. Among them are:
Action
on the closing of hospitals and health facilities statewide under
a plan scheduled for release today. Without the legislature's objection,
the plan could be effective Jan. 1.
A
possible override of Pataki's veto of an early retirement plan for
public workers.
Increasing the number of charter schools allowed in the state from
the current cap of 100.
Pataki
called the legislature back yesterday, less than a week after his
executive order to confine dangerous sex offenders in psychiatric
facilities was overturned by the state's highest court.
On
Nov. 21, the Court of Appeals said the Pataki administration acted
illegally when it ordered sex offenders held without hearings as
psychiatric patients after their prison terms were up. Pataki ordered
the convicts held because he was frustrated by the legislature's
failure to enact a law preventing their return to communities where
they might repeat their crimes.
Pataki
has said "civil commitment" is needed because of the high
rate of repeat attacks by some sex offenders.
Don't Rush to Legislate - Civil confinement of sex offenders
is too contentious to act on hastily. Editorial
Newsday, November 28, 2006
The
question of how to protect our communities from sex offenders is
so complex, and the solutions so elusive, that the last thing that's
needed now is a special session of the State Legislature to try
to pass a bill that the two houses have futilely batted back and
forth for many months.
The
issue is civil confinement: sending the worst sex offenders to psychiatric
facilities after they have completed criminal sentences for their
crimes. Last year, after the state's lawmakers failed to agree on
a civil confinement bill, Gov. George Pataki decided to confine
sexually violent predators by ordering the commitments administratively.
Last week, the Court of Appeals unanimously slapped down that approach.
Pataki
responded by saying he'd call a special session to pass a bill.
That's the wrong way to do it.
Clearly,
Pataki wants to resolve the issue before he leaves office. His stated
reason is all the work he has done, without getting the bill he
wants through the Assembly. But there's an obvious subtext: He wants
to be president, and presidential candidates always strive to appear
tough on crime.
The
governor-elect, Eliot Spitzer, also knows a lot about this issue.
As attorney general, he has had to defend Pataki's approach in court
- an effort the Court of Appeals has now rejected. But Spitzer does
agree with Pataki on the need for a civil confinement bill. Better
to leave this issue for Spitzer to handle after he takes office
in January.
Everyone
wants children protected from violent sex offenders. Pataki says
the State Senate bill that he favors is similar to laws in other
states that the U.S. Supreme Court has found acceptable. But civil
confinement still means sending people to psychiatric facilities
for treatment, even though many experts say that the personality
disorder in those who prey on children can't be treated successfully.
At
least in psychiatric centers, some argue, sex offenders can be monitored
and studied for treatments that may help. Maybe. And perhaps, with
carefully constructed judicial review, civil confinement can work
fairly. But New York shouldn't pass a law hastily, in a special
session, as one governor leaves office and a new one waits in the
wings.
Keep Sex Predators Behind Bars. Editorial.
NY Daily News, November 24, 2006
Gov.
Pataki is calling the Legislature into special session in an effort
to win passage of a law allowing New York to keep proven sexual
predators confined in mental hospitals long after they have finished
their prison sentences. Lawmakers should happily return to Albany
for the quick enactment of the strongest possible bill.
The
soon-to-be ex-governor issued his summons after the Court of Appeals
ruled that he could not institutionalize these dangerous felons
under existing state laws - an action Pataki began taking only because
the state Senate and Assembly couldn't agree on a so-called civil
confinement bill. They must now remedy that failure.
The
onus falls primarily on Assembly Democrats and their leader, Speaker
Sheldon Silver of Manhattan. While Pataki and the Republican-led
Senate have supported civil confinement measures for nine consecutive
legislative sessions, the Assembly took no action on the issue until
this year. Then it passed a bill that would have provided the alleged
predators with greater procedural protections than those fashioned
by the Senate. Then the two houses never finished conferencing on
the issue, for which Silver blames the Senate.
Enough
is enough. The net result was inaction on a vital matter of public
safety.
Pataki's
proposal follows a model that the U.S. Supreme Court has found constitutional
and is being used by 16 states. It sets up a process for screening
sexual offenders while they're still in prison, having psychiatrists
determine which ones are most likely to attack again and - after
a trial-like hearing - commit the most dangerous to secure treatment
facilities until they're safe for release.
Silver
says he supports civil confinement in principle. Gov.-elect Eliot
Spitzer goes for the concept as well. There is no reason the Legislature
and the present governor cannot come to terms on a muscular law
by year's end. Pataki has already confined 112 predators using procedures
invalidated by the court, which did a public service in not ordering
the immediate release of the dozen who challenged their confinement.
But it is only a matter of time before a court starts cutting predators
loose, unless Albany finally acts responsibly.
N.Y. Needs Law on Civil Confinement. Editorial.
Utica Observer-Dispatch, November 28, 2006
AT
ISSUE: Court ruling on sex offenders reiterates need for law
The
ruling by New York's top court regarding sex offenders illustrates
the need for state lawmakers to address the matter of civil confinement
— at last.
Our
state should have a legal process that protects the public, particularly
our children, from dangerous sex offenders and affords due process
of law to the offenders.
Gov.
George Pataki had used a state mental health law that allows people
deemed a threat to society to be confined in secure psychiatric
facilities to keep violent sex offenders likely to attack again
off the streets. This latest court ruling says Pataki didn't have
the authority to do that.
In
a 7-0 decision, the Court of Appeals found that 12 sex offenders,
who are still in custody, should have been granted a hearing to
determine whether they were still dangerous before being transferred
to psychiatric facilities. The ruling ordered hearings take place
immediately.
No
one wants to see dangerous sex offenders released, but no one who
appreciates the freedoms of our democracy should be happy about
denying anyone — however egregious their offense — due
process of the law.
This
issue of civil confinement for sex offenders, who have a high rate
of recidivism, has been out there for some time. Pataki's frustration
with the lack of action by the Legislature is understandable and
no doubt shared by many, but his solution was the wrong one. The
need for lawmakers to create a legal process for handling these
cases is clear and immediate.
And
as Assemblywoman RoAnn Destito, D-Rome, said, the new law should
also be specific about what level of security is to be used at the
Sex Offender Treatment Program at Central New York Psychiatric Center,
where some of these offenders will be confined.
There
has been some controversy over whether security hospital treatment
assistants or lesser-grade secure care treatment aides should be
the ones handling security for the sex offenders at Marcy. The new
legislation should resolve that issue with the safety of the offenders,
employees and the neighboring communities — as well as the
costs — in mind.
This
legislation can make New York a safer place to live. It's time to
act.
Proof Is Scant on Psychiatric Drug Mix for Young.
By Gardiner Harris
The New York Times, November 23, 2006
Their
rooms are a mess, their trophies line the walls, and both have profiles
on MySpace.com. Stephen and Jacob Meszaros seem like typical teenagers
until their mother offers a glimpse into the family’s medicine
cabinet.
Bottles
of psychiatric medications fill the shelves. Stephen, 15, takes
the antidepressants Zoloft and Desyrel for depression, the anticonvulsant
Lamictal to moderate his moods and the stimulant Focalin XR to improve
concentration. Jacob, 14, takes Focalin XR for concentration, the
anticonvulsant Depakote to moderate his moods, the antipsychotic
Risperdal to reduce anger and the antihypertensive Catapres to induce
sleep.
Over
the last three years, each boy has been prescribed 28 different
psychiatric drugs.
“Sometimes,
when you look at all the drugs they’ve taken, you wonder,
‘Wow, did I really do this to my kids?’ ” said
their mother, Tricia Kehoe of Sharpsville, Pa. “But I’ve
seen them without the meds, and there’s a major difference.”
There
is little doubt that some psychiatric medicines, taken by themselves,
work well in children. For example, dozens of studies have shown
that stimulants improve attentiveness. A handful of other psychiatric
drugs have proven effective against childhood obsessive compulsive
disorder, among other problems.
But
a growing number of children and teenagers in the United States
are taking not just a single drug for discrete psychiatric difficulties
but combinations of powerful and even life-threatening medications
to treat a dizzying array of problems.
Last
year in the United States, about 1.6 million children and teenagers
— 280,000 of them under age 10 — were given at least
two psychiatric drugs in combination, according to an analysis performed
by Medco Health Solutions at the request of The New York Times.
More than 500,000 were prescribed at least three psychiatric drugs.
More than 160,000 got at least four medications together, the analysis
found.
Many
psychiatrists and parents believe that such drug combinations, often
referred to as drug cocktails, help. But there is virtually no scientific
evidence to justify this multiplication of pills, researchers say.
A few studies have shown that a combination of two drugs can be
helpful in adult patients, but the evidence in children is scant.
And there is no evidence at all — “zero,” “zip,”
“nil,” experts said — that combining three or
more drugs is appropriate or even effective in children or adults.
“There
are not any good scientific data to support the widespread use of
these medicines in children, particularly in young children where
the scientific data are even more scarce,” said Dr. Thomas
R. Insel, director of the National Institute of Mental Health.
Psychiatrists
who prescribe drug combinations say that the ability to mix and
match medications improves their chances of being able to help children
who are seriously, even desperately, ill.
Dr.
Joseph Biederman, a professor of psychiatry at Harvard, said that
doctors commonly used multiple medicines to treat heart disease,
diabetes, cancer and AIDS. “Child psychiatry is not any different,”
Dr. Biederman said. “These drugs have revolutionized how we
treat severe psychopathology in children.”
The
controversy leaves parents in a terrible bind. Desperate to help,
many agonize over whether to medicate their children.
Mothers
and fathers sometimes disagree, with the dispute straining or even
ending marriages. Since some psychiatric drugs can cause worrisome
physical effects, parents say that they must on occasion make a
terrifying choice between their child’s physical health and
his mental health.
The
parents interviewed for this article told their stories, they said,
in hopes of gaining greater acceptance for their children and themselves.
Nearly all recalled being in a store when their child threw a tantrum
and feeling that onlookers branded them as bad parents. They also
said they hoped to help others negotiate what many said were unequal
and often fraught relationships with psychiatrists.
“We
struggled so much, made so many mistakes and felt so stigmatized,
I hope our story can make it easier for others,” said Jacquie
Erickson of Anchorage. Her daughter, Kaitlyn Johnston, 10, has taken
psychiatric drugs since she turned 5 for diagnoses that include
bipolar disorder.
ON
SHAKY GROUND
Stimulants like Ritalin are by far the most commonly prescribed
psychiatric medicines in children. But doctors routinely pair stimulants
with antidepressants, antipsychotics and anticonvulsants, even though
some of these medications can cause serious side effects, have few
proven pediatric psychiatric benefits and lack clear evidence about
how they interact or influence mental and physical development.
Last
year, the Food and Drug Administration required drug makers to warn
on their labels that antidepressants can cause suicidal thoughts
and behavior in some children. Anticonvulsant drugs carry warnings
about liver and pancreas damage and fatal skin rashes. The side
effects of antipsychotic medicines can include rapid weight gain,
diabetes, irreversible tics and, in elderly patients with dementia,
sudden death. When drugs are combined, these risks compound.
Ms.
Kehoe, who receives government financial and child-care assistance
because her children are considered mentally ill, said she knew
that there were risks to the drug cocktails. Both her sons are short
and underweight for their age — a common side effect of stimulants
— and she fears that the drugs have affected their health
and behavior in other ways.
“But
I don’t think the insurance would pay for it if the F.D.A.
didn’t decide that children should use it,” said Ms.
Kehoe, who herself takes psychiatric medication.
In
fact, the drug agency has specifically warned against the use of
Lamictal, one of the drugs Stephen takes, in children who, like
him, do not suffer from seizures because in 8 out of 1,000 children
the drug causes life-threatening rashes.
Stephen
and Jacob’s psychiatrist did not reply to telephone messages
left with an office secretary on three different days. Ms. Kehoe
said that she asked him to speak to this reporter but that he refused.
The boys have had 11 psychiatrists over the last three years, according
to prescription records, and many more before that, Ms. Kehoe said.
In
interviews, Stephen and Jacob said they hated taking their drug
cocktails.
“Everybody
hates meds,” Jacob said.
Ms.
Kehoe said her youngest son, Lucas Keck, was showing signs of attention
deficit disorder and might soon need to start medication.
“I
see the hyperness in him,” she said. “My pediatrician
has said that he would venture to say that Lucas will be A.D.H.D.”
Stephen
and Jacob were Lucas’s age — 6 — when they were
given their first prescriptions.
The
F.D.A. requires drug makers to prove that their drugs work safely
before the agency will approve them for sale in the United States.
But doctors can prescribe and combine approved medicines as they
see fit. Such mixing is common in medicine but rarely studied by
drug makers.
Psychiatrists
started mixing psychiatric medications because the drugs were only
moderately effective and often caused terrible side effects, said
Dr. Steven E. Hyman, the provost of Harvard University and former
director of the National Institute of Mental Health. “None
of these drugs by themselves do an adequate job of controlling symptoms,”
Dr. Hyman said.
If
one drug failed, many psychiatrists assumed that two or more drugs
used together might succeed. For decades, no one studied whether
this was accurate. But in recent years, a trickle of studies have
examined the question, with mixed results.
In
studies in adults, some combinations of two drugs have been shown
to work better than single medications to improve the symptoms of
depression, obsessive-compulsive disorder and the mania associated
with bipolar disorder. For example, a recent large government-financed
study in adults, published in The New England Journal of Medicine,
found that two antidepressants worked a bit better than one for
adults who suffered from chronic, severe depression. But other studies
have found no benefit from commonly prescribed drug combinations.
The
use of two-medicine combinations in children is on much shakier
ground. Even for single drugs, the effectiveness of some psychiatric
medications in younger patients is questionable: most trials of
antidepressants in depressed children, for instance, fail to show
any beneficial effect. But hardly any studies have examined the
safety or the effectiveness of medicine combinations in children.
A 2003 review in The American Journal of Psychiatry found only six
controlled trials of two-drug combinations. Four of the six failed
to show any benefit; in a fifth, the improvement was offset by greater
side effects.
“No
one has been able to show that the benefits of these combinations
outweigh the risks in children,” said Dr. Daniel J. Safer,
an associate professor of psychiatry at Johns Hopkins University
and an author of the 2003 review.
If
the evidence for two-drug combinations is minimal, for three-drug
combinations it is nonexistent, several top experts said.
“The
data is zip,” Dr. Hyman said.
Many
psychiatrists said that they turned to drug cocktails only in desperate
circumstances. “If you’ve got a 15-year-old who is cutting
up her arms, you’ve got a barn on fire and what are you supposed
to do?” asked Dr. Alexander Lerman, a child and adolescent
psychiatrist in New York, who said he rarely prescribed combinations.
Billy
and Jackie Igafo-Te’o of Jackson, Mich., are among the desperate.
In the last seven years, their 12-year-old son, Michael, “has
been on just about everything you can put a child on,” Mrs.
Igafo-Te’o said. He is now taking four medications: an antipsychotic,
an anticonvulsant, an antidepressant and a sleep medicine.
Despite
the medications, Michael’s behavior has grown increasingly
disruptive. He has kicked and punched holes in almost every wall
of the Igafo-Te’o home. He wrenched the sink off the wall
in the upstairs bathroom and pulled two bedroom doors off their
hinges, damaging the frames. The family no longer fixes the damage.
During
a recent visit, Michael and Mr. Igafo-Te’o were sitting on
the living-room floor. Michael wanted the phone. His father held
it out of reach to prevent Michael from playing with it. Michael
became increasingly desperate. He cried. He cursed.
“That’s
it, you have a timeout,” Mr. Igafo-Te’o said.
“No,
no, no,” Michael answered. “You pimp!”
He
slapped his father in the face, hard. Mr. Igafo-Te’o hustled
Michael into the kitchen and forced him to sit for 20 minutes.
“What’s
the purpose of all this medication if I still have to do that?”
Mr. Igafo-Te’o asked.
He
said he wanted to end Michael’s drug therapy. Among other
side effects, the drugs have made Michael obese, which has led to
asthma.
Mrs.
Igafo-Te’o quietly disagreed. “I’m afraid he wouldn’t
be able to focus,” she said. “I’m afraid he would
regress socially.”
“Regress
socially? Look at him!” her husband responded, motioning to
their son, crying uncontrollably on the kitchen floor.
“I
have to believe in something,” his wife mumbled and walked
out of the room.
Mr.
Igafo-Te’o watched her go and then smiled apologetically.
“We
always debate meds,” he said.
DIVERGENT
VIEWS
Most experts agree that some children are so violent or suicidal
that a combination of psychiatric drugs is worth trying. But recently,
more psychiatrists have been asking whether in some cases drugs
are being prescribed for children who do not need them, or for problems
that fall within the spectrum of normal behavior. The doubters are
especially concerned with the growing use of drug combinations for
preschoolers.
Fate
Riske, 3, of Fond du Lac, Wis., takes two antipsychotics and a sleeping
medicine to control what her mother, Elizabeth Klein-Riske, said
were hours-long tantrums, a desire to watch the same movies repeatedly
and an insistence on eating the meat, cheese and bread in her sandwiches
separately.
On
a recent visit, Fate played sweetly for four hours as her parents,
who both have trouble walking, sat in front of a television. Sucking
on a pacifier, Fate showed off her pink dress and matching shoes.
Mrs.
Klein-Riske credited the drugs for Fate’s cherubic behavior
during the visit. But a few weeks on a different antipsychotic led
Fate to become aggressive, talk rapidly and “run around wild,
totally out of control,” said Mrs. Klein-Riske, who receives
government financial and child-care assistance because her daughter
is considered mentally ill.
Fate’s
weight ballooned in five months to 48 pounds from 30.
Dr.
Gary Sachs, director of the Bipolar Clinic and Research Program
at Massachusetts General Hospital in Boston, estimated that half
the children referred to his clinic for research in recent years
— including many who took drug combinations — had the
wrong diagnosis and often did well on fewer drugs. “Even among
properly diagnosed bipolar patients, many come to our program already
taking medicines that interfered with each other,” Dr. Sachs
said.
But
Dr. Judith Rapoport, a senior investigator in child psychiatry at
the National Institute of Mental Health, said that in her experience,
few children were overmedicated. Dr. Rapoport studies children with
schizophrenia. Before entering her study, children must be drug-free
for three weeks.
“We’ve
had a handful of cases who are completely normal when they get off
drugs,” Dr. Rapoport said. “But most of these kids become
very, very sick and unmanageable without drugs.”
The
first psychiatric problem diagnosed in most children is attention
deficit disorder, treated with stimulants — drugs that improve
attentiveness. But when children’s problems persist, parents’
relatively good experience with stimulants often convinces them
to agree to try other medicines — in some cases drugs like
the antipsychotic Risperdal or the anticonvulsant Depakote that
have few proven benefits in children and greater dangers, said Dr.
Ranga Krishnan, chairman of the department of psychiatry and behavioral
science at Duke University.
“After
you get them on one drug, parents don’t seem to mind the second,”
said Dr. Krishnan, who said that he had grave doubts about the growing
use of psychiatric drug cocktails in children.
Antidepressants
are commonly paired with stimulants, but antidepressant use has
declined over the last year after the F.D.A. warning about suicide
risk. In their place, physicians are prescribing combinations that
include antipsychotic and anticonvulsant drugs, according to Medco.
From 2001 to 2005, the use of antipsychotic drugs in children and
teenagers grew 73 percent, Medco found. Among girls, antipsychotic
use more than doubled.
ON
AGAIN, OFF AGAIN
Andrew Darr of Caldwell, Idaho, whose sons took medications, said
that he was opposed to it from the start. “When you come home
from work and instead of getting them clawing at your feet and yelling,
‘Daddy, Daddy,’ you get a lethargic grunt, it just kills
you,” Mr. Darr said.
His
wife, Leslie Darr, eventually agreed to stop the medicines, but
only after a family tragedy.
The
Darrs have four children, Nicholas, 16, Nathan, 15, Becky, 12, and
Benjamin, 9. At 3, Nicholas suffered a mild brain injury when undiagnosed
appendicitis led him to suffer weeks of high fever, Mrs. Darr said.
Mrs.
Darr said that she was pressured by school officials to give Nicholas
a stimulant at age 6. Nathan soon followed.
Three
years later, the boys had a traumatic weekend away with relatives.
A month after that, Mrs. Darr said, both were hospitalized for a
week and given a diagnosis of bipolar disorder and prescriptions
for antipsychotic, antidepressant and sleeping medicines.
Over
the next three years, Nicholas’s weight ballooned to 140 pounds
from 52. Nathan went to 115 pounds from 48. Neither boy got much
taller, Mrs. Darr said. They did poorly in school.
Then
Becky developed a brain tumor. A nurse practitioner gave Mrs. Darr
free samples of an antipsychotic drug to help her cope. After starting
it, she said, she could not sleep or think straight. She realized
that she had been giving similar medicines to her sons for years
and she decided to wean the boys off the pills.
Their
behavior immediately worsened. At one point, Nicholas left the house
during a blizzard wearing only boxer shorts, Mrs. Darr said. They
found him in a tire swing saying, “Baaa.”
“There
were several times that we almost gave up,” Mr. Darr said.
But
after four months off medication, the boys’ behavior normalized,
the Darrs said, and they were transferred out of special education
and into regular classes. The Darrs recently allowed the boys to
spend their first evening at a mall without supervision, and in
July they gave both boys their first bicycles. “They’ve
come a long way,” Mrs. Darr said.
In
an interview, Nicholas said the drugs “were not cool.”
“You
go to school and everybody thinks, ‘Look at that retard,’
” he said.
Still,
most of the parents interviewed for this article said their children’s
behavior deteriorated rapidly without medication.
Joanne
Johnson of Hillsborough, N.J., described a psychiatrist’s
effort to wean her 17-year-old son, Brad, off of all five of his
psychiatric medicines as “the biggest mistake of our lives.”
Brad,
then 13, became suicidal and was hospitalized for weeks, Ms. Johnson
said.
“He
went into the hospital on five drugs and came out on five different
ones, but he was unstable,” she said. “It took a little
over two years to find the right match again.”
Brad
is now taking lithium, an antipsychotic, an anticonvulsant, an antidepressant,
a stimulant and a sleeping pill.
“He’ll
probably be on these for the rest of his life,” Ms. Johnson
said.
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