{"id":27457,"date":"2012-09-17T01:06:51","date_gmt":"2012-09-17T05:06:51","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=27457"},"modified":"2012-09-17T01:43:47","modified_gmt":"2012-09-17T05:43:47","slug":"talking-points-2","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/09\/17\/talking-points-2\/","title":{"rendered":"talking points?…"},"content":{"rendered":"\n
I started browsing the American Academy of Child and Adolescent Psychiatry<\/font><\/strong><\/u><\/a> web site several weeks ago when I was looking at Study 329. I was originally looking for their statements about the 2004 Black Box warning on antidepressants. While I found no policy statements<\/font><\/strong><\/a>, there were plenty of Press Releases<\/font><\/strong><\/u><\/a> of the AACAP’s opposition and later displeasure with the warning. I was surprised with the intensity of their reaction. This October 31, 2004 document entitled SUPPLEMENTARY TALKING POINTS FOR CHILD AND ADOLESCENT PSYCHIATRISTS REGARDING THE FDA BLACK BOX WARNING ON THE USE OF ANTIDEPRESSANTS FOR PEDIATRIC PATIENTS<\/font><\/u><\/strong><\/a> came out shortly after the warning was issued:<\/div>\n
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What do the research data suggest about the efficacy of antidepressants for treating depression in children and adolescents?<\/font><\/strong><\/em>
New research, such as the Treatment for Adolescents with Depression Study (TADS), confirms that using cognitive behavioral therapy (CBT) – a type of psychotherapy that focuses on managing negative emotions and thoughts – and fluoxetine (Prozac) results in successful treatment of moderate-to-severe adolescent depression. Seventy-one percent of the patients responded positively to the combination treatment of fluoxetine and therapy, which is a rate double the 35 percent response rate for patients on placebo. Over 60 percent of those assigned to fluoxetine alone were found to be responders by the end of the 12-week trial. This means that on average each practitioner would need to treat just three patients to see a strong response to fluoxetine. This is in contrast to the need to treat over 50 patients in order to see evidence of the medication causing suicidal ideation or suicidal behavior. The Work Group on Research finds this risk-benefit ratio for the treatment of pediatric depression acceptable for child and adolescent patients<\/u>… [underlined in the original<\/em>]
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What is the downside of not using antidepressant medications to treat my child and adolescent patients with depression?<\/font><\/strong><\/em>
The NIMH TADS did not find an advantage of cognitive behavioral therapy (CBT) alone over placebo in the short term. However, CBT has been shown to be effective in other treatment studies of depression in children and adolescents. For that reason, effective treatment may include CBT or other evidence-based psychotherapies alone or with the antidepressant fluoxetine as a first-line treatment for depression. In particular, psychosocial treatment has been shown to have a protective effect against suicidal behavior or ideation when combined with antidepressant medication…<\/sup><\/div>\n<\/blockquote>\n
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Why should childhood depression be treated with medications that carry any risk at all?<\/font><\/strong><\/em>
The AACAP Work Group on Research strongly supports the treatment of children and adolescents with depression despite risks. Pediatric depression is a real illness, with neurobiological underpinnings. Effective treatments for this disorder are available. Although antidepressant treatment carries risks, untreated depression has potentially greater risks, and treatment is effective, especially when started early. Depression is a serious illness, sometimes episodic and often chronic, when it occurs in childhood. In addition to the human suffering that occurs because of the depression, the symptoms can and do interfere with academic learning, peer relationships, and family interactions, often derailing normal development…<\/sup><\/div>\n<\/blockquote>\n
I didn’t expect that. The Black Box warning didn’t say they were contraindicated in kids, but the imperative tone here comes across as an injunction to treat. At the least, it certainly seems to overstate efficacy by my reading of the studies. And the TADS suicidality data is wide open for interpretation [The Real Suicide Data from the TADS Study Comes to Light<\/font><\/u><\/a><\/strong>][significant I…<\/font><\/u><\/em><\/a><\/strong>]. <\/div>\n

So it got me to browsing around and I continued to be surprised at the pro-medication bent to the site. Here are their practice guidelines [they call them parameters]. Take a look at Depression, Atypical Antipsychotic Medications, Bipolar Disorder. In a time when the front burner concern is the overmedication of children and teens, these recommendations seem both anachronistic and even suspicious [of pharma influence]… <\/p>\n\n\n\n
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AACAP Practice Parameters are clinical practice guidelines developed by the AACAP Committee on Quality Issues to encourage best practices in child mental health… Parameters are categorized as patient-oriented and clinician-oriented.<\/sup><\/div>\n
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    Patient-oriented parameters<\/strong> are designed to provide clinicians with assessment and treatment recommendations for child and adolescent psychiatric disorders. Recommendations are based on the critical appraisal of empirical evidence (when available) and clinical consensus (when not), and are graded according to the strength of the empirical and clinical support.<\/div>\n<\/li>\n
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    Clinician-oriented parameters<\/strong> are designed to provide clinicians with principles guiding the general and special assessment of children, adolescents, and their families, and the management of children and adolescents with special mental health needs. Although empirical evidence may be available to support certain principles, principles are primarily based on clinical consensus.<\/div>\n<\/li>\n

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Patient-Oriented Parameters<\/strong><\/sup><\/div>\n
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Clinician-Oriented Parameters<\/strong><\/sup><\/div>\n