Posted by Dr. Bob on April 19, 2001, at 8:53:15
> 1) I realize that it is difficult to do studies involving children, but have noticed more AD's being prescribed for children. In your opinion how safe is this? In my opinion, if the symptoms are severly disrupting the childs well-being socially etc then the benefits outweigh the risks, but what about the child who's symptoms are just limitting their life. What is your opinion on these meds for this group of children? Also I've heard cases of them being prescribed for babies in different countries. Have any studies been done on how these meds affect a growing individual?
There is a dearth of data on use of psychiatric drugs in children from controlled trials. In an attempt to rectify this situation, the FDA offers a patent life extension, if a drug company will do a clinical drug study with children. I agree that if the symptoms are severely disrupting, then a trial is warranted. Again, there is not sufficient knowledge to predict long term adverse effects of most of the psychiatric drugs in young patients. The only studies I am aware of with respect to effects of psychiatric drugs on growth rate in children, are some very old reports on the use of stimulants to treat hyperactivity: N Engl J Med 1972 Aug 3; 287 (5): 217-20, Depression of growth in hyperactive children on stimulant drugs. Safer D, Allen R, Barr E; J Pediatr 1975 Jan; 86 (1): 113-6, Growth rebound after termination of stimulant drugs. Safer DJ, Allen RP, Barr E.
> 2) As a person with a pharmacology background what is your opinion on the role of "talk therapy?" (psychology/therapist)
The scientific evidence accumulating suggests that psychotherapy is beneficial in combination with the pharmacological treatment of depression. So, although I do not do "talk therapy," I frequently send patients that I am treating with antidepressants to psychologists. I do not think psychotherapy is very useful for treating patients who suffer from psychoses. With these patients, the physician needs to establish good rapport, which I consider a form of psychotherapy, in order to keep the patient compliant.
> 3) Most studies are done just for several months regarding side-effects and effectiveness. My doctor has said that I can stay on my medication for life. What risk factors are involved in this option?
The long term effects of psychiatric drugs can vary with the type of medication. Most of these drugs in the long term can cause weight gain, which can lead to medical problems (e.g., diabetes, high blood pressure). Antidepressants fall into this class, as do mood stabilizers, and antipsychotic drugs. This last class, antipsychotic drugs, long term can cause abnormal movements (tardive dyskinesia), which is much less likely to occur with the newer compounds (e.g., Zyprexa, Risperdal, Seroquel). Otherwise, there are no other major concerns about taking these drugs for many years.
> 4) What's with these side effects?? I've noticed that when many people find a successful medication it causes weight gain and sexual disfunction. Personally I've tried many different ADs and haven't been effected in this way until I started taking one that was effective. Are the effects psychological or physical?
The therapeutic and adverse effects of antidepressants are the result of pharmacological effects of these compounds. Unfortunately, the properties that lead to therapeutic effects of the currently available antidepressants also lead to the side effects that you mention.
> 5) This question is probably related to my third and fourth questions. How accurate are the reporting of side-effects? For myself I have noticed with the older ADs, TCAs, alot of side effects that the doctors haven't acknowledged to be caused by the medication though my pharmacist has said they they can be and they have went away with the discontinutation of the medication. Are they being reported more accurately with the newer medications?
This is a good question. Only in the past 15 years or so have controlled trials adequately addressed the side effect issue. The best way to get the frequency data on side effects is to obtain this information as part of a controlled trial, involving placebo. The frequency of side effects needs to be adjusted for the frequency of those side effects seen with placebo. Additionally, in the design of a controlled trial, patients need to be asked specifically about some types of side effects (e.g., sexual), otherwise they might not mention them. So, with the tricyclic antidepressants, which have been available clinically for over 40 years, the controlled data on side effects are not available. I always believe a patient when he or she tells me about a side effect. The proof is found when the drug is stopped and the side effect goes away.
> 6) How much co-operation is there between different researchers? Different countries? And do you think more so would benefit developments?
Research is highly competitive, which is good. Research is also highly complex. Co-operative relationships are forged, when there is mutual benefit seen by both sides, no matter what country the investigators may be in. Otherwise, the enthusiasm for getting the experiments done is not there. I have had very successful collaborations with colleagues outside my institution and outside my country. I have also had unsuccessful collaborations, because the other investigators were really not interested in the project. On balance, the "sum is greater than the whole" applies here.
> And finally, I would like to say thank you. These newer medications are doing alot more towards improving the quality of life for members of my family, as I'm sure they are also helping many other people too!
You're welcome, although I was not involved in bringing any of the present drugs to marketplace.
poster:Dr. Bob
thread:60422
URL: http://www.dr-bob.org/babble/20010417/msgs/60422.html