Skip to comments.Therapy? Or Pills? A Quandary in Britain
Posted on 12/31/2004 1:13:02 PM PST by neverdem
LONDON, Dec. 20 - One year after British drug regulators advised against prescribing a new generation of antidepressants, except Prozac, for depressed adolescents, British doctors say they are in a frustrating bind.
Warned away from using the antidepressants, they are recommending psychotherapy for their young patients instead. But under the British health system, depressed teenagers face a six- to nine-month waiting list for psychotherapy, a situation unlikely to improve in the short term.
"On the ground, we feel very much abandoned," said Dr. Dick Churchill, a general practitioner and senior lecturer at Nottingham University. "The advice seems to be these kids should be having psychological treatment. But we don't have ready access to trained services to give them. So we are stuck in a difficult position at the moment."
Dr. Peter Hill, an independent child and adolescent psychiatrist and an honorary consultant to the Great Ormond Street Hospital for Children, said the advisory was at first greeted with deep concern and bewilderment by parents, patients and the general practitioners who are on the front line of medical care here.
"The phone was red hot for days on end," Dr. Hill said.
The situation has settled since then, he said, but a certain amount of confusion remains about antidepressants, particularly about those addressed by the regulators, most of which belong to the class known as selective serotonin reuptake inhibitors, or S.S.R.I.'s.
"I have a letter on my desk at the moment from a G.P. who thinks he is unable to prescribe any S.S.R.I.'s for any children, and that included 17½-year-olds," Dr. Hill said.
The government's warning, issued last December, came on the heels of an enormous rise in the use of antidepressants and stimulants among young people here. Prescriptions of the drugs to children in Britain jumped to 700,000 in 2002 from 400,000 in 2000, according to an international study by a research team from the University of London's School of Pharmacy, published in November in the journal Archives of Disease in Childhood.
From January 1992 until December 2001, the use of antidepressants for children rose 70 percent, according to a second study published in the journal by the same team.
The British government estimates that 40,000 children under 18, or about 1 child in 300, were taking antidepressants in 2003.
Doctors here say the popularity of the drugs could be traced to several factors, including the availability of newer drugs, greater awareness about childhood depression and an increase in diagnoses of the illness by family doctors.
In its 2003 advisory, the Medicines and Healthcare Products and Regulatory Agency, the British equivalent of the Food and Drug Administration in the United States, stopped short of an outright ban on prescribing antidepressants for children. But the recommendation was more sweeping than the action taken by the F.D.A., which in October toughened warning labels on antidepressants for children and adolescents but did not tell doctors not to use them.
Under the British guidelines, general practitioners are advised not to prescribe any of six newer generation antidepressants for children and teenagers and to consult with a mental health specialist before prescribing Prozac, which was exempted from the warning.
The regulators based their decision on data suggesting a link between the drugs and suicidal thinking and behavior among young people and a lack of evidence for their effectiveness in treating childhood depression.
In December, the British drug agency weighed in again, this time for adults, recommending, on the basis of an 18-month review of 600 published and unpublished clinical trials, that antidepressants not be prescribed for mild depression. But the officials stressed that the benefits of antidepressants for more severe depression were well proved, and said that there was "no clear evidence" of an increased risk of self-harm and suicidal thoughts in adults.
Psychiatrists in Britain say that for the most part, children and adolescents who were already taking the antidepressants continued to take them after the 2003 advisory was issued, but with greater vigilance by doctors. New patients who visited psychiatrists, as opposed to family doctors, were given Prozac if medication was required. "Specialists can still prescribe whatever S.S.R.I. is necessary, but we are using much more fluoxetine than before," said Dr. Mark Berelowitz, a child and adolescent psychiatrist who is a consultant at the Royal Free Hospital in Hampstead, referring to Prozac.
General practitioners, on the other hand, have grown increasingly squeamish about prescribing any medication to depressed children.
"The key thing that seems to be happening in my awareness is that most G.P.'s are fairly reluctant to prescribe any antidepressant to teenagers at the moment," Dr. Churchill said. "The guidance from the government has made everybody wary, even of Prozac."
In theory, the national health system advocates a holistic approach to mental health. Troubled or depressed teenagers are referred to mental health teams that include counselors and psychiatrists, all of them working together in treating the patient. The problem is the scarcity in the number of child counselors and psychiatrists, a shortage that has led to long waiting lists once a referral is granted.
Some experts believe the government's action was rashly taken. The evidence that the drugs cause suicidal thinking and behavior, they say, is not clear-cut, and they worry that some teenagers may not be getting the help they require.
The regulators "may have been flatly overcautious," said Dr. David Coghill, a senior lecturer in child and adolescent psychiatry at the University of Dundee in Scotland and a clinician.
"I did prefer the black-box warning that the U.S. came out with," Dr. Coghill said. "I think that was more considered. It addresses the concerns but does point out that the number of children and young people who will have these reactions are very small."
But many family doctors say that they were never altogether comfortable dispensing medication for depressed teenagers, but that often they felt they had no choice.
Still, the turmoil surrounding the use of antidepressants has had some positive repercussions. Psychiatrists say there is now a greater emphasis on consulting with child psychiatrists before prescribing medication.
And for the first time in a long time, the government now is focusing on the need for psychotherapists and psychiatrists for young people, and promising to steer more money into psychotherapy, a critical component to mental well-being, doctors say.
"The national guidelines, which are about to be published, are going to say that we should almost always be trying psychotherapy first, and medication should be in addition to that rather than something used on its own," Dr. Berelowitz said.
He added, "If my child was depressed, I would be very unhappy if a family doctor started him on medication and didn't arrange for a specialist opinion and specialist psychotherapy."
Dr. Sue Bailey, an adolescent forensic psychiatrist at the University of Lancashire in Manchester, said that "child psychology in the U.K. had been a Cinderella" for too long.
They should send people to church.
As it stands it is illegal to defend your home against the endless maurauding leftist UK thugs. Shoot these vermin in self defense as they attack you in your home? YOU go to jail.
Hell, I would need meds or "therapy" if I had to live in such a nightmare.
Just the weeniest hint of hyperbole here, perhaps. Sitting at my bedroom window here in Devon anxiously scanning the horizon with binoculars, the first marauding thug of the New Year has yet to appear. Any moment now, perhaps...Oh, and I'm intrigued by the 'leftist' epithet. I wonder what distinguishes a leftist thug from any other kind of marauding thug? In my limited experience of thugs, marauding or otherwise, political consciousness isn't one of their immediately obvious characteristics....
I have a much better solution for maladies of all kinds.
Prayer, Vigilance and Right Action.
The three essential ingredients of a long, healthy and happy life.
Peace and blessings to the good people of Britain.
"They should send people to church."
Then they would have to socialize the churches and put pastors on the public payroll, and the waiting time to get into a church would be six months to a year.
Heartily reciprocated, of course.
The Brit criminal element is enabled and coddled by the left. Innocent men like farmer Tony Martin suffer political oppression of the worst sort for exercising basic human rights.
But does being coddled by the left make the thugs themselves leftist? I doubt it. Also it's a mistake to assume that cases like Tony Martin's are frequent. When they happen, they get so much coverage and debate because they're rare, not because they're typical (if they were, they wouldn't get reported). In reality, domestic life in most of the UK is pretty safe most of the time, though I wouldn't wish to minimise the seriousness of those cases when it isn't.
Socialized medicine, anyone?