A case study on the ethical dilemma surrounding anti depressant experiments on children

Additionally, case studies are probably a biased source of information, as they are written about patients who stand out in the clinician's mind.

Sertraline mania

The NNH has a corresponding measure of the magnitude of beneficial treatment effects, the number needed to treat NNT in order for one more patient to have a good outcome. A six-point difference can be obtained just by changes in sleep patterns, with no change in any other symptom of depression. Is it clear that antidepressant exposure preceded the onset of the outcome? The number comes from a recent study published in the Canadian Journal of Psychiatry in which researchers tallied drug-store transactions from across the country. Indeed, the difference was virtually nil 0. The decisive design to evaluate the risk of antidepressant-induced mania would be to take a group of youths, randomly assign half to antidepressants and half to placebo and then follow them over a long time period to evaluate the relative risk of developing mania while taking antidepressants. Statistical significance does not tell you anything about the size of the effect. Keywords: depression, antidepressants, effectiveness, serotonin, placebo On February 26, , an article about antidepressants that my colleagues and I wrote was published in the journal PLoS Medicine Kirsch et al. Journal of Clinical Psychopharmacology, 29, —

Instead of increasing the amount of serotonin in the brain, it is supposed to decrease it. It is called tianeptine, and it has been approved for prescription as an antidepressant by the French drug regulatory agency.

The development of mania was not specifically assessed.

how to treat antidepressant induced mania

Symptoms had to be unduly severe or prolonged before clinical depression was decreed. I have since encountered this phenomenon over and over again. Additional references were gathered from the reference list of identified articles.

During a particularly bad time inhe went back on the stimulants, and this time, felt worse.

Antidepressant made me manic

There was just one thing left to do now that my daughter had been prevented from killing herself: attempt to understand why she had wanted to do so in the first place. Instead, we were interested in understanding the placebo effect. The Serotonin Myth Over the years, I have noticed something very strange in the antidepressant literature. Psychotherapy and Psychosomatics, 78, — Prevalence, burden, and treatment of insomnia in primary care. Bipolar depression hypothesis — when treating youths for depression, we are often dealing with the depressed phase of what will prove to be a bipolar illness. Meta-analysis suggests that approximately 3. In fact, she took Cipralex, which is escitalopram. Predicting Response to Treatment Severity of depression is one of the few predictors of response to treatment. False alarms hypothesis Mislabeling juvenile behavior as pathological when it still falls within normal limits; mistaking aggressive behavior due to other causes as pediatric mania [ 35 ]; or alternatively, mistaking the return of energy and positive emotions as depression lifts for hypomania. The authors analyzed mental health outpatient and pharmacy claims of 87, individuals, aged 5—29 years, over a median of 41 weeks. The FDA even did its own meta-analysis on all of the antidepressants that they have approved Khin et al. Reducing noise and hearing placebo more clearly.

The Medication as irrelevant hypothesis appears at least as plausible as any of the Iatrogenic hypotheses based on the data. One is personalized medicine based on genetic testing.

ssri child development

Ideally, use random assignment and a large trial to equate groups on characteristics besides compound. False alarms hypothesis Mislabeling juvenile behavior as pathological when it still falls within normal limits; mistaking aggressive behavior due to other causes as pediatric mania [ 35 ]; or alternatively, mistaking the return of energy and positive emotions as depression lifts for hypomania.

A case study on the ethical dilemma surrounding anti depressant experiments on children

But many are unable to wait. This appears to be a likely contributor to the rates of mania noted during treatment of mood, and actually could explain seemingly higher rates in youths than adults because of the possibility that bipolar depression will be the first phase of illness to drive treatment seeking. In the parlance of the decision-making literature, we are forced to rely on heuristics to guide our practices, and these may be biased in predictable ways such as overestimating risks [ 21 ]. That morning, I awoke to find that our paper was the front page story in all of the leading national newspapers in the United Kingdom. This hypothesis is likely to contribute to the high rates of mania observed in open trials, which ironically often have used better monitoring of manic symptoms than many of the blinded, randomized, controlled trials. I was not particularly interested in the drug effect. As part of its research into psychotropic drugs, CAMH offers a cheek-swab test that can swiftly determine which, if any, agents a patient can metabolize. I am persuaded that they not only have a right to know but that they should know. The NNH has a corresponding measure of the magnitude of beneficial treatment effects, the number needed to treat NNT in order for one more patient to have a good outcome. Canadian Journal of Psychiatry, 56, — How is it possible that medications with such weak efficacy data were approved by the FDA? For two days, we had her sleep in our bed on a sort of impromptu suicide watch, until the alien pull to self-destruction receded. This hypothesis appears consistent with longitudinal data about course of illness and epidemiological data; it can also account for much of the apparently high rate of manic symptoms emerging during the course of treatment for mood disorders. Faedda, Baldessarini, Glovinsky and Austin reported a rate of
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The Danger of Putting Youth on Antidepressants