20% of American children suffer from mental illness

The new SCHIP (State Children’s Health Insurance Program) law that President Obama signed significantly increases health coverage for children, which also includes mental health parity. According to Nancy Shute of U.S. News & World Report, health coverage is expanded to:

“4 million more children beyond the 6 million already covered but also brings mental-health parity to the state programs that provide insurance for children in low-income families, requiring that they get the same access to treatment for bipolar disorder, depression, anxiety, and other serious disorders as they do for physical ailments.”

Then I stumble across this:

“Mental-health needs are nowhere near being met,” says Jay E. Berkelhamer, past president of the American Academy of Pediatrics and chief academic officer at Children’s Healthcare of Atlanta. “At least 20 percent of all visits to pediatricians’ offices are related to mental-health problems.“

Normally, though, overworked pediatricians may not ask if a child has a mental-health problem—and may not know where to refer him or her if they do. About 20 percent of children and teenagers have a mental-health problem at any given time, or about 8 million to 13 million people. Two thirds of them are not getting the help they need.

That means out of roughly 40-65 million kids, we have 8-13 million who are “mentally ill.” And then about 5-8 million who aren’t getting proper mental help.

Color me cynical but I think 20 percent is a disproportionately high number to classify children as mentally ill. I think the percentage of adults being classified as mentally ill is exorbitant enough, let alone children who are going through stages in their lives where they’re simply developing, encountering mood swings, being disobedient, and perhaps, being — perish the thought! — normal children.

But let’s address something else here: I don’t think it’s impossible for children to suffer from mental illness but the incidence should be significantly lower.

According to Dr. Louis Kraus, the chief of child and adolescent psychiatry at Rush University Medical Center in Chicago, suicide ranks as the sixth-leading cause of death among ages 5-14 — “although rare.” From ages 15-24, it jumps to number three.

The key word in that last paragraph is suicide is “rare.” The rate of mental illness in children should reflect that somehow. While I’m very happy SCHIP includes widespread mental health parity for low-income families, I’m also concerned children will be overdiagnosed with a “mental illness” when they may simply be dealing with the normal challenges of a difficult life.

“I used to care, but now I take a pill for that.” — Author unknown

Philip Dawdy at Furious Seasons has some great posts on the bipolar child paradigm that further explore the murky world of psychiatry pushing psychiatric illnesses and psychotropic drugs on kids. I’d also recommend reading Soulful Sepulcher as Stephany recounts her and her daughter’s experiences in and out of the mental health system.

(pic from save.org)

Loose Screws Mental Health News

ReadWriteWeb reports Stony Brook University researchers discovered too much exposure to “texting, instant messaging, and social networking” can make teenage girls more likely to suffer from anxiety and depression. This landmark discovery sampled a whopping 83 teenage girls.

The results of their tests, recently published in The Journal of Adolescence, showed that the girls who excessively talked with their friends about their issues had significantly higher levels of depression. Today’s online tools provide even more ways for this to occur. Says Dr. Davila, “Texting, instant messaging and social networking make it very easy for adolescents to become even more anxious, which can lead to depression.”

The problem with these electronic tools du jour is that they allowed the girls to discuss the same problems over and over again. This caused them to get stuck obsessing over a particular emotional setback, unable to move forward.

–snip–

It’s not necessarily the medium through which the chatter tasks place that’s the issue – it’s the amount of discussion that leads to the feelings of depression. Said Dr. Davila, “[The girls] often don’t realize that excessive talking is actually making them feel worse.”

So we can conclude then that keeping your teenage daughter from MySpace, Facebook, Twitter, AIM, and texting will help improve her mental health so she’s less likely to be depressed. Back in the day, I just wrote morbid poetry in a sad, lonely marble notebook. Alas, those days are gone. (pic via reviews-for-you.com)

On a related note, another study has discovered that teens who watch TV for long periods of time are more likely to be depressed. (Does nearly everything cause an increased risk of depression these days?) The study tracked over 4,000 teenagers and their TV-watching habits. The conclusion? Seven years later, participants were more likely to be depressed and the risk increase with each hour of television exposure. Perhaps it’s because TV creates an unrealistic perception of how a person should look and act and how life should be. Although researchers of the study did note that exposure to electronic media yielded the same result.

On the Christian tip, I need to once again dispel this nasty rumor that the MOTHERS Act is intent on drugging pregnant women (and thereby the baby) to oblivion. (I addressed this issue around this time last year once again from Christians who think some left-wing liberal nuts are out to “indoctrinate hundreds of thousands of mothers into taking dangerous psych drugs.”) Once again, I need to repost the goal of the MOTHERS Act as stated in the original bill:

To ensure that new mothers and their families are educated about postpartum depression, screened for symptoms, and provided with essential services, and to increase research at the National Institutes of Health on postpartum depression.

The legislation is only intended to increase the resources for screening of mental issues in women. Women will NOT be forced to take medication if they do not want it.

In the Congressional findings, medication is mentioned only as a form of treating PPD. That’s not directly encouraging new moms to take drugs; it’s encouraging them to seek treatment, whether it be therapy or some other course. Not every new mom will need therapy, hospitalization, or medication, and this bill is far from attempting to “indoctrinate” moms with psych drugs. Also, the bill only mentions “medication” once. It does not even use the word “drug.”

It’s unfortunate to hear stories of women who suffered miscarriages or acted erratically as a result of medication. However, postpartum depression has become such a prevalent issue that proper screening — not necessarily medication — is needed. And the mother in conjunction with her doctor must make an informed and appropriate decision on how to proceed with treating her mental health. A great resource on the MOTHERS Act can be found at Postpartum Progress where blogger Katherine Stone vigilantly monitors the progress of this bill and clearly lays out what the bill entails:

• Encouraging Health and Human Services (HHS) to coordinate and continue research to expand the understanding of the causes of, and find treatments for, postpartum conditions.
• Encouraging a National Public Awareness Campaign, to be administered by HHS, to increase awareness and knowledge of postpartum depression and psychosis.
• Requiring the Secretary of HHS to conduct a study on the benefits of screening for postpartum depression and postpartum psychosis.
• Creating a grant program to public or nonprofit private entities to deliver or enhance outpatient, inpatient and home-based health and support services, including case management and comprehensive treatment services for individuals with or at risk for postpartum conditions.  Activities may also include providing education about postpartum conditions to new mothers and their families, including symptoms, methods of coping with the illness, and treatment resources, in order to promote earlier diagnosis and treatment.

Although a vote on the act was blocked in the Senate in September, Sen. Robert Menendez of NJ has reintroduced the bill, championing the cause for PPD awareness at the federal level.

And on a humorous note, if you are single and mentally ill, you can go to TrueAcceptance.com and find someone who suffers from mental illness just like you. That’s right, TrueAcceptance matches the mentally ill with… the mentally ill. The premise is based on the idea that matching people who both suffer from mental illness are more likely to understand and support each other. The idea amuses me but I’d be too afraid that being with someone else who suffers from mental illness would end up being an enabler. (via Fox News)

The Bipolar Child, Part II: Childhood bipolar disorder criteria

CLPsych wrote a post on the "Growing Up Bipolar" Newsweek cover story. I agree with most of his points. Especially:

1. Max's problems are described by the journalist as "incurable" and as "a life sentence." It is true that the kid is likely in for a life of trouble. But stating that such difficulties are a certainty for the rest of his life? That's a little too certain and it's not based on any evidence. Show me one study that indicates that 100% of children like Max will always have a high level of psychological difficulties and essentially be unable to function independently.

The article even mentions that "Max will never truly be OK." Apparently, I just learned from my recent viewing of Depression: Out of the Shadows that diagnoses are not static.

Miracles have happened but to say that Max's future doesn't have a grim tint to it is unrealistic. Not because of his diagnoses but because of all 38 different medications that he's already been on.

By 7½, Max was on so many different drugs that Frazier and his
parents could no longer tell if they were helping or hurting him. He
was suffering from tics, blinking his eyes, clearing his throat and
"pulling his clothes like he wanted to get out of his skin," says
Richie.

By the time Max had reached 8 years old, he was already showing the symptoms of side effects that can occur long-term. Tardive dyskinesia, hyperglycemia, diabetes, akathisia, neuroleptic malignant syndrome are all very real side effects that could develop in Max's teenage years and stick with him permanently. "Max will never truly be OK." Not because of his disorders but because these medications have given him a different "life sentence" — a life sentence of physical, visible afflictions in addition to the emotional and mental disorders he already struggles with.

I haven't really gotten into the child bipolar disorder conversation on this blog because

• it's such a controversial diagnosis that would require lengthy posts that I didn't have time for
• I found the entire diagnosis to be a bunch of hooey

But I will now.

Breggin takes on Newsweek's "Growing Up Bipolar" article

Breggin’s post on Newsweek‘s "Growing Up Bipolar" article makes good points but steers clear into wackiness throughout. My only wish is that instead of pointing out the problems of the psychiatric industry, he would have offered some suggested solutions.

Oh, and he flat-out gets some things wrong:

Newsweek makes clear that Max’s parents have serious conflicts over how to raise their son, but they have not pursued therapy, marriage counseling or, apparently, not even parenting classes.

The article DID mention that they tried to pursue marriage counseling but dropped out.

He says he has never been to therapy. But late last year, Amy demanded that the two of them see a marriage counselor. Richie agreed. They went a few times, but there were "scheduling issues," says Richie, and they haven’t gone back. For the moment, they are getting help from the same people who help Max. Anything that makes his life easier makes theirs easier, too.

Then he applies a broad brush from the cases of "out-of-control" children that he’s seen:

In every case of an out-of-control child I have seen in my psychiatric practice, either the parents were unable to reach agreement on a consistent approach to disciplining their child, or a single working mom was trying to raise a young boy without the aid of a male adult in the child’s life.

I like Peter Breggin’s approach to psychotropic drugs for the most part, but sometimes he just gets a little off-base for me.

Analysis of "Depression: Out of the Shadows"

The show is essentially Depression 101 – for those new to learning
about the illness. As someone who struggles with depression (within
bipolar disorder), I found a lot of the two hours pretty boring (90
minutes on personal stories and about 22 minutes for "candid
conversation"). The "a lot" comes from the stuff that I've either heard before or flies over my head, eg, how depression affects the brain, prefrontal cortex, neurotransmitters, synapses, etc. The personal stories were powerful: depressingly heartwarming. (Yes, I mean that.)

My heart sank as I heard the stories of Emma and Hart, teenagers who were diagnosed with depression and bipolar disorder, respectively. Both were such extreme cases that they needed to be sent away for special psychiatric care. They are on medications for their disorders; the specific drugs are never mentioned.

While watching Deana's story of treatment-resistant depression, I instantly thought of Herb of VNSDepression.com whose wife suffers from the same malady.

I tried to listen attentively for the antidepressant that Ellie, who suffered from PPD after the birth of her first child, would be taking during her next pregnancy. It was never mentioned.

My jaw nearly dropped to the carpet as Andrew Solomon, carefully plucked brightly colored pills from his pillbox that he takes every morning for his unipolar depression: Remeron, Zoloft, Zyprexa, Wellbutrin, Namenda, Ranitidine, and two kinds of fish oil. He might have even mentioned Prozac. He takes Namenda, an Alzheimer's drug to combat the effects of an adverse interaction between Wellbutrin and one of the other drugs that I can't remember. Solomon says he's happy. I'm happy for him and I'm happy that his drug cocktail works for him but I couldn't help but sit there and wonder, "Isn't there a better way?"

While I thought the stories covered the gamut, in retrospect, I'm surprised they didn't interview a veteran or U.S. soldier to discuss PTSD. If the producers were able to fit in dysthymia, I'm sure they might have been able to throw in a story about a soldier who struggles with depression and suicidal thoughts stemming out of PTSD. Considering all the stories coming out of the VA, it's rather relevant. It would have been more interesting than the Jane Pauley segment. But I'll get to that in a minute.

As I listened to the narrator, I couldn't help but wonder what alternate perspectives could have popped up. For what it was, I fear none. This was a Depression 101 show — a program designed to either get people to fight against fear and stigma and get help or to open the eyes of loved ones to this debilitating disorder. I'm not sure how to slip in an opposing view on medication from a doctor without confusing or scaring people away. What would Healy or Breggin say that would encourage people to seek appropriate care?

Holistic or natural treatment was not mentioned. It's not mainstream and it's not recommended by most doctors as first-line therapy. I would have been surprised had something been said about it.

The depression portion of bipolar disorder was briefly discussed in Hart's story then Pauley added commentary about her personal experience in the remaining 22 minutes of the program.

Pauley appears at the end of the show promising a "candid conversation" on the topic. The three experts: Drs. Charney, Duckworth, and Primm sit and smile politely as Pauley rattles on occasionally about herself. Some people might find her exchange endearing and personal. After the first 3 minutes, I found it annoying. As a journalist, I wish she would have taken the impartial observer approach rather than the "intimate discussion" approach. In my opinion, she seemed to have dominated the "discussion."

It ended up being a Q&A with each doctor. Her questions were focused and direct. I expected a little bit of an exchange between doctors, talking not only about the pros of medication and treatment like ECT and VNS but also the cons. (Should I apologize for being optimistic?) Charney interjected into the conversation maybe once or twice but was only to offer an assenting opinion. Primm spoke least of everyone on the panel. I think she was placed on the show solely to represent diversity.

There were no "a recent study said…" or "critics say such-and-such, how do you address that?" It was a straightforward emphasis on encouraging people to get help or for those suffering to get treatment. Pauley's segment didn't discuss any negatives (not with the medical director of NAMI there!). The closest the entire 2 hours gets to any cons is with ECT shock treatment and giving medication to growing children. The childhood medication thing isn't dwelt on. The basic gist is: Doctors don't understand how medication works in children but are working on trying to understand it and improve its efficacy.

Forgive me for being negative. The point of the program was designed to give hope to those suffering. Instead, it just made me feel even worse. Thoughts raced through my head: "Well, if this doesn't work, then it's on to that. And if that medication doesn't work then I'll probably be prescribed this therapy, and if that doesn't work, then I'm treatment-resistant at which point, I'll have to do…"

I hope the program does what it's designed to do and that's to get those suffering with depression to seek appropriate care. The one upside is that talk therapy was stressed. I'm a huge proponent of talk therapy myself. Let me know what you thought of the show if you were able to catch it.

In the meantime, this depressed girl is going to cure herself for the night by going to bed.

P.S. Is it really fact that depression is a disease?

Loose Screws Mental Health News

In Deutsches Arzteblatt International, a medical health online journal, two researchers contend that depression in children can be manifested through “weeping, irritability, or defiance.” Professor Claudia Mehler-Wex and Dr. Michael Kolch point out the ways to spot depression in children of various ages:

The signs of depression in infants are often screaming, restlessness, and weeping attacks for no clear reason. Preschool children may behave irritably and aggressively, while schoolchildren may be listless and apathetic. The symptoms in adolescents become similar to those in adults.

I’m no professor, doctor, researcher, scientist or expert but here’s what I can tell you: Much of this behavior is normal for children. Infants scream, become restless, and weep because they want attention. Preschoolers can be irritable and aggressive because they didn’t get their nap time. Schoolchildren may be “listless and apathetic” because they don’t like school or they don’t get to play as often. Adolescents are a bit trickier – they’re basically young adults at this point and it’s difficult to tell whether they’re enduring teenage angst or true depression.

But the point of the article is how depression in children is different than that of adults. It is estimated that nearly “3.5% of children and 9% of adolescents in industrial countries are depressive.” It’s scary to think that INFANTS are included in the 3.5% figure.

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A man jumped from the Golden Gate Bridge in a suicide attempt and survived. Apparently, the GGB is a popular place for people to commit suicide:

Last summer, Marin County Coroner Ken Holmes released findings from a 10-year study on suicide trends from the Golden Gate Bridge. In his report, Holmes found that 206 people plunged to their deaths from 1997 to 2007, including 59 San Francisco residents, a group that formed the largest percentage — 29.6 — of the jumpers.

Check out the photo to the left. I think it’s incredibly helpful how the government keeps things running these days.

(Image from SFist)

Loose Screws Mental Health News

Let’s start off small and build up, shall we?

A blog I came upon, Providentia, has a post on the suicide rate in Kentucky over a 10-year period. Male schizophrenics have the highest rate of suicide. The leading methods of suicide in the state are firearm use, overdose, and hanging.

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Mary Winkler, the preacher’s wife who killed her husband, has been moved from jail to a mental health facility, where she will serve the remainder of her three-year sentence.

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East meadow, a poster on the drugs.com message board, asks about Lexapro’s correlation to suicide. Her sister committed suicide while on Lexapro and questions whether the Lexapro might have affected her in that way. As a former Lexapro user, I can empathize with the change in her sister’s behavior.

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The Depression Calculator: see how much depression is costing your company and see if treatment is worth your while. I went through it for kicks and basically, I walked away feeling like it cost too much to hire someone with depression, especially if I were running a small business. Blah.

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Apparently, bipolar disorder is covered under the Americans with Disabilities Act (ADA). Starbucks is settling an $85,000 lawsuit with Christine Drake, a former Starbucks employee who suffers from bipolar disorder. It seems that Drake’s first manager was willing to work with her “psychiatric impairment” and allow her to gain “extra training and support.” Then, get this:

“But, during her third year, new management told her she was “not Starbucks material,” refused to continue the accommodation and ultimately fired her for discriminatory reasons, the agency alleged.”

Starbucks probably put up one helluva fight, but in the end, they’ve tried to put a good face and good spin on the situation:

Starbucks agreed to pay Drake $75,000 and donate another $10,000 to the Disability Rights Legal Center, which provides legal representation for low-income people with disabilities facing discrimination, as part of the settlement.

“The facts of this case illustrate how relatively minor accommodations are often all that disabled people need to be productive members of the work force,” said the EEOC’s San Francisco district office director, Joan Ehrlich. “It is important that all of Starbucks’ managers understand their legal duties regarding disabled employees and provide them with the tools necessary to succeed. This is in everyone’s best interest.”

Ms. Drake, who seems to be more than capable of handling a job well, has probably eeked out several years of a barista’s salary from the Starbucks suit.

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I’m amused, but it’s not necessarily a good thing.

Johnson & Johnson is gearing up to put Risperdal for children on the market. I’m sure other blogs have beat me to the punch on this, but I just came across this info and found it absolutely retarded. (But what do drug companies care?)

The FDA has approved “expanded use” for Risperdal in teenagers who suffer from schizophrenia and the short-term treatment of bipolar mania in kids ages 10-17. I’m leery enough about antidepressants in kids let alone antipsychotics.

“J&J said the agency has not requested the company perform any additional studies, implying that it need only agree with the FDA on acceptable labeling for the expanded uses in order to gain final approval.”

I wasn’t sure what “expanded use” was so I looked it up. This was the best I could come up with:

“Applications for a new or expanded use, often representing important new treatment options, are formally called “efficacy supplements” to the original new drug application.”

Well, I didn’t know what efficacy supplements were so I looked that up too:

“The legislative history indicates that this provision was directed at certain types of efficacy supplements (i.e., supplemental applications proposing to add a new use of an approved drug to the product labeling).”

So – correct me if I’m wrong – it sounds like the studies performed that led up to this “expanded use” are not as rigorously evaluated by the FDA as the initial studies that allowed the drug to be released on the market in the first place. It just seems like a company and the FDA simply need to agree on “acceptable labeling.” So if we’re following the theory that I’m still correct, the FDA doesn’t follow up on the clinical trials performed on these children, they just agree with J&J on the “acceptable labeling.” Doesn’t that thought make you feel all warm and fuzzy inside about your health?

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On the subject of children and psychotropic medications, 12-year-old Christopher Pittman shot and killed his grandparents and then set their house on fire in November 2001 all while on an adult dosage of Zoloft. It looks like the drama is still playing out in June 2007.

According to CourtTV.com, Pittman suffered from hallucinations while on the 200 mg dose and while in jail, displayed symptoms of mania.

“Three years after the killings, Pittman was tried in adult court and convicted of murder. He was sentenced to 30 years in prison. He was then 15 years of age.”

No doubt Pittman should be held responsible for what occurred, especially if he admitted to the killings (which he did). However, the situation raises a few questions. First of all, why was he on 200 mg of Zoloft when he was TWELVE? Why wasn’t he considered mentally ill and placed in a mental health facility? I could go on and on. While Pittman “did the crime and needs to do the time,” why isn’t the doctor who prescribed this not present in any of the reported stories? If this incident was 2001, it can only be worse for antidepressants and other psych meds today.

Teens should not have access to parents' guns

“Montgomery County District Attorney Bruce Castor said he thought the teen had gone to school ‘to make a big show without shooting anyone.'” – Philly Inquirer article

The more I read about Shane Halligan, the more I realize that this 16-year-old had more access to guns and agility with them than most his age. He was an Eagle Scout and had an intense fascination with guns. He also knew where the key to his father’s gun cabinet was located.

It seems a bit of a stretch to hold his parents accountable in the face of such a tragedy but why did Halligan know where the key was located? Why? Was it that they trusted him? Was it because he had taken so many shooting classes and was so well-versed in gun technology that his parents had no reason to fear? It is a tragedy, but one at the very least, parents with guns should learn from:

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Never let your child know where the key to your gun cabinet is.

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The Inquirer editorial addresses this:

“That fatal mistake was put in motion by Shane Halligan himself. Eagle Scout, fire company volunteer, ‘all-American boy,’ in the words of one parent, Halligan apparently despaired over falling grades. His parents talked of limiting free-time activities until he raised his grades.

Such caring parenting should not have become a life-and-death matter. But Shane Halligan was able to secretly grab his father’s AK-47, smuggle it into school, and shoot himself – with no chance for anyone to talk him safely through his pain.

Why does anyone need such a powerful weapon at home, and how could a teen get his hands on it so easily? Those questions no doubt haunt the Halligan family today.”

Kids might seem well, but teenagers are a volatile bunch. One never knows when a teen might “snap.” With the recent surge of school shootings, I’m not going overboard when I say parents should not allow their children – no matter how old – to have access to their gun cabinet. If your son or daughter does not have a permit to use a gun, s/he should not have easy access to a gun. It’s that simple.

Much of the latest articles surrounding the Montgomery County shooting have focused on better protection for schools and how to prevent children from bringing weapons to school. These focuses are valid. However, focusing on what drives teenagers to performing such actions is also just as valid. The Inquirer has an article on how to spot the signs of depression in teens. It doesn’t cover everything but it gives a bit of help. One thing I do appreciate the article pointing out is that males tend to seem more angry than sad when struggling with depression.

“Young boys and some men tend to manifest this profound depression more in irritability and angry outbursts,” said Nadine Bean, an associate professor in West Chester University’s master of social work program. “Sometimes, a boy is labeled as incorrigible when, in fact, he may be struggling with major depression.”

And why do some students choose school – a public place – to take their lives?

“Typically, those committing suicide at school are looking for a place where they can enjoy greater attention and recognition,” [Ronald Stephens, director of the National School Safety Center, a nonprofit that studies school violence and provides violence-prevention training, in Westlake Village, Calif.] said.