radicalnorthbelfast

GPs to stop prescribing antidepressants blamed for suicidal feelings in under-18s

· Pills to be phased out for up to 40,000 children
· New treatments to include exercise and counselling

Sarah Boseley, health editor
Wednesday September 28, 2005
The Guardian

Doctors were yesterday told to stop giving antidepressants to children and people under 18, because of the risks that the pills will make them feel suicidal.

The new NHS guidance marks a watershed in the treatment of children's mental health. It shifts the focus sharply away from the psychiatric drugs that around 40,000 children are thought to be taking for depression, anxiety and other problems. Children with mild depression should be given advice on diet and exercise, the guidance tells GPs. Those with moderate and even severe depression should be offered a three-month course of counselling.

The guidance is likely to cause consternation among GPs who do not have enough counsellors and therapists available to treat all the children who will need help. "The very significant shortage of practitioners able to deliver these therapies is a cause for concern," said Dinah Morley, the deputy director of the charity Young Minds, which applauds the new emphasis on therapy.

The government's National Institute for Clinical Excellence (Nice), which has produced the guidance, says only one drug - Prozac - may help children, and even that carries risks. Only if the "talking therapies" do not work can children be prescribed antidepressants - and even then, only in combination with other forms of counselling and close monitoring for side- effects.

Until recently, most under-18s diagnosed with depression have been treated by their GP and most will have been given a prescription. But in response to growing concern at the potential of the modern antidepressants to make young people feel suicidal - highlighted over several years by the Guardian - Nice has said pills should never again be the treatment of first resort.

In June 2003 the drug licensing body in the UK warned doctors of the risks in prescribing any of the modern antidepressants known as the SSRIs (selective serotonin reuptake inhibitors) for anybody under 18, with the exception of Prozac. All of them had a tendency to increase suicidal thinking, but only Prozac showed any benefit in children to counterbalance the dangerous side-effects.

A study in the Lancet in April last year, which looked not only at trial results the drug companies had published but also those they had not, confirmed the risks to children.

From the mid-90s until two years ago, more and more children who were diagnosed with depression were given tablets by their doctors. The SSRIs were much better tolerated than older antidepressants and were thought very safe for GPs to prescribe. The annual number of prescriptions to those under 18 soared from 13,227 in 1995 up to 27,658 in 2003.

But then the few clinical trials carried out in children had shown that the drugs had serious risks. Some children felt suicidal. That was the case with adults too, but significant numbers of adults appeared to recover from their depression. In children, there was not significant evidence, except for Prozac, that the SSRIs had any benefit to set against the risk. This only came to light because GlaxoSmithKline, British manufacturer of the bestselling SSRI, Seroxat, applied for a licence for the drug to be used in depressed children. It submitted the trial evidence it had to the Medicines and Healthcare Regulatory Authority (MHRA), which regulates drugs.

The data showed that 3.4% of children experienced mood changes, tried to harm themselves or thought of suicide, compared with 1.2% who took a dummy pill in the trials. At the time, there were 8,000 children on Seroxat. In June 2003 the MHRA put out a warning to doctors that they should no longer prescribe it to under-18s. In September they issued a similar warning for a second drug, Efexor. On December 11 the MHRA told doctors all the drugs, except for Prozac, were unsuitable for children, although it left it up to doctors to decide whether or not to continue using them, and many are thought to have done so.

Tim Kendall, joint director of the National Collaborating Centre for Mental Health, who was one of the authors of the Lancet study and also led the formulation of the Nice guidelines, said they were even more clear now about the risks. "No child, however severe the depression, should have their firstline treatment with a drug," he said.

He and his colleagues are concerned about the numbers of children with depression, which is sometimes triggered by a sad event like a death, but is often linked to poverty, deprivation, abuse and family breakups. "Our view is that we should be targeting these children as best we can," he said. "Out of 1,200 kids in a comprehensive, at least 40 would be expected to suffer a diagnosis of depressive illness and only 10 are getting any help."

The new guidance for doctors says GPs should advise children with mild to moderate depression on ways they can help themselves through exercise and diet. "But then if there is any significant risk, we should be offering individual cognitive behaviour therapy or family therapy, depending on their needs," he said. "We're really serious that we don't think these drugs should be used lightly."

Even when a young person is severely depressed, the first step should be psychotherapy for around three months. Only if there has been no improvement after four or five sessions should the doctor - and by this stage it would be a psychiatrist - consider prescribing Prozac.

Andrew Dillon, chief executive of Nice, said the guideline "makes it clear that psychological treatments are the most effective way to treat depression in children and young people." Children taking pills should talk to their GP about phasing them out.

At present, there are not enough counsellors and therapists to help all the children who may need it. Yesterday Louis Appleby, the national director for mental health, said: "We know that not everyone who needs treatment is able to access it easily or quickly and expertise and services are not equally distributed around the country." He added that the government was "considering ways of increasing numbers of staff" trained in cognitive behaviour therapy, which is usually the preferred treatment for depression. More than £300m had gone into child and adolescent mental health services.

Mind, the mental health association, urged the government to give the NHS the support and resources it would need to ensure children have proper access to psychological treatments. Research on antidepressants "has shown many to be totally unsuitable for young people. They must be provided with effective alternatives," said a policy officer, Alison Cobb.

"These guidelines are a welcome step in the right direction: the onus is now on the government to provide the means to make them happen," said Liz Nightingale of the mental health charity Rethink.

Danger signs

In 2003, under-18s in England were given 27, 658 prescriptions for antidepressants

40,000 children and young people are thought to be on psychiatric drugs, including antidepressants

Doctors were warned in 2003 of the risks of using Seroxat, Efexor, Lustral, Cipramil, Cipralex and Faverin in children and young people

A survey of GPs in March 2004 found 80% thought they were prescribing SSRIs to too many adults and children

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Interview with Gerard McCartan
father of young Danny McCartan
who took his own life in 2005.
Taken from COMMUNITY ACTION
newspaper Cliftonville C.E.P.

Last month Community Action carried an article on the newly formed Danny McCartan Youth Drop-in project, based in Cliftonville Community Centre the project provides a safe environment for young people aged between 13yrs and 25yr olds. This month Community Action interviews Danny McCartan’s father Gerard McCartan on how the family are coping since young Danny’s death.

Q1/ in the months since Danny’s death how have you and your family coped and what sort of professional help have you received from the North and West Health Trust?

Without the help of family and friends we couldn’t have coped. We are also grateful for the assistance of P.I.P.S. through Jo Murphy and Phillip McTaggart. Their help and advice has been a great comfort to the family, it has also enabled us to meet other families who are trying to come to terms with suicide of a loved one.
Where we have been disappointed has been the response of the statutory agencies such as the North and West Belfast Health Trust, they were absolutely no use when Danny was alive and even less now that he is dead.

Q2/ What have you learned about suicide and the causes of suicide?

Since Danny’s death I have studied a lot of information on suicide, I have learned through talking to other families, trying to question health experts and the internet, my knowledge of the issues surrounding suicide has greatly improved. From my own perspective it is clear whatever the causes of suicide? When patients go to the health professionals suffering from depression or suicidal tendencies there is very little help available apart from prescription of anti depressants, this is especially true for those under eighteen.

Q3/ Depression appears to be linked to the recent surge in suicides in North and west Belfast. Do you believe that patients suffering from depression are receiving the necessary counselling and professional psychiatric treatment?

The waiting lists for young people looking for professional counselling or psychiatric treatment are subjected to intolerable delays and waiting lists. In North and West Belfast there are no psychiatric beds for under eighteens which is a total disgrace. Whilst waiting to see a counsellor or get professional treatment patients are often given anti depressants to control their depression. I am concerned that a certain type of anti-depressants called SSRI’s that has been subject to a number serious international health alerts. These drug alerts warn of the increased danger of suicide and suicidal thoughts among some patients especially those under eighteen.

Q4/ Was Danny being treated with SSRI’s and how long had he been prescribed them? Have or did any of the health professionals involved in Danny’s case advise him or you of these suspected dangers?
Yes Danny had been treated for depression with anti depressants from he was sixteen, neither Danny or the family were warned about any potential dangers of suicide thought the use of SSRI’s

Q5/Do you believe that the general public needs to be warned about the dangers of these SSRI’s?

Yes, a certain tablet Danny was taking from he was sixteen years old up until his death had never been tested on children and adolescents for side effects. Just recently the drug is being investigated in USA. We only learned of the potential dangers after Danny’s death. We asked his doctor why he was prescribed this particular drug and we are still waiting for an answer.

Q6/ the Danny McCartan Drop-in project named by the young people of the area and Danny’s friends and based in Cliftonville Community Centre. You are a volunteer for the project. What if anything have you learned about the difficulties faced by many young people today?

First of all we are very proud of the Drop-in project named after our Danny and we would like to thank all involved in keeping his memory alive. The erection of the wall mural for Danny inside the main hall of the community centre is an amazing likeness of young Danny and a wonderful piece of work by the artist. I have recently started volunteering at the drop-in and that has given me a better opportunity to get to know some of the young people. The problems that face young people today are different than in times past, pressure on young people through the media and television to be high –achievers, they are told that anything is possible. When young people ‘fail to achieve’, they then feel that the have failed to make the grade. Drugs, alcohol abuse and anti social behaviour then fill the vacuum in areas like north Belfast with no statutory youth provision.

Q7/ In Conclusion, the DMC Drop-in project aims to campaign on the issue of teenage suicide, what direction do you think that campaign should concentrate on?

The Drop-in project aims to take a two pronged approach to the issue of teenage suicide. Firstly the drop-in itself has to provide a safe place for young people to gather and socialise. It is through talking and listening to young people that we hope to learn about the problems they are facing. It is important that young people and the wider community engage with each other, this engagement gives the young people feel a sense of self worth, an understanding of their place in the community and the important part that they have to play in making this community a better place to live for everyone. The second issue that the project is concerned with is campaigning on the issues surrounding suicide and especially the effect that SSRI’s are having on our young people. The latest study by the British Medical Council and published in its journal BMC Medicine warns that it is not only young people but also adults who need to be cautious about using these SSRI’s. It is of the utmost importance that the statutory health agencies north and south of the border stand up to the multi-national drug companies on issues of public health.

PEOPLE HAVE A NEED TO FEEL THEIR PAIN

Daily Ireland 10/10/05
Pain brings families awareness
CHARLES MCMENAMIN
The US psychotherapist Arnold Mindell said: “People have a need to feel their pain. Very often pain is the beginning of a great deal of awareness. As an energy, it awakens consciousness.”
Imagine someone you love being missing without trace for five weeks — no contact, no sightings. Imagine knowing that that person is capable of self-harm and may be in need of care and attention.
Then imagine switching on a radio some morning and hearing that a body has been taken from the local river. This certainly asks questions of the media’s approach to this type of incident and the sensitivities needed.
That is one of the experiences we heard at a conference in Brussels last week hosted by Sinn Féin MEPs Bairbre de Brún and Mary Lou McDonald on the subject of suicide. The conference was also attended by MEPs Gay Mitchell (Fine Gael) and Kathy Sinnott (independent) and a representative from the Irish government.
The experience of pain and trauma associated with suicide is something that has affected all walks of life on our island — cross-Border, cross-community, cross-gender. The list is endless, yet the hurt imposed on the wider families of the person who has taken their life is immense.
There are very few support services available from the statutory sector to help families who find themselves not only grieving for someone who has been a major part of their lives but to answer in some way all of the complicated and mixed feelings associated with suicide. A big theme during the conference was the persistent failure of health-care systems, both North and South in Ireland, in dealing with the issue of suicide prevention, as well as identifying those most at risk and having intervention agencies and strategies in place on an all-Ireland basis to give families and individuals more flexibility and choices to meet their needs.
Another experience shared was that of a community worker who was assisting an individual within the “at risk” category and needed to access services immediately. Living on the Border became a problem because of two different health-care systems. The community worker was refused help because the individual’s family could not come up with an initial lump sum of cash that was to be put up front to access a detoxification facility.
This certainly raised some questions when you think of the equality agenda and all-Ireland approach that were supposed to be part of the Good Friday Agreement. Where was the equity and co-operation in health there?
Everyone on the delegation had stories to tell and proposals to make, all of which were strongly put across and received by the MEPs and NGOs present.
The pain and feelings of frustration coming from the families and community groups are something that cannot be ignored. This is particularly relevant when one considers that, at European level, suicide is recognised as a major public health concern, yet locally and nationally it does not seem to have been prioritised by the Irish or British governments.
No one could have failed to have been touched by the stories of all the individuals who travelled from the north, south, east and west of Ireland. I would like to encourage everyone to keep up the hard work and stay unified in their approach.
The pain felt by these families has certainly brought to them an awareness of the needs of people at risk of suicide. I have no doubt we have not heard the last of the families as a campaigning group.
It is also timely and appropriate to praise what is widely considered to be one of the best intervention programmes on suicide prevention in the northwest — Foyle Search and Rescue. The group’s 40 volunteer workers can be called out any time, day or night, on the River Foyle. All the volunteers are fully trained in life-saving skills and the group has crisis-intervention counsellors to deal with individuals threatening to take their own lives.
This group is also very skilled in dealing in a dignified and very humane way with the aftermath of suicide and with those who have tried to take their lives.
It is vital that such charities’ work is both recognised as best practice and supplemented by a more equitable, effective, well-resourced and all-Ireland approach to this issue, an issue that not only negatively affects individuals but also their families and wider communities.

ANTI-DEPRESSANT ADDICTION IN NORTH WEST
136,112 PRESCRIPTIONS IN 11 MONTHS

Belfast Telegraph

New bid to fight tranquilizer crisis
Foyle health chiefs unveil plan after statistics shock

By Brendan McDaid
19 October 2005

Foyle health chiefs will next week unveil a major new strategy aimed at drastically cutting shocking levels of tranquilizer addiction across the North West.

The Foyle Tranquilizer Initiative - to be launched next Tuesday - comes just months after the Telegraph revealed that doctors in the Western Health Board area issued a staggering 136,112 prescriptions for benzodiazepines between March, 2004, and February, 2005.

The figure shows a rise of more than 5,000 prescriptions on the previous year.

It also emerged that while Government guidelines recommend no one should be using benzodiazepine drugs (such as Temazipam, Diazepam and Nitrazapem) for more than three months at a time, many patients have been taking the sedatives for the past 20 to 30 years.

A similar Sperrin Lakeland Area Tranquilliser Initiative (SpLAT) will also be introduced next Tuesday.

The Western Health and Social Services Board said an awareness campaign will also be launched aimed at pharmacists and GP practices. The campaign will involve the distribution of posters and information leaflets and is also designed to raise awareness among those prescribed tranquillisers, specifically those who take benzodiazepines.

Glenn Hinds, chairman of Foyle Tranquilliser Initiative, and Jimmy Cleary, chairman of the Sperrin Lakeland Area Tranquilliser Initiative, last night issued a joint statement about the new project.

They stated: "There are a lot of people in the community who are long-term benzodiazepines users, particularly Diazepam and Temazepam, with others abusing medications along with alcohol or other illicit drugs.

"The Foyle Tranquilliser Initiative and Sperrin Lakeland Area Tranquilliser Initiative are primarily campaigns to promote the safe use of tranquilizers.

"There is no doubt that the issue of benzodiazepines is deep-rooted and far-reaching but we believe that, with the efforts of all those involved in FTI and SpLAT, progress will be made." they said.

Trauma caused by the Troubles and alcoholism in the home have been cited as major reasons why so many people in the North West have been prescribed the prescription drugs.

The most recently documented rise came despite retrained GPs writing to patients offering counselling programmes to help them off the drugs.

Mr Hinds, also a local community drugs therapist, said tranquilizers had become "an emotional crutch" for many.

Piczo