- It took just 25 minutes for Dr Patrick Cosgrove to diagnose
10-year-old Anthony with attention deficit hyperactivity disorder (ADHD).
Without speaking to or examining the boy, Cosgrove, a consultant child
and adolescent psychiatrist, took his pen and issued a prescription for
the stimulant Ritalin and with it, Liz Thompson, Anthony's mother, thought
he had handed over the answer to her prayers.
-
- Although her child had displayed behavioural problems
since the age of four, a succession of doctors in Scotland had failed to
find him either a final diagnosis or an effective treatment. In desperation,
she travelled hundreds of miles from her Glasgow home to Cosgrove's private
Priory Clinic in Bristol.
-
- The diagnosis of ADHD, a disorder that includes symptoms
such as impulsiveness, hyperactivity and sometimes violence, meant that
Anthony Thompson could no longer be labelled a 'bad child'. There was,
in fact, something medically wrong with him.
-
- Soon after his diagnosis, Anthony stopped sleeping and
eating properly. His mother contacted Cosgrove again and a second drug,
Risperidone ñ normally used to treat schizophrenia ñ was
prescribed. For three years he took both drugs and, although he was initially
less disruptive, Thompson says he appeared to be "doped up".
With her son now on a constant cocktail of drugs, his behaviour again began
to deteriorate so badly that she turned to another psychiatrist for help.
-
- This time she saw a specialist in Glasgow who was so
concerned about Anthony's health and the combination of the drugs he was
taking, he immediately began steps to wean him off both. Of greatest concern
was Risperidone.
-
- "When I first went to see Dr Cosgrove I though he
was a godsend ," says Thompson. "I asked if Anthony still needed
help along with the drugs and he said he would not need any whatsoever,
that these drugs would take away any of the problems he had been experiencing.
Nothing could be further from the truth."
-
- She adds: "I went to see another adolescent psychiatrist
who was immediately unhappy that [Anthony] was on Risperidone and did a
blood test which showed the levels of one of his blood cell types were
down."
-
- Thompson claims that Cosgrove never recommended that
Anthony had tests to check out how his body was dealing with the medication.
Now 18, her son still has psychological problems, which she believes were
masked but not treated by the drugs.
-
- So incensed was she about her son's treatment that Thompson
and Edinburgh-based charity Overload Network complained to the General
Medical Council (GMC) about Cosgrove's conduct. In June, the GMC found
the doctor guilty of serious professional misconduct and criticised him
for failing to properly monitor Anthony and another patient to whom he
had prescribed powerful drugs, such as Ritalin and Risperidone.
-
- In a statement, Professor Norman Mackay, the GMC committee
chairman, says: "Dr Cosgrove prescribed drugs to these patients but
did not take appropriate steps to monitor the patients while they were
taking the drugs prescribed and as such acted irresponsibly." The
GMC ruled that although he had retired from medical practice, Cosgrove
should be suspended for 12 months.
-
- Although the two-week inquiry in Manchester into Cosgrove's
conduct received little press coverage, campaigners say it is indicative
of a major problem that is spiralling out of control. Last week, two major
studies pub lished by researchers from London University found that soaring
numbers of children in the UK were being prescribed antidepressants and
other mind-altering drugs. The first, published in Archives Of Disease
In Childhood, found that the rate doctors were putting young people on
antidepressants had jumped by 68% in recent years, rising more quickly
than in eight other major countries: France, Germany, Spain, Canada, US,
Argentina, Brazil and Mexico.
-
- A second, in the same publication, focused on the rise
in antidepressant prescriptions for children in the UK from 1992 to 2001.
During this time, researchers found that almost 25,000 children and adolescents
up to the age of 18 were given a total of 93,000 prescriptions. Children
as young as five appeared to be among those receiving the drugs. Overall,
it found the rate of prescriptions for anti depressants for children rose
by 70% in a decade. But while the rate for tricyclics, the older generation
of antidepressants, fell by 30%, prescriptions for SSRIs (selective serotonin
re-uptake inhibitors), including Prozac and Seroxat, increased tenfold.
-
- The findings have fuelled fears among Scottish health
experts at the increasing "medicalisation" of children's problems.
In September, research by the Scottish Executive revealed that hundreds
of Scottish children, some as young as two, had been diagnosed by GPs as
suffering from depression last year. Meanwhile, the bill for antidepressants
is also soaring, quadrupling to £55 million over the past decade.
-
- Child psychiatrists and GPs are being blamed in large
part for the increase of antidepressant use. Although no anti depressants
are licensed for use among under-16s, doctors can prescribe them where
they feel it is clinically appropriate.
-
- Dr Des Spence, a GP in Glasgow, accuses medical colleagues
of having a mindset in which children's unhappiness is addressed by drugs
rather than alternative therapies such as counselling. "There is this
idea that life can be broken down into a collection of chemical interactions,
but in reality it's nothing like that," he says. "It's very convenient
to give someone a tablet and try to cure them. The more their problems
are medicalised, the more people will try to treat them with medication.
Surely there are better ways to treat children."
-
- Spence, also the UK spokesman for the No Free Lunch Campaign,
a group of healthcare professionals concerned at the undue influence of
the pharmaceutical industry on doctors in promoting drug products, believes
another reason for the rise is the drugs companies' successful marketing
of their products.
-
- He adds: "Recently there were figures which showed
that 90% of postgraduate education in medicine is funded through the pharmaceutical
industry. The people who set the agenda influence what happens.
-
- "Medicalising kids' problems deflects us from the
real question about why they are becoming depressed. There needs to be
distance between pharmaceutical companies and healthcare professionals."
-
- Janice Hill, founder and director of the Overload Network,
an Edinburgh-based charity that campaigns on behalf of ADHD sufferers and
their parents, warns that children were becoming addicted to antidepressants
and had little help to come off them.
-
- She says: "It's all very well prescribing mind-altering
drugs to children but when they want to come off these drugs it's very
hard. There's no facility for them to do so. There's also very little safety
data on how these drugs will affect children. The norm is to have no hard
information on their effects on children."
-
- Hill says the organisation was calling for an all-out
ban for all psychiatric drugs in children under six years old. "Children
are not fully developed," she adds. "The effects on their long-term
health are uncertain. We're using our children as guinea pigs. It's really
a public health scandal."
-
- Those behind the latest research into prescribing rates
also expressed concern at the lack of scientific evidence of the drugs'
safety. The research team, led by Ian Wong and Macey Murray from the university's
Centre for Paediatric Pharmacy Research, call for more studies to assess
their suitability for young people.
-
- They say it should always be remembered that "children
are not small adults" and research on adult patients should not automatically
apply to children. They add: "The observed increase in so many countries
should raise concern, as little research has been conducted in children
to study the effects of most psychotropic medications."
-
- In the US, all antidepressant drugs must now carry the
strongest possible public warning that they could cause children to harm
themselves or commit suicide. The landmark ruling, made in September, went
beyond the unilateral action taken in December 2003 by the UK regulator,
the Medicines and Healthcare Products Regulatory Authority (MHRA), which
banned the use of certain drugs in children under 18. A UK expert working
group warned that all but one of the SSRIs should not be given to children
and that there were risks of children becoming suicidal, aggressive and
suffering mood swings, and the drugs were anyway not very effective. Prozac,
known by the generic name of fluoxetine, was the exception.
-
- Currently, the MHRA is considering a licence application
by Eli Lilly, the makers of Prozac, to treat children with depression in
the UK and Europe with the drug. However, the Sunday Herald has learned
that unpublished clinical studies carried out on children by the company
show that youngsters who used Prozac appeared to have problems with physical
development.
-
- Documents held by the Federal Drug Administration, which
licenses drugs in the US, reveal that its own investigators had concerns
about Prozac in 2001. Its medical officer, Andrew Mosholder, writes: "Nineteen
weeks of fluoxetine treatment was associated with reduced growth velocity
relative to placebo. On balance, I believe that this trial provides evidence
of reduced growth velocity with fluoxetine treatment."
-
- Other studies into fluoxetine on mice and beagles show
marked decreases in testicular weight. Research on mice, analysed by the
FDA in 1984, found that testis weight was 12% below the control group at
the end of the dosing period and 26% below the control group in some of
the animals after a one-month recovery period. In the tests on dogs, testis
weights ended up being 26% below the control group.
-
- The studies, which had never before been made public,
were unearthed by Dr David Healy, of north Wales, an expert on psychiatric
drugs. His warnings that antidepressant drugs like Seroxat and Prozac could
cause suicide led to the entire class of antidepressants, except Prozac,
being banned last year from use on children.
-
- He says the newly unearthed evidence about the potential
side effects of Prozac should be of great concern. "There does seem
to be hazards with these drugs. The research showing testicular shrinkage
could be a real issue for teenage boys. There have been so few tests on
these drugs that we simply don't know if there is a risk there or not."
-
- But he too believes that medical experts are looking
for a "quick fix". "It's unquestionably the case that teenagers
and children have problems, but I don't think they are having any more
than they had before. There will be a few kids who in their teens will
have a genuine illness. At the moment we're in a situation where the problems
of the teenage years are being made into an illness. The risks of kids
being put on pills that are not going to help them is hugely greater now
than it was five years ago.
-
- "I think that GPs do think they are being helpful
and that these pills couldn't do much harm, but in actual fact they haven't
been told what the risks are."
-
- But Dr Iain McClure, a child and adolescent psychiatrist
and spokesman for the Royal College of Psychiatrists in Scotland, says
that young people benefited from being prescribed antidepressants. He says
instead of the medicalisation of children's problems, factors such as better
recognition of the symptoms of depression may account for the increase.
-
- "Primary care could be recognising the symptoms
of depression better than it has done in the past," he says. "Therefore,
doctors are prescribing more antidepressants because depression is revealed.
-
- "Also, it could be that there is more distress in
the community and that what we're witnessing is an increasing social phenomena
of young people experiencing mental health difficulties because of the
pressures of modern life.
-
- "Other social factors, such as family breakdown,
pressures on young people to grow up sooner than they feel able to do,
could be putting young people under more pressure now than they have ever
been.
-
- "What mustn't be lost sight of is that there are
young people who do require these medications and can benefit from them."
-
- Mental health charities such as Penumbra have begun promoting
alternatives to medication. Pat Little, the charity's development manager
for young people's services, says: "We are alarmed at the rise in
young people prescribed medication, particularly antidepressants.
-
- "We need to provide access to counselling and support
so that young people can work through the difficulties they're experiencing.
If people are going to use medication to deal with things, it's the wrong
road to go down.
-
- "A lot of the work that we do now is about helping
young people keep themselves well. We need to provide opportunities for
young people to talk about things and offer them support when they need
it."
-
- A spokeswoman for the department of health describes
the drop in antidepressant prescribing since the MHRA's unilateral ban
last year as "enormous". She adds: "The figures in the two
studies are out of date. They relate to 2002 and we put out our advice,
that all antidepressants should be banned for use in children, in 2003.
The drop has been huge since last year."
-
- WHAT THEY'RE TAKING
-
- Drug name: Tryptizol
-
- Trade name: Amitriptyline
-
- Drug class: Tricyclic
-
- Uses include: Treats spontaneous endogenous depression
and is extremely sedating.
-
- Side effects may include: Blurred vision, constipation,
racing heartbeat, seizures.
-
- Drug name: Doxepin
-
- Trade name: Sinequan
-
- Drug class: Tricyclic
-
- Uses include: Treats many types of depression. Also used
for treatment of anxiety and post traumatic stress disorder.
-
- Side effects may include: Constipation, blurred vision,
seizures, sexual problems.
-
- Drug name: Paroxetine
-
- Trade name: Seroxat
-
- Drug class: SSRI
-
- Uses include: Treatment of obsessive-compulsive disorder,
depression, diabetic nerve pain and chronic tension headaches.
-
- Side effects may include: Blurred vision, loss of appetite,
nervousness, nausea, liver toxicity, hypomania, feelings of suicide.
-
- Drug name: Fluoxetine
-
- Trade name: Prozac
-
- Drug class: SSRI
-
- Uses include: Mainly in the treatment of depression.
Also used to treat other psychological disorders.
-
- Side effects may include:
-
- Anxiety or nervousness, trouble sleeping, abnormal sweating,
sedation, seizure.
-
- Drug name: Methylphenidate
-
- Trade name: Ritalin
-
- Drug class: Central nervous system (CNS) stimulant
-
- Uses include: The drug of first choice for treatment
of attention deficit hyperactivity disorder in children.
-
- Side effects may include: Nausea, difficulty sleeping,
mood changes, joint/chest pain, unusal movements.
-
- ©2004 newsquest (sunday herald) limited. all rights
reserved
-
- http://www.sundayherald.com/46196
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