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- Just three weeks after Eric Harris and
Dylan Klebold went on their April 20 killing spree at Columbine High School
in Littleton, Colo., President Clinton hosted a White House conference
on youth violence. The president declared it a strategy session to seek
"the best ideas from people who can really make a difference: parents
and young people, teachers and religious leaders, law enforcement, gun
manufacturers, representatives of the entertainment industry and those
of us here in government."
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- There was, however, complete silence
from the president when it came to including representatives from the mental-health
community, whom many believe can provide important insight about the possible
connection between the otherwise seemingly senseless acts of violence being
committed by school-age children and prescription psychotropic drugs such
as Ritalin, Luvox and Prozac.
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- There are nearly 6 million children in
the United States between the ages of 6 and 18 taking mind-altering drugs
prescribed for alleged mental illnesses that increasing numbers of mental-health
professionals are questioning.
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- Although the list of school-age children
who have gone on violent rampages is growing at a disturbing rate -- and
the shootings at Columbine became a national wake-up call -- few in the
mental-health community have been willing to talk about the possibility
that the heavily prescribed drugs and violence may be linked. Those who
try to investigate quickly learn that virtually all data concerning violence
and psychotropic drugs are protected by the confidentiality provided minors.
But in the highly publicized shootings this spring, information has been
made available to the public.
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- April 16: Shawn Cooper, a 15-year-old
sophomore at Notus Junior-Senior High School in Notus, Idaho, was taking
Ritalin, the most commonly prescribed stimulant, for bipolar disorder when
he fired two shotgun rounds, narrowly missing students and school staff.
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- April 20: Harris, an 18-year-old senior
at Columbine High School, killed a dozen students and a teacher before
taking his own life. Prior to the shooting rampage, he had been under the
influence of Luvox, one of the new selective serotonin reuptake inhibitor,
or SSRI, antidepressants approved in 1997 by the Food and Drug Administration,
or FDA, for children up to the age of 17 for treatment of obsessive-compulsive
disorder, or OCD.
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- May 20: T.J. Solomon, a 15-year-old at
Heritage High School in Conyers, Ga., was being treated with Ritalin for
depression when he opened fire on and wounded six classmates.
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- Two other high-profile cases from last
year show a similar pattern: May 21, 1998: Kip Kinkel, a 15-year-old at
Thurston High School in Springfield, Ore., murdered his parents and then
proceeded to school where he opened fire on students in the cafeteria,
killing two and wounding 22. Kinkel had been prescribed both Ritalin and
Prozac. Although widely used among adults, Prozac has not been approved
by the FDA for pediatric use.
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- March 24, 1998: Mitchell Johnson, 13,
and Andrew Golden, 11, opened fire on their classmates at Westside Middle
School in Jonesboro, Ark. Johnson had been receiving psychiatric counseling
and, although information about the psychotropic drugs that may have been
prescribed for him has not been made public, his attorney, Val Price, responded
when asked about it: "I think that is confidential information, and
I don't want to reveal that."
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- A great deal has been written about all
of these cases. There have, however, been no indications that all of these
children watched the same TV programs or listened to the same music. Nor
has it been established that they all used illegal drugs, suffered from
alcohol abuse or had common difficulties with their families or peers.
They did not share identical home lives, dress alike or participate in
similar extracurricular activities. But all of the above were labeled as
suffering from a mental illness and were being treated with psychotropic
drugs that for years have been known to cause serious adverse effects when
given to children.
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- At the top of the list of so-called "mental
illnesses" among children is attention-deficit/hyperactivity disorder,
or ADHD, which is diagnosed when a child meets six of the 18 criteria described
in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV,
published by the American Psychiatric Association, or APA.
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- ADHD was determined by a vote of APA
psychiatrists to be a "mental" illness and added to the DSM-IIIR
in 1987. By definition, children with ADHD exhibit behaviors such as not
paying attention in school, not listening when spoken to directly, failing
to follow directions, losing things, being easily distracted and forgetful,
fidgeting with hands or feet, talking excessively, blurting out answers
or having difficulty awaiting turn. The most common ADHD remedy among pediatricians
and representatives of the mental-health community is, as noted, Ritalin.
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- First approved by the FDA in 1955, Ritalin
(methylphenidate) had become widely used for behavioral control by the
mid-1960s. It is produced by the Swiss pharmaceutical company Novartis.
According to the Drug Enforcement Administration, or DEA, the United States
buys and uses 90 percent of the world's Ritalin. A U.N. agency known as
the International Narcotics Control Board, or INCB, reported in 1995 that
"10 to 12 percent of all boys between the ages of 6 and 14 in the
U.S. have been diagnosed as having ADD [attention-deficit disorder, now
referred to as ADHD] and are being treated with methylphenidate."
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- But opponents are concerned about evidence
they say confirms a close relationship between use of prescribed psychotropic
drugs and subsequent use of illegal drugs, including cocaine and heroin.
While the United States has spent more than $70 billion on the war on drugs,
says Bruce Wiseman, president of the Citizens Commission on Human Rights,
a California-based organization that investigates violations of human rights
by mental-health practitioners, "if you think the Colombian drug cartel
is the biggest drug dealer in the world, think again. It's your neighborhood
psychiatrist ... putting our kids on the highest level of addictive drugs."
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- This complaint is not new and there is
a lengthy list of government agencies connecting the prescribed psychotropic
drugs to use of illegal substances.
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- Twenty-eight years ago the World Health
Organization, or WHO, concluded that Ritalin was pharmacologically similar
to cocaine in its pattern of abuse and cited Ritalin as a Schedule II drug
-- the most addictive in medical usage. The Department of Justice followed
the WHO by citing Ritalin in Schedule II of the Controlled Substances Act
as having a very high potential for abuse. As a Schedule II drug, Ritalin
joins morphine, opium, cocaine and the heroin substitute methadone.
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- According to a report in the 1995 Archives
of General Psychiatry, "Cocaine is one of the most reinforcing and
addicting of the abused drugs and has pharmacological actions that are
very similar to those of Ritalin." In the same year the DEA also made
the Ritalin/cocaine connection, saying, "It is clear that Ritalin
substitutes for cocaine and d-amphetamine in a number of behavioral paradigms,"
expressing concern that "one in every 30 Americans between 5 and 19
years old has a prescription for the drug."
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- Despite decades of warnings about the
potential for abuse of Ritalin, experts continue to argue that the benefits
far outweigh the consequences. Yet the INCB has reported that "Methylphenidate's
[Ritalin] pharmacological effects are essentially the same as those of
amphetamine and methamphetamine. The abuse of methylphenidate [Ritalin]
can lead to tolerance and severe psychological dependence. Psychotic episodes
[and] violent and bizarre behavior have been reported."
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- These are, in fact, some of the same
symptoms exhibited by Eric Harris. David Fassler, a child and adolescent
psychiatrist and chairman of the APA group on Children, Adolescents and
Their Families, says he is unaware of any research to suggest a correlation
between the recent cases of violent behavior in school-age children and
the widespread prescription of psychotropic drugs. Fassler argues that
the number of school-age children suffering from mental illnesses such
as depression is "more than earlier believed and it is important that
there be a comprehensive evaluation by a mental-health clinician trained
in this area." He stresses that "treatment should be multimodal
-- not left to medications alone."
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- Mike Faenza, president and chief executive
officer of the National Mental Health Association, the country's oldest
and largest mental-health group, notes that "there is little known
about how the drugs affect brain function." Faenza adds that "we
do know that a hell of a lot of kids commit suicide because they aren't
getting the help they need. It's irresponsible not to give them the help
just because we don't know what causes the mental illness."
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- Opponents are quick to capitalize on
this admission. "There is no such thing as ADHD," declares Wiseman.
"It's not a deficiency of 'speed' that makes a kid act out. If you
look at the criteria listed in the DSM-IV for ADHD, you'll see that they
are taking normal childhood behavior and literally voting it a mental illness.
This is a pseudoscience, entirely subjective. Unlike medical conditions
that are proved scientifically, with these mental illnesses the only way
you know you're better is if the psychiatrist says you're better. That's
not science."
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- Pediatric neurologist Fred Baughman not
only agrees that there is no such illness as ADHD, but says: "This
is a contrived epidemic, where all 5 million to 6 million children on these
drugs are normal. The country's been led to believe that all painful emotions
are a mental illness and the leadership of the APA knows very well that
they are representing it as a disease when there is no scientific data
to confirm any mental illness."
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- Peter Breggin, a psychiatrist and director
of the International Center for the Study of Psychiatry and Psychology
and author of Talking Back to Prozac, Toxic Psychiatry and Talking Back
to Ritalin, for years has waged a war with the APA about what he regards
as its cavalier diagnoses of mental illnesses. "Psychiatry has never
been driven by science. They have no biological or genetic basis for these
illnesses and the National Institutes of Mental Health are totally committed
to the pharmacological line." He is concerned that "there is
a great deal of scientific evidence that stimulants cause brain damage
with long-term use, yet there is no evidence that these mental illnesses,
such as ADHD, exist."
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- Breggin points out that the National
Institutes of Health, or NIH, admitted as much at their 1998 Consensus
Development Conference on the Diagnosis and Treatment of Attention Deficit
Hyperactivity Disorder. Thirty-one individuals were selected by NIH to
make scientific presentations to the panel on ADHD and its treatment. The
panel made the following observations and conclusions: "We don't have
an independent, valid test for ADHD; there are no data to indicate that
ADHD is due to a brain malfunction; existing studies come to conflicting
conclusions as to whether use of psychostimulants increases or de-creases
the risk of abuse, and finally after years of clinical research and experience
with ADHD, our knowledge about the cause or causes of ADHD remains speculative."
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- If so, there is little evidence to support
a scientific basis for classifying ADHD as a mental illness. On the other
hand, there is an abundance of evidence that stimulants such as Ritalin
can produce symptoms such as mania, insomnia, hallucinations, hyperactivity,
impulsivity and inattention. And the DEA's list of potential adverse effects
of Ritalin includes psychosis, depression, dizziness, insomnia, nervousness,
irritability and attacks of Tourette's or other tic syndromes.
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- While Ritalin is the drug of choice for
treating ADHD, other mental illnesses such as depression and obsessive-compulsive
disorder, or OCD, from which Columbine shooter Harris suffered, are being
treated with new SSRI antidepressants. Harris' autopsy revealed that he
had used Luvox (Fluvoxomine), an SSRI, prior to the shooting spree. And
days earlier he had been rejected by the Marine Corps because he was taking
the psychotropic drug.
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- Luvox, a cousin of Prozac, has been approved
by the FDA for pediatric use, although research shows that a small percentage
of patients experience adverse effects such as mania, bouts of irritability,
aggression and hostility. But many physicians still prescribe it to children.
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- More disturbing to those who believe
sufficient evidence exists that prescription psychotropic drugs may play
a role in the violence being carried out by school-age children is the
response of physicians to the issue. Rather than erring on the side of
caution by reducing the number of kids on mind-altering drugs, physicians
instead are prescribing psychotropic drugs even to infants and toddlers.
The warning label states that "Ritalin should not be used in children
under 6 years, since safety and efficacy for this age group has not been
established" and "sufficient data on safety and efficacy of long-term
use of Ritalin in children are not yet available."
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- A report in the July 1998 issue of the
Clinical Psychiatric News revealed that in Michigan's Medicaid program,
223 children 3 years old or younger were diagnosed with ADHD as of December
1996. Amazingly, 57 percent of these children, many of whom are not yet
capable of putting together a complete sentence, were treated with one
or more psychotropic drugs including Ritalin, Prozac, Dexedrine, Aventyl
and Syban. Thirty-three percent were medicated with two or more of these
drugs.
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- But it is Ritalin that is being prescribed
to 6 million American children. Children's Hospital in Washington has been
running television advertisements expressing concern. According to its
spokeswoman, Lynn Cantwell, the ads were part of a series covering many
medical issues. "We wanted to advocate that children get a comprehensive
evaluation because we are finding that children were coming in who were
taking Ritalin who actually did not have ADHD."
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- Wiseman has suggested that the only way
to gain control of the situation is to expose widespread "fraudulent
diagnoses" of psychiatrists. "Without the diagnoses, you can't
get the drugs," he says. Baughman's answer isn't too far from Wiseman's.
He says, "A big-time class-action lawsuit needs to be filed."
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