Archive for Tuesday, March 15, 2005

Double Take: Columnist offers rebuttal to clarify recommendations

March 15, 2005


Wes and Jenny: We were perplexed at Dr. Joseph Glenmullen's op-ed piece (March 4, Journal-World), responding to our Jan. 11 column. We considered the column a cautionary take on the topic of teens and antidepressants that Dr. Glenmullen would embrace. Therefore, we encourage readers to take another look at the column online and compare what we said with what the doctor implied we said.

Then do your own research. You can do this easily by going to and clicking on the Double Take link. There you can link to the column and Dr. Glenmullen's response. You also can link to several resources set up to give you the original sources -- including those cited by Dr. Glenmullen.

We are concerned at the sort of anxiety the doctor's comments might create for parents with teens on antidepressants, and both of us believe it is vital for those who took interest in his piece to review what the FDA is really saying about this topic. Wes will finish out the column today, given its rather technical nature.

Wes: I want to respond to Dr. Glenmullen's passionate comments, especially since they imply a great many things, which are neither in our column nor in the FDA documents he cites. First of all, he implies that the FDA wants children and teens to be seen weekly for medication checks -- which I stated in the column should occur at least twice monthly and never less than once a month. In fact, there is nothing in the FDA advisory to prohibit this monitoring from being conducted as a part of therapy. We were clear that medication management for teens should be a team effort involving therapy and med management when necessary. Thus, my clinical recommendations actually included MORE contacts than Dr. Glenmullen or the FDA suggests, and we suggest longer follow up than the FDA recommends.

Second, Dr. Glenmullen fails to mention that this advisory is dated Jan. 28, two weeks AFTER our column was printed. At the time, my suggestions for medication management were more stringent than common practice, and I believe that is still true and will remain so, despite the FDA advisory.

Finally, Dr. Glenmullen appears unaware of how this particular advisory could discourage needed treatment in families that cannot afford four medication checks per month AND therapy services. This doesn't mean it isn't important to monitor teen clients closely, and the FDA provides good guidelines on how to do this in the clinic and at home. It just means that families with limited resources must balance many factors in making these decisions. I'm certain that parents who read this column are all too familiar with that problem. I hope the idea of weekly medication management will not turn anyone away from seeking treatment.

Additionally, we were very clear that families should not rush to use antidepressants, and Jenny was downright skeptical about them. I even noted the National Institute of Mental Health guidelines for therapy to be the first line of defense for teen depression. In short, Jenny and I were far from the purveyors of happy pills for kids that Dr. Glenmullen implies.

Dr. Glenmullen also failed to mention recent changes in FDA labeling, which backed off a bit on the original warning. The revision, published in late January, now states that the drugs "increased the risk of suicidal thinking and behavior in short-term studies of adolescents and children with depression and other psychiatric disorders" and dropped the sentence, "a causal role for antidepressants in inducing suicidality has been established in pediatric patients." In fact, NO causal role between the medications and suicidal thoughts has been established.

Most importantly to the position in our column, the FDA's revision states, "It now seems clear that the drugs do indeed increase the risk of suicidality in the trials, from about 2 percent to about 4 percent..." but then goes on to state "Antidepressants may provide significant benefit for depressed pediatric patients when used appropriately. The new warning language does not prohibit the use of antidepressants in children and adolescents. Rather, it warns of the possible risk of suicidality and encourages prescribers to balance the risk with clinical need." The paper also reminds us in italic type that "no one committed suicide" in the study. I believe this report actually supports the tenor and content of our original column.

I originally included links in my column for parents to learn more about this issue, but space limitations prevented their publication. I have instead posted all these links, and several others at I also have posted Dr. Glenmullen's link so you can learn more about his work and his position on this issue, and alternative books on the subject. Most importantly, I encourage you to read what the FDA is actually saying about this important issue, as well as other resources in making treatment decisions. We also will post other links on the site in future columns we feel might be helpful to families and teens.

In closing, Dr. Glenmullen has a well-known and impassioned position on this topic, has written a couple of books about it, and successfully garners media attention for that view. Readers should be aware that his opinion is not as widely held as he implies, just as the FDA report points out. As professionals and parents, we are all concerned about these issues precisely because we care about our teens and want to do right by them. Thus, Jenny and I opened the discussion in the column.

Here, our goal is always to encourage readers to think and learn more for themselves about the issues we briefly discuss, not to persuade them to our way of thinking. We welcome civil dialogue on these subjects. However, we stand by the position that in seriously considering antidepressants for their children, parents should consult with a mental health provider they trust, and read what is available, not simply adopt views in this column or those expressed by Dr. Glenmullen.

In my 12 years of experience in this field, and another seven in graduate school, I have found no two kids or families that are alike and no cure-all for anyone. We should never use the media to cast complex diagnostic and treatment opinions upon a population of young people that we have never actually met. That certainly would be irresponsible.

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