BMJ Evidence-based medicine blog. Primary Care Corner with Geoffrey Modest MD
BMJ published an article finding the lack of benefit of either paroxetine or imipramine in adolescents with major depressive disorder (see BMJ 2015;351:h4320). To me, this study was really interesting because it resulted from an initiative called RIAT (Restoring Invisible and Abandoned Trials), an attempt by an international group to challenge the selective reporting of outcomes of randomized controlled trials, either because the results were never published or were misreported.
In this case, the study (Study 329) was funded by a drug company (smithkline beecham), reported in 2001 in the Journal of the American Academy of Child and Adolescent Psychiatry, but “was largely ghostwritten, claimed efficacy and safety for paroxetine that was at odds with the data” (see Account Res 2008; 15: 152, which found that Study 329 showed “how ghostwriting of clinical trial results can contribute to the manipulation of data to favor the study medication. Study 329 of paroxetine pediatric use was negative for efficacy and positive for harm”). The concern was that this was an important article influencing the use of antidepressants, including paroxetine, in adolescents.
HRH The Duchess of Cambridge, Royal Patron of children’s mental health charity Place2Be, has recorded a special video message to help launch Children’s Mental Health Week 2016 (8-14 February) which this year focuses on the importance of building children’s resilience and their ability to cope with life’s stressful situations.
In the video, primary school children from Salusbury School in London talk with The Duchess about the importance of being able to express their feelings openly and the value of having Place2Be in their school.
Putnam-Hornstein, E. et al. Journal of Adolescent Health. Available online: 4 February 2016
Purpose: This analysis examined California county birth rate variations among girls in foster care. The objective was to generate data to assess potential intervention points tied to federal legislation extending foster care beyond age 18 years.
Methods: Child protection records for all adolescent girls in foster care at age 17 years between 2003 and 2007 (N = 20,222) were linked to vital birth records through 2011. The cumulative percentage of girls who had given birth by age 21 years was calculated by county and race/ethnicity.
Results: One in three (35.2%) adolescent girls in foster care had given birth at least once before age 21 years. Although significant birth rate variations emerged, even at the low end of the county range, more than one in four girls had given birth by age 21 years.
Conclusions: Child welfare systems are now charged with coordinating transitional services for foster youth beyond age 18 years. Extended foster care provides new opportunities for pregnancy prevention work and targeted parenting support.
O’Connor, B. C. et al. Usual Care for Adolescent Depression From Symptom Identification Through Treatment Initiation. JAMA Pediatrics, 2016;
While most adolescents with newly identified depression symptoms received some treatment within three months, some of them did not receive any follow-up care and 40 percent of adolescents prescribed antidepressant medication did not have any documented follow-up care for three months, according to an article.
The authors report that among 4,612 participants (average age 16 at the initial event and 66 percent female), treatment was initiated for 2,934 participants and most of them received psychotherapy alone or in conjunction with medications.
However, in the three months after symptoms were identified, 36 percent of adolescents received no treatment (n=1,678), 68 percent did not have a follow-up symptom assessment (n=3,136) and 19 percent did not receive any follow-up care (n=854), according to the results. Additionally, 40 percent of adolescents prescribed antidepressant medication did not have follow-up care documented for three months (n=356).
Black-box warnings about the dangers of attention-deficit hyperactivity disorder (ADHD) medications are confusing and could have serious consequences for the risk of youth suicide, according to researchers at the Institut universitaire en santé mentale de Montréal (CIUSSS de l’Est-de-l’Île-de-Montréal) and the University of Montreal, whose correspondence has just been published in the most recent issue of the journal The Lancet Psychiatry.
“Health Canada has issued a series of black-box warnings about the suicidal potential of ADHD medications. However, these warnings have failed to take into account epidemiological studies showing the opposite, that increased use of this medication has been associated with reduced suicide risk in adolescents,” says Dr. Alain Lesage, psychiatrist and researcher at the Institut universitaire en santé mentale de Montréal (CIUSSS de l’Est-de-l’Île-de-Montréal) and one of study’s authors.
In the past decade, the medical treatment of ADHD increased three-fold in Quebec, reaching 9% of boys aged 10 years and 4% of boys aged 15 years. However, suicide rates in Quebec’s adolescents decreased by nearly 50% during that period among 15-19 year olds, which contradicts the warnings issued by Health Canada.
“Clearly, the increased use of ADHD drugs indicates that they might actually reduce rather than augment the risk of suicide,” says Edouard Kouassi, pharmacist and researcher at the Institut universitaire en santé mentale de Montréal (CIUSSS de l’Est-de-l’Île-de-Montréal) and co-author of the study.