Click on the title for an interesting article by Susan Perry about a meta-analysis by Glen Spielmans, an associate professor of psychology at Metropolitan State University. Susan herself teaches writing and editing courses at Metro State.
Glen looked at studies of the efficacy of anti-depressants in children and adolescents, which included the child’s own perspective on whether the drugs had helped or not. This was a relatively small number of studies, because very often placebo-controlled studies will include the viewpoints of clinicians (who often report improvements), but not include the viewpoints of those taking the drugs (who tend to say no improvements).
From a person-centred and common sense perspective, it seems to us absurd and objectionable to give psychotropic drugs to someone, and then discount their own sense of the effects/usefulness of this. There is a political dimension to this, about disempowerment, as Susan’s article suggests:-
‘As he read each new study, he noticed that the results that got the attention were those reported by the children’s psychiatrists — not by the children and teens themselves….those reports were almost always downplayed or ignored.
“It didn’t seem to get discussed very often,” said Spielmans in an interview with MinnPost Tuesday………
………….the children’s psychiatrists and other clinicians involved in the studies were reporting that the antidepressants were leading to improvements in symptoms, the children themselves were often saying something else.’
He goes on to make the point that this preference for clinician ratings lacks an evidence base (so is essentially a political act):-
“Psychiatry research has traditionally valued clinician-rated measures over self-reports,” he said. “But there really isn’t a lot of great evidence [to support that approach]. It’s based more on tradition than on great evidence that that’s the best way to do things.
“I think it’s valuable to get clinician input,” Spielmans added, “but in the end, it would seem like the opinion of the child or adolescent — or in adult studies, the adult patients — should be pretty valuable.”
We agree. It should – politically and evidentially. We have a concern about culturally sanctioned disempowering/dehumanizing ways of seeing, doing and relating within the psychiatric system affecting all ages. The often coercive imposition of external locus viewpoints. This is even more of an issue in the case of a child, who has less power legally and culturally to start with, to make their own decisions/have a voice.
Glen Spielmans’ meta-analysis suggests ‘the overall benefits of antidepressants in youth have been overstated and that their overall benefit over placebo may be vanishingly small.’ As Susan comments, this is particularly disturbing, when prescription/use of these drugs has greatly increased in the past 20 years in all age groups. Currently 3.2% of Americans aged 12-19 are taking them. That’s more than 10 million people.
There is a shortage of reliable data in the UK, which is worrying in itself. Anecdotally, the sense our 28 therapists have from their work for our service, in their private practices and in their varied day jobs, is that many GPs prescribe these drugs readily, sometimes insistently, for a wide range of presenting issues. We do not as a service work with under 18s, but several of our therapists have considerable experience in this field, and anti-depressant use is common in under 18s too.
In statistical terms, 46.7 million prescriptions for anti-depressants were issued in England in 2011, across all age groups. This compares with 39.1 million in 2009, compared with 20.1 million in 1999 – a 95% jump (data from The Guardian and The Times, based on statistics released by the NHS’s Business Services Authority).
Glen Spielmans makes the key point that these drugs – unlike placebo – are not neutral in their impact on the human system. They may not have the effects wanted or intended, but they DO have powerful effects, and carry significant risks.:-
‘Studies have reported that children, teens, and young adults who take antidepressants for depression are at greater risk of thinking about and attempting suicide than their peers who do not take these drugs to treat their depression. They are also more likely to become agitated and hostile.’
Here’s a link to more information on Glen Spielmans:-
And to the abstract of his meta-analysis in the journal ‘Psychotherapy and Psychosomatics’ (the full study is behind a paywall):-
We also want to refer you to Monica Cassani’s recent post featuring Dr. Joanna Moncrieff, who is a psychiatrist and senior lecturer at University College London. Joanna Moncrieff is essentially giving a similar message to Glen Spielmans – the evidence base does not exist to support how we are prescribing and using these drugs, they do not appear to give users significant advantage over placebo, and (unlike placebo) they are not inert and often have powerful undesired effects:-
Monica includes links to a wealth of other information/resources.
Palace Gate Counselling Service