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By Charles Ornstein and Tracy Weber
January 24, 2012

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The Huffington Post
By Anthony Turner
December 3, 2011

This is a teen-written article from Represent Magazine, a platform for and by young people in foster care.

It all started when I said something stupid in school. A girl was ignoring me, and I got mad and said, “F-ck this sh-t. I’m gonna do some Virginia Tech sh-t.” I only said it so the girl would pay attention to me. But I shocked all my classmates and teachers, and the school said I’d made a “terrorist threat.”

I was in the 9th grade, and I had recently moved out of an abusive situation with my mom and into a foster home I knew nothing about. I needed someone to listen so I could get my feelings out. But there was no one I could really trust.

My caseworker came to my foster mom’s house and told me that he would take me to KFC and then to a “nice place to get help.” I thought, “OK, that sounds cool. I get my favorite food and I go to a center to feel better.”

The next stop we made was a psychiatric hospital for kids. We went through door after door, and it dawned on me that every door had a lock. Once the door shut you couldn’t open it. The doors locked you in. They intended to keep me here. That realization gave me a panic attack. I started running and the security tackled me. I was forcibly dragged in.

What Was I Signing?

When I got inside, the kids peeked out of their rooms to see who was coming. I was so scared I thought I would pee on myself. I had never been to a place like this. When I entered a dayroom, a place where the kids hang out, they slowly introduced themselves. I shook my head in fright. I wasn’t like these kids. Some were twitching and others drooled. I kept to myself and didn’t speak a word to anyone.

I felt forced into signing a bunch of papers. I didn’t realize I was signing consent to take medication.

The first things they prescribed were Depakote and Risperdal. I didn’t get a say in what I wanted, and that made me feel powerless.

At the hospital, staff joked about it in a perverse way. “Hey kids, come and get your happy pills!” “Come right up for your Skittles, it makes the world a better place!” I was disgusted that the staff were making light of my situation. I wondered how they’d feel if they were forced to take pills in a lockdown facility.

The meds made me feel bad. Sometimes I over-ate, ate too little, or had trouble sleeping. I hated the fake smile the nurses gave me after I took my medication.

I didn’t want to talk to anyone, especially my therapist, because I believed that my depressing stories about my mom’s abuse might make the doctors prescribe more medication.

I was afraid if I kept taking medication I would be just like every kid in the hospital. I wanted to be the kid who stood out, the kid who didn’t take medication. There were kids already looking up to me but I wanted them to think, “Wow, Anthony doesn’t take medication. I want to follow his lead.”

I tried hiding the pills in my hand. I learned how to put pills deep in my throat and spit them out later. It worked for a while but then one pill got stuck there. The staff helped get it out. After that they checked me carefully.

Another way I avoided pills was simply putting them under my tongue. I would hide them in a soap bar box until my roommate saw it and told the nurse. Then I was forced to take liquid medication, which was disgusting.

A Target

The Depakote was supposed to make me feel “calmer” and “happy.” Instead I gained over 30 pounds, and that brought my self-esteem down. I felt fat and I wasn’t comfortable with myself. Some of the kids and even staff called me names like fat ass or b-tch tits. I went off on one staff once because he said, “I know the perfect birthday present for you—a training bra!”

I really wanted to do well, and I tried to behave and present myself in a mature manner. But it didn’t seem to make a difference. And the uncontrollable and unpredictable behavior around me started to affect me.

The one and only time I truly flipped out, though, was when the whole unit tried to jump me. “Yo, let’s f-ck up this p-ssy n-gga Anthony,” said one kid. Suddenly everyone turned to me grinning sinisterly, like they’d just found their new target.

“Nah, come on guys, let’s play some board games or something,” I suggested.

“You ain’t gonna get out this, b-tch,” said a fat kid with squinty eyes. “You think you Mr. Goody Two Shoes. We gonna straighten you out.”

I ended up getting chased down by 12 guys. One person caught me and then they stomped me out. I thought I would beg for them to leave me alone, but suddenly I felt myself becoming so enraged that I no longer felt the pain. I got up and screamed, “LEAVE ME ALONE!!!”

I was surprised at my sudden outburst, but most of the guys just laughed. Then everything turned red and my surroundings became a blur. I didn’t gain full consciousness until I was near the dayroom area. I noticed some of the guys holding their lip or arm. “Did I do this?” was the only thought that came to mind.

I was shocked that I’d stood up to them, much less beaten them up. A weird feeling came over me then. I wondered for the first time in the hospital if I was losing my sanity and just becoming one of maybe thousands of nut jobs who end up staying in hospitals.

Suppressing My Feelings

But most of the time I was quick to disengage and try to find ways to occupy myself when I saw these kinds of incidents starting. I tried reading, writing, talking with a staff I could trust, or daydreaming. These were ways to block out any negativity that surrounded me. Although these strategies were very helpful, I was still suppressing my feelings because there were overwhelming situations I wasn’t familiar with and didn’t know how to deal with emotionally.

While I was in the hospital, I saw two people commit suicide, including my roommate. They said I was “further traumatized” by that and put me in a state hospital, which was even more restrictive.

Looking at it now, I can see that the suicides did really impact me. However, I felt outpatient therapy (therapy where you see your therapist but you’re not confined to a psychiatric unit) could’ve been more effective. I didn’t see how living in the state hospital was going to help. I just wanted to be back in the community where I’d be able to interact more freely, go out, and feel more like a normal kid.

I was glad to leave the first hospital, but this was no better. I wanted to get off medication completely. Some doctors finally decided I was stable enough to behave without meds. They started to take me off a little at a time. I was happy to be off the medication, but if I messed up or acted out one bit, like by cursing, I was back on it.

For example, once a staff ticked me off by yelling at me for not doing my laundry. I cursed at him because he kept pressuring me. The doctors and staff said the fact that I cursed meant I was too unstable to stay off medication. But wouldn’t anyone curse if they felt pressured or nervous that a staff he hardly knew started yelling at him?

I had seen some staff do terrible, abusive things to the kids, like getting them to fight each other in exchange for Chinese food (a special treat). Of course I was on edge around some of the staff. The doctors didn’t know that, though.

Can’t We Talk About This?

I felt trapped. Some doctors said, “Well, Anthony, it’s possible to get off medication, but will it benefit you in the long run?” What were they trying to say? That I couldn’t function properly without the use of a drug?

I didn’t question it further because the mental health system had trained my brain to think that meds were my solution to everything. If I felt angry the doctor would say, “Maybe it’s time for Abilify, a drug that stabilizes your mood swings.” If I felt anxious the doctor would try to prescribe Zoloft, a pill that helps with some types of anxiety. I thought, “Have you guys ever heard of talking your feelings out? NOT EVERYTHING CAN BE SOLVED WITH THE USE OF A DRUG!”

I was receiving therapy at the time, and I felt it helped more than the meds. I had a really good therapist, and it was such a physical release to be able to express my feelings. I’m sure the meds did improve my moods somewhat; I was less likely to curse and talk back. But what helped the most was having a direct connection with a trusted adult like I got in therapy.

I sat down one day and wrote how I felt the pills were helping me—pros—and how they weren’t—the cons. I wanted time to reflect on where I was going in life, to feel some control. The cons on my list—the physical side effects, and the depressing feeling I got from taking meds—outnumbered the pros. I wasn’t going to tell the doctor that everything I was taking was all right with me. It wasn’t and I had to put a stop to it.

I was tired of taking meds and then being taken off just to get back on again. No one even gave me a real explanation. Their excuse was usually, “We’re putting you back on because we feel you could be in a more stable condition.” Being on and off meds made me really jumpy. My eyes would twitch sometimes.

I also felt mentally tired because I’d been on drugs for over a year and I wasn’t getting better. I was constantly sleeping and I couldn’t focus. Emotionally, I was tired of the need to even be on meds in the first place.

I believed that in order for me to be better I had to be exposed to the community because then I could feel how a teenage life is supposed to be. To me this meant a cell phone so I could communicate with friends, my own room, decent curfews, a real home, and to be around my family. It wasn’t pills I needed; it was the chance to feel like a normal teenager after years of abuse and being institutionalized.

Love Is the Best Medicine

After eight months at the second hospital, I was sent to a group home at a Residential Treatment Facility (RTF), where I continued to take medication. I began to wonder when I would ever get back in the community. I had just started going on visits with my aunt and I had decided that I would like to go live there. I just wanted to stay somewhere permanently and feel cared for. Thinking about all this moving made me as depressed as when I first came into the hospital.

Finally, they let me go live at my aunt’s house. I think the reason why the RTF agreed to it was because I kept advocating for myself. I felt excited and at peace. I felt that I had achieved the impossible and that I deserved to be with my aunt and my family who would love me for me, instead of living with the institution’s idea of “support.” I had worked two and a half years to get to this point. I would not let it go to waste.

Alone in my room at my aunt’s house, I thought quietly. I looked to the left. There was no nurse ready to give me a cup full of meds. I looked to my right. There was no doctor trying to switch my meds or giving me higher doses. It dawned on me then. There were obviously rules and expectations, but ultimately I could make my own decisions now. I didn’t have to continue the medication. So I made an appointment with the doctor and said, “I no longer feel like I need medication.”

The doctor seemed a little concerned that I was in a rush. She said, “Anthony, you’re a very bright kid, but are you sure that you want to get off? I want you to perform at your highest and do well.” I told her I was sure of my choice and that I wouldn’t regret it. And I don’t.

The Community Transformed Me

Now that I don’t take medication I feel a lot happier, more powerful, and in control. Yeah, I had to get adjusted to living back in Brooklyn, but I adapted quickly. It felt good to see my neighborhood friends and the employees I always talked to at the Burger King across the street. I never ever felt this happy when I was on medication. I always felt drugged or out of it. I’m not always happy, but when I do feel bad I talk my feelings out with people I trust, and I write. Writing allows me to get overwhelming or negative things off my mind onto paper.

Being in the community is what I’ve always wanted. Now I have a sense of freedom. I go to regular school, I have easy access to friends, and I socialize on my time. I’m not on someone else’s schedule and I don’t have to be cooped up inside all day feeling anxious. The community has transformed me.

Read the rest of the article here

http://www.huffingtonpost.com/2011/12/02/foster-teens-i-needed-emo_n_1126659.html?page=1

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11/29/2011 by Maia Szalavitz

More than 8% of children in foster care have received antipsychotic medication, and just over one quarter of those in foster care who also receive disability benefits take these drugs, according to a recent studyin the journal Pediatrics.

The question is why? Children in foster care have typically been neglected or abused — indeed, simply removing a young child from his or her parents, even abusive ones, is in itself traumatic — so, not surprisingly, kids in foster care are more likely to suffer from psychiatric and behavioral problems than those who have stable families. Previous data suggest that foster-care children are about twice as likely as those outside the system to receive psychiatric medications.

Whether these problems are leading to higher rates of antipsychotic use, however, is not clear. “I think we have clinicians facing some very challenging situations,” says Susan dosReis, associate professor at the University of Maryland School of Pharmacy and lead author of the study. “But we don’t have information as to why the prescribers decided on these medications for [these particular] youths.”

The numbers suggest that the influence of pharmaceutical company marketing cannot be overlooked. Ninety-nine percent of youth receiving antipsychotic medications in the study were given atypical antipsychotics — the newer generation of these drugs, which are expensive and mostly unavailable in generic form and have been heavily advertised.

All of the major manufacturers of these drugs have been fined by the Food and Drug Administration for illegal marketing practices — in part, for marketing the drugs for unapproved use in children — with some convicted of criminal charges.

Eli Lilly, which manufactures the atypical antipsychotic Zyprexa, paid out $1.42 billion in 2009 — $615 million of that to settle criminal charges. The charges against Lilly involved selling Zyprexa to doctors for use in children, despite the fact that it was not approved for this age group.

Bristol Myers Squibb paid $515 million in 2007 to settle charges that it also illegally pushed its antipsychotic Abilify to child psychiatrists. Pfizer paid out $301 million in a similar case related to its drug Geodon. AstraZeneca paid out $520 million to settle charges over the drug Seroquel. In all of these cases, the drugs were sold for unapproved use in youth.

Read the rest of the article here

Watch one foster kid’s story:

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Note from CCHR:  While the FDA and its Pediatric advisory panel sit around pondering if one antipsychotic drug is more likely to cause diabetes in children than another while continuing their stall tactic of  “let’s study it some more ” routine, we’d like to point out the simple solution:  Considering that  antipsychotic drugs are already documented by international drug regulatory agencies to cause not only diabetes but obesity, psychosis, blood clots, heart problems, cardiac events, seizures, toxicity, confusion, coma and stroke (and that’s just in kids) as well as brain atrophy (meaning they actually shrink brains); considering there is no medical test to prove any child has a brain malfunction, chemical imbalance or any physical condition requiring the administration of these lethal drugs—and considering these drugs are literally killing kids that have nothing medically wrong with them in the first place— Do the job you are paid by U.S. Taxpayers to do and BAN their use on children.   Period.

GAITHERSBURG, Maryland (Reuters) – U.S. pediatric health advisers on Thursday urged drug regulators to continue studying weight gain and other side-effects of antipsychotic drugs as they are increasingly taken by children.

Significant numbers of U.S. children are receiving drugs to tame aggression, attention deficit disorder and other mental problems, even though there is little conclusive data to show exactly how the medications work or whether they damage kids’ health.

Similar to the recommendations the panel has made in previous years, it voted 16-1 to support the U.S. Food and Drug Administration’s routine safety monitoring of the new generation of antipsychotics.

But the panel did so with a caveat that the agency specifically look at how to clarify the drugs’ labels to highlight concerns about their impact on children, namely the risks of weight gain and diabetes.

“There is serious concern that children may be at a higher risk for serious adverse effects and we just don’t have sufficient data to answer that question,” said Dr. Jonathan Mink, a child neurology expert from the University of Rochester Medical Center.

Dr. Jeffrey Wagener, a pediatric pulmonologist from the University of Colorado Medical School, was the one adviser to vote “no” out of concern that wouldn’t get regulators closer to dealing with the risks of using antipsychotics in children.

“I don’t see how the FDA is responding to the December 8, 2009 request by this committee in a thorough fashion,” he said. “It’s taken them two years to not respond to that that we need to be more than in the observational role.”

The FDA in the next month to six weeks will release a revised label for Abilify, a drug sold by Bristol-Myers Squibb Co and Otsuka Pharmaceutical and approved to treat schizophrenia in adolescents, bipolar disorder in children 10 to 17 years old and irritability associated with autism in those as young as six.

“We ask that with this upcoming revision that you carefully consider the language around pediatric use and adverse events,” said Dr. Geoffrey Rosenthal, the committee’s chair and director of Pediatric and Congenital Heart Center at the University of Maryland Medical Center.

Abilify’s new label will detail the drug’s latest clinical trials, warn of metabolic concerns and remind doctors to monitor weight and symptoms of diabetes in all patients, said Dr. Thomas Laughren, FDA’s psychiatry products chief. The pediatric section of the label would contain a reference to those warnings, he said..

Such revisions, which are already incorporated into Johnson & Johnson’s antipsychotic medication Invega Sustenna, are being considered for other similar drugs on a case by case basis, Laughren said.

The new generation of antipsychotic medications has raised a wave of concerns as they are increasingly being prescribed for a host of uses and for younger and younger patients, with little conclusive research addressing their impact on children and sometimes with little evidence they work.

Newer antipsychotics include J&J’s Risperdal, known generically as risperidone; Eli Lilly & Co’s Zyprexa or olanzapine; AstraZeneca’s Seroquel or quetiapine; and Abilify, known generically as aripiprazole.

U.S. researchers have found that the drugs’ use in children increased by 65 percent from 2002 to 2009, primarily through prescriptions for teenagers.

From fall 2009 to spring of this year, 1.9 million prescriptions of Abilify alone were dispensed to patients under 18, including even 875 prescriptions for toddlers younger than 2, according to FDA research.

Most commonly, the prescriptions were for bipolar disorder in teenagers and preschoolers, and for affective psychoses in children between the ages of seven and 12.

Advisers also voted unanimously to require the FDA to show them label revisions and report back in the next year or 18 months on progress in designing more studies of the drugs in children.

http://www.fox43.com/lifestyle/sns-rt-us-usa-fda-antipsychotictre78l77l-20110922,0,216106.story

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Scoop News – July 25, 20011

By Martha Rosenberg

"Psychiatry mimics science but is not a real science. The symptoms it treats are subjective and have not been demonstrated and cannot be demonstrated at the cellular level."

Phillip Sinaikin, MD, is a Florida psychiatrist who has been in practice for 25 years. His new book focuses on excesses and industry influence in the field of psychiatry.

Rosenberg: Your new book, Psychiatryland, traces how deception, conflicts of interest, medical enabling and direct-to-consumer advertising have resulted in millions being on psychiatric drugs they don’t need. One patient you describe has legitimate mourning and grief work to do after his wife leaves him for his own cousin. But his grief is pathologized into “bipolar disorder” by the system, including his own mother.

Rosenberg: Can you explain the popularity of such drug cocktails? The drugs haven’t been tested together so the patient is a guinea pig. And their total cost can exceed $1000 per month, often shuttled onto taxpayers because the people are considered disabled under federal entitlement programs.

Sinaikin: Psychiatry mimics science but is not a real science. The symptoms it treats are subjective and have not been demonstrated and cannot be demonstrated at the cellular level. That gives psychiatrists free reign to just experiment and symptom chase, often insanely chasing the side effects and negative interactions of the current drug regimen with more and more drugs. Polypharmacy is also a way psychiatrists can distinguish themselves in an increasingly competitive market. No one believes you need a specialist for one drug — any primary care physician can give you Zoloft — but for multi-drug therapy you do. If you don’t write a prescription as a psychiatrist, you won’t work these days. It is like being a pacifist and having no choice but working in a bullet factory.

Rosenberg: A lot of this trial-and error polypharmacy is buttressed by the concept of “treatment resistance” and “Prozac poop-out.”

Sinaikin: I write in the book that an antidepressant not working anymore is no different than getting used to anything that used to thrill us. We buy our dream house with two bedrooms and a garage and after a while it doesn’t make us happy anymore and we are eyeing the house with three bedrooms and a pool. Another example, of course, is falling in and out of love.

Rosenberg: You document in Psychiatryland the creation of new diseases to sell drugs including adults now diagnosed with childhood disorders like ADD and children with adult disorders like bipolar and depression.

Sinaikin: One scientific article I read about the new childhood disorders sounds like a satire. Two well-respected “thought leaders” in psychiatry were debating the underlying pathology of a three-year-old girl who ran out in traffic. The first doctor believed her dangerous behavior was indicative of an Oppositional-Defiant disorder. The other doctor argued her impulsive act represented grandiose delusions where this girl believed she was special and cars could not harm her. She was, therefore, bipolar.

Rosenberg: Another shocker in your book is how everyday drug and alcohol addicts were recast as having psychiatric conditions for money.

Sinaikin: The insurance companies told the rehabs they would no longer pay for inpatient rehab for heroin, cocaine or alcohol unless there was also another Axis 1 psychiatric disorder like bipolar disorder or major depression. I was working in a drug treatment facility when the change happened. Since addicts typically complain of anxiety and depression, a completely understandable emotional response to their toxic lifestyles, it was “no problem” to add a new label and throw a few psychiatric drugs at their now relabeled “dual diagnosis.” Of course the central tenet of recovery, taking personal responsibility, was buried by the new victim narrative of self-medicating a previously undiagnosed mental illness.

Rosenberg: Treating addiction with psychiatric drugs before or instead of seeking a higher power is antithetical to the 12 Steps of Alcoholics Anonymous.

Sinaikin: As I say throughout my book, human beings are indescribably complex. There are times when the dual-diagnosis concept is necessary and helpful but clearly not applicable to 100% of the cases of addiction as it is now applied. I believe that the 12 Step model is an ideal model of recovery. Patients can have the help whenever they are truly ready, not just when someone decides to foist it on them. Most importantly, the addicts helping other addicts are doing it to facilitate their own recovery and not for ulterior motives such as money. Amazingly, in a world gone profit crazy 12 Step recovery programs are still free. I conceptualize the 12 Steps as a distillation of the spiritual principles world’s great religions but no one is forced to believe in anything including God.

Rosenberg: Given conflicts of interest at the American Psychiatric Association, which drives psychiatric diagnoses, in the FDA drug approval process itself and the legions of doctors willing to huckster for pharma as thought leaders or Key Opinion Leaders (KOLs), do you see any hope of rescuing people from Psychiatryland?

Sinaikin: The system is unbelievably bad and even worse than it looks. But, I think a goal that could be achieved would be a repeal of direct-to-consumer advertising. Patients now come into my office asking me if they have ADD or bipolar disorder or if they can have Cymbalta. When I began practicing psychiatry, long before direct-to-consumer advertising, this would never have happened.

Psychiatryland

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Business Insider – July 20, 2011

by Robert Johnson

Image: wikipedia commons

Outselling even common drugs to treat high blood pressure and acid reflux, antipsychotic medications are the single top-selling prescription drug in the United States.

Once reserved for hard-core, One Flew Over The Cuckoo’s Nest type of mental illnesses to treat hallucinations, delusions or major thought disorders; today, the drugs are handed out to unruly kids and absent minded elderly.

A recent story in Al Jazeera by James Ridgeway of Mother Jones illuminates the efforts by major pharmaceutical companies to get doctors prescribing medicines like Zyprexa, Seroquel, and Abilify to patients for whom the drugs were never intended.

Focusing on psychiatrists because they rely on subjective diagnoses, the drug reps have been so successful that they’ve changed the criteria for mental illness and disability payments. Ridgeway quotes former New England Journal of Medicine editor Marcia Angell.

“[T]he tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007 – from one in 184 Americans to one in seventy-six. For children, the rise is even more startling – a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children.” Under the tutelage of Big Pharma, we are “simply expanding the criteria for mental illness so that nearly everyone has one.” Fugh-Berman agrees: In the age of aggressive drug marketing, she says, “Psychiatric diagnoses have expanded to include many perfectly normal people.”

Particularly vulnerable because medication decisions are often out of their hands the old and the young suffer most.

For kids: the number diagnosed with bi-polar disorder rose 40-fold between 1994 and 2003 and one in five comes away from a psychiatrist with a prescription for an antipsychotic.

Dosing the elderly at nursing homes has become so common that sales reps have coined the term “five at five” — meaning 5 milligrams of Zyprexa at 5 pm to sedate difficult residents.

For all their nefarious wrangling, in 2009, Lily agreed to pay $1.4 billion, including a $515 million criminal fine. The largest ever in a health care case and the largest criminal fine on any corporation in the U.S.

That year, Lilly sold $1.8 billion of Zyprexa alone.

http://www.businessinsider.com/zyprexa-antipsycotics-top-selling-drugs-in-us-2011-7

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Modern Medicine – July 16, 2011

Long-term-care (LTC) facilities are overusing antipsychotic drugs. One of every 7 elderly nursing home residents is receiving at least 1 atypical antipsychotic; in 83% of these cases, the drug is associated with a dementia diagnosis, yet the use of atypical antipsychotics in dementia increases the risk of death and is not approved by FDA, according to a report from the Office of the Inspector General (OIG).

Erroneous claims

“Government, taxpayers, nursing home residents, as well as their families and caregivers, should be outraged — and seek solutions,” said Daniel R. Levinson, Inspector General, Department of Health and Human Services (HHS), in a statement. “Despite the fact that it is potentially lethal to prescribe antipsychotics to patients with dementia, there’s ample evidence that some drug companies aggressively marketed their products toward such populations, putting profits before safety.”

OIG analyzed atypical antipsychotic use in LTC at the request of Sen Charles Grassley (R-Iowa). The report, issued in May, evaluated Part B and Part D claims data from January to June 2007. Analysts concluded that 51% of Medicare claims for atypical antipsychotics were erroneous. The claimed drugs were not used for medically accepted indications, not used off label as supported by recognized compendia, or not documented as having been administered to the elderly nursing home resident. The erroneous payments totaled $116 million for the 6 months studied.

Unmet standards

OIG also found that 22% of atypical antipsychotics used in LTC were not administered according to Medicare standards regarding unnecessary drug use in nursing homes. The standards are designed to reduce excessive dosage, excessive duration of therapy, inappropriate use, and lack of appropriate monitoring. Noting that violation of unnecessary drug-use rules may affect nursing homes’ participation in Medicare, OIG recommended that HHS act to reduce unnecessary drug use in LTC.

The report included aripiprazole (Abilify, Bristol-Myers Squibb), clozapine (Clozaril, Novartis), olanzapine (Zyprexa, Eli Lilly), olanzapine/fluoxetine (Symbyax, Eli Lilly), paliperidone (Invega, Janssen), quetiapine (Seroquel, AstraZeneca), risperidone (Risperdal, Janssen), and ziprasidone HCl (Geodon, Pfizer).

http://drugtopics.modernmedicine.com/drugtopics/Modern+Medicine+Now/Antipsychotics-overused-in-LTC-setting-OIG-says/ArticleStandard/Article/detail/730695

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ALJAZEERA – July 12, 2011

by James Ridgeway

Drug companies like Pfizer are accused of pressuring doctors into over-prescribing medications to patients in order to increase profits - GALLO/GETTY

Has America become a nation of psychotics? You would certainly think so, based on the explosion in the use of antipsychotic medications. In 2008, with over $14 billion in sales, antipsychotics became the single top-selling therapeutic class of prescription drugs in the United States, surpassing drugs used to treat high cholesterol and acid reflux.

Once upon a time, antipsychotics were reserved for a relatively small number of patients with hard-core psychiatric diagnoses – primarily schizophrenia and bipolar disorder – to treat such symptoms as delusions, hallucinations, or formal thought disorder. Today, it seems, everyone is taking antipsychotics. Parents are told that their unruly kids are in fact bipolar, and in need of anti-psychotics, while old people with dementia are dosed, in large numbers, with drugs once reserved largely for schizophrenics. Americans with symptoms ranging from chronic depression to anxiety to insomnia are now being prescribed anti-psychotics at rates that seem to indicate a national mass psychosis.

It is anything but a coincidence that the explosion in antipsychotic use coincides with the pharmaceutical industry’s development of a new class of medications known as “atypical antipsychotics.” Beginning with Zyprexa, Risperdal, and Seroquel in the 1990s, followed by Abilify in the early 2000s, these drugs were touted as being more effective than older antipsychotics like Haldol and Thorazine. More importantly, they lacked the most noxious side effects of the older drugs – in particular, the tremors and other motor control problems.

The atypical anti-psychotics were the bright new stars in the pharmaceutical industry’s roster of psychotropic drugs – costly, patented medications that made people feel and behave better without any shaking or drooling. Sales grew steadily, until by 2009 Seroquel and Abilify numbered fifth and sixth in annual drug sales, and prescriptions written for the top three atypical antipsychotics totaled more than 20 million.  Suddenly, antipsychotics weren’t just for psychotics any more.

Not just for psychotics anymore

By now, just about everyone knows how the drug industry works to influence the minds of American doctors, plying them with gifts, junkets, ego-tripping awards, and research funding in exchange for endorsing or prescribing the latest and most lucrative drugs. “Psychiatrists are particularly targeted by Big Pharma because psychiatric diagnoses are very subjective,” says Dr. Adriane Fugh-Berman, whose PharmedOut project tracks the industry’s influence on American medicine, and who last month hosted a conference on the subject at Georgetown. A shrink can’t give you a blood test or an MRI to figure out precisely what’s wrong with you. So it’s often a case of diagnosis by prescription. (If you feel better after you take an anti-depressant, it’s assumed that you were depressed.) As the researchers in one study of the drug industry’s influence put it, “the lack of biological tests for mental disorders renders psychiatry especially vulnerable to industry influence.” For this reason, they argue, it’s particularly important that the guidelines for diagnosing and treating mental illness be compiled “on the basis of an objective review of the scientific evidence” – and not on whether the doctors writing them got a big grant from Merck or own stock in AstraZeneca.

Marcia Angell, former editor of the New England Journal of Medicine and a leading critic of the Big Pharma, puts it more bluntly: “Psychiatrists are in the pocket of industry.” Angell has pointed out that most of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of mental health clinicians, have ties to the drug industry. Likewise, a 2009 study showed that 18 out of 20 of the shrinks who wrote the American Psychiatric Association’s most recent clinical guidelines for treating depression, bipolar disorders, and schizophrenia had financial ties to drug companies.

In a recent article in The New York Review of Books, Angell deconstructs what she calls an apparent “raging epidemic of mental illness” among Americans. The use of psychoactive drugs—including both antidepressants and antipsychotics—has exploded, and if the new drugs are so effective, Angell points out, we should “expect the prevalence of mental illness to be declining, not rising.” Instead, “the tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007 – from one in 184 Americans to one in seventy-six. For children, the rise is even more startling – a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children.” Under the tutelage of Big Pharma, we are “simply expanding the criteria for mental illness so that nearly everyone has one.” Fugh-Berman agrees: In the age of aggressive drug marketing, she says, “Psychiatric diagnoses have expanded to include many perfectly normal people.”

Cost benefit analysis

What’s especially troubling about the over-prescription of the new antipsychotics is its prevalence among the very young and the very old – vulnerable groups who often do not make their own choices when it comes to what medications they take. Investigations into antipsychotic use suggests that their purpose, in these cases, may be to subdue and tranquilize rather than to treat any genuine psychosis.

Carl Elliott reports in Mother Jones magazine: “Once bipolar disorder could be treated with atypicals, rates of diagnoses rose dramatically, especially in children. According to a recent Columbia University study, the number of children and adolescents treated for bipolar disorder rose 40-fold between 1994 and 2003.” And according to another study, “one in five children who visited a psychiatrist came away with a prescription for an antipsychotic drug.”

A remarkable series published in the Palm Beach Post in May true revealed that the state of  Florida’s juvenile justice department has literally been pouring these drugs into juvenile facilities, “routinely” doling them out “for reasons that never were approved by federal regulators.” The numbers are staggering: “In 2007, for example, the Department of Juvenile Justice bought more than twice as much Seroquel as ibuprofen. Overall, in 24 months, the department bought 326,081 tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for use in state-operated jails and homes for children…That’s enough to hand out 446 pills a day, seven days a week, for two years in a row, to kids in jails and programs that can hold no more than 2,300 boys and girls on a given day.” Further, the paper discovered that “One in three of the psychiatrists who have contracted with the state Department of Juvenile Justice in the past five years has taken speaker fees or gifts from companies that make antipsychotic medications.”

In addition to expanding the diagnoses of serious mental illness, drug companies have encouraged doctors to prescribe atypical anti-psychotics for a host of off-label uses. In one particularly notorious episode, the drugmaker Eli Lilly pushed Zyprexa on the caregivers of old people with Alzheimer’s and other forms of dementia, as well as agitation, anxiety, and insomnia. In selling to nursing home doctors, sales reps reportedly used the slogan “five at five”—meaning that five milligrams of Zyprexa at 5 pm would sedate their more difficult charges. The practice persisted even after FDA had warned Lilly that the drug was not approved for such uses, and that it could lead to obesity and even diabetes in elderly patients.

In a video interview conducted in 2006, Sharham Ahari, who sold Zyprexa for two years at the beginning of the decade, described to me how the sales people would wangle the doctors into prescribing it. At the time, he recalled, his doctor clients were giving him a lot of grief over patients who were “flipping out” over the weight gain associated with the drug, along with the diabetes. “We were instructed to downplay side effects and focus on the efficacy of drug…to recommend the patient drink a glass a water before taking a pill before the  meal and then after the meal in hopes the stomach would expand” and provide an easy way out of this obstacle to increased sales. When docs complained, he recalled, “I told them, ‘Our drug is state of the art. What’s more important? You want them to get better or do you want them to stay the same–a thin psychotic patient or a fat stable patient.’”

For the drug companies, Shahrman says, the decision to continue pushing the drug despite side effects is matter of cost benefit analysis: Whether you will make more money by continuing to market the drug for off-label use, and perhaps defending against lawsuits, than you would otherwise. In the case of Zyprexa, in January 2009, Lilly settled a lawsuit brought by with the US Justice Department, agreeing to pay $1.4 billion, including “a criminal fine of $515 million, the largest ever in a health care case, and the largest criminal fine for an individual corporation ever imposed in a United States criminal prosecution of any kind,”the Department of Justice said in announcing the settlement.” But Lilly’s sale of Zyprexa in that year alone were over $1.8 billion.

Turning people into zombies

As it turns out, the atypical antipsychotics may not even be the best choice for people with genuine, undisputed psychosis.

Read the rest of the article here: http://english.aljazeera.net/indepth/opinion/2011/07/20117313948379987.html

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By Michael LaForgia

Palm Beach Post Staff Writer

By the time Florida started paying Dr. Gold Smith Dorval to counsel and medicate jailed children, the Pembroke Pines psychiatrist already had experience with kids in state custody.

He had used them, authorities said, to bilk the government out of money for the poor.

When Dorval pleaded no contest to a felony grand theft charge, it should have barred him, by law, from working for Florida’s Department of Juvenile Justice.

It didn’t.

And, like Dorval, other doctors have emerged from past troubles and gotten jobs at DJJ – with authority to prescribe drugs to kids in state jails, a Palm Beach Post investigation has found.

Some psychiatrists took DJJ jobs after they were cited for breaking the law, making grave medical missteps or violating state rules. Others were hired after they were accused of overmedicating patients, sometimes fatally.

All were empowered to prescribe drugs to jailed kids as powerful antipsychotic pills flowed freely into Florida’s homes for wayward children.

“It’s appalling. A psychiatrist is a psychiatrist. They’re licensed, they’ve been to medical school, and there is a certain trust placed in that person’s judgment when they tell you that this child needs to be medicated,” said John Walsh, an attorney with the Palm Beach County Legal Aid Society who has represented children in juvenile court. “This just illustrates that we always have to be on guard with children.”

In two years, Florida bought hundreds of thousands of tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for children housed in state-run jails and programs. The meds were administered in a juvenile justice system that doesn’t track prescriptions and has no way of telling whether doctors are prescribing to make kids easier to control.

In some jails and homes, pills were prescribed by psychiatrists who took huge speaker fees from companies that make antipsychotic drugs, The Post found. In others, the task fell to doctors with troubled pasts.

In response to the newspaper’s first reports, published last month, DJJ Secretary Wansley Walters launched an investigation into the department’s use of antipsychotic drugs. DJJ officials declined to discuss The Post’s latest findings, citing the probe.

Spokesman C.J. Drake acknowledged, though, that the department has struggled to find psychiatrists willing to work in jails and programs. He also said DJJ sometimes has relied on companies that employ a stable of doctors, rather than signing a contract with a single physician.

As a result, Dorval went to work in a Broward County jail for children – even though he would have failed a state-mandated background check required by the contract.

Doctor’s bogus billings

In the late 1990s, Dorval claimed he was providing juvenile delinquents and other vulnerable children with needed therapy. Instead, state investigators said, he used bogus counselors to bill Medicaid for more than $350,000 in fraudulent claims.

He charged the government for offering more than 24 hours’ worth of children’s therapy in a single day, investigators said, and structured the scheme around kids who were homeless or in DJJ custody or foster care.

He tended to bill “for those children that the system ‘lost,’ ” according to an affidavit for his arrest.

Originally charged with four felonies in Broward, Dorval pleaded no contest to one count of grand theft in 2004.

Later, to keep his medical license, he agreed to pay $10,000 and was suspended, reprimanded and put on four years’ probation.

Although a judge withheld a formal finding of guilt, the plea disqualified Dorval from seeing patients in a juvenile jail. Even so, his employer, Miami-based Compass Health Systems, sent him to work at the Broward Juvenile Detention Center between August and December 2007.

No one screened his background beforehand.

In written responses to questions, Dorval said he was doing as he was told when Compass sent him to work in the Broward juvenile jail.

“At that period you cited, the psychiatrist that was seeing patients at the DJJ was out. Therefore I was designated by the management office to go and cover for that psychiatrist, until they switched me again to another place. I was not aware of any wrongdoing,” wrote Dorval, who stressed that he never signed a contract with DJJ. “I am only an employee. Wherever they send me to work I have to go.”

As for the criminal charges, he offered this explanation: “This case was a simple matter that became complicated, because my first lawyer messed me up.” After wrangling over the facts, “they decided to offer me a plea that would allow me to get a chance to fight for my license to practice medicine,” he wrote. “It was a real nightmare that generated in me a post-traumatic syndrome that I will never forget.”

DJJ officials declined to comment on Dorval’s hiring, again citing the investigation.

Compass officials didn’t respond to questions about Dorval.

DJJ had no contract with Compass as of May, records show.

Patient’s death missed in screening

In state-operated jails and programs, the rules say DJJ must screen doctors’ backgrounds and verify that physicians’ hold valid medical licenses. In privately run programs, which house the majority of children in the department’s custody, that responsibility falls to contracted companies.

Such screenings don’t catch everything: Doctors who kept their licenses after the state accused them of serious lapses have gone on to work in juvenile jails and homes.

Dr. Charles J. Dack is an example. For six years, Dack, a Lakeland-based physician who is board-certified in addiction and child psychiatry, prescribed a cocktail of antidepressants and powerful painkillers, including methadone and morphine, to a patient named Mary Tuxbury.

Eventually, Dack ramped up the doses of pills Tuxbury was taking, keeping her “at a toxic level of morphine for approximately two and a half years,” regulators from the state health department said. In March 2002, Tuxbury was found dead. She was 42.

An autopsy showed she died of “multiple drug intoxication, namely opiates and tricyclic antidepressants.”

Regulators charged Dack with failing to meet care standards and inappropriate prescribing. Dack settled the allegations in August 2007. He admitted no wrongdoing but agreed to pay a $7,000 fine and complete a course on “misprescribing” drugs.

A year later, he was hired to care for children at three privately run programs in Central Florida: Wilson Youth Academy, Peace River Youth Academy and New Beginnings Youth Academy. He worked in the homes until April.

Dack didn’t respond to messages seeking comment.

Doctor hired after child’s death

Other DJJ doctors weren’t cited by regulators, but they were accused in court of fatal neglect. Roughly one in eight of the psychiatrists who have worked for DJJ in the past five years has settled a malpractice lawsuit in Florida, records show.

Among these was Dr. Samuel McClure. As a psychiatrist in Orlando, McClure diagnosed an 11-year-old boy named David Morganthal with attention deficit disorder. He prescribed powerful, mind-altering drugs for David – even though the child was much smaller than other kids his age, according to court documents.

One morning in November 2001, David’s mother woke to find her son dead on the floor of her double-wide mobile home. When they laid David out at the morgue, he measured less than 4-foot-2 and weighed 49 pounds.

Lab tests showed his blood contained an unusually high concentration of an antidepressant: about 60 percent more of the medication than doctors had expected.

The drug, mirtazapine, still hasn’t been approved as safe for children. David was taking the drug along with another antidepressant that hasn’t been approved for kids, citalopram.

The autopsy concluded the boy probably died from a seizure and heart problems caused by “reaction to prescription medication.”

Read the rest of the article here: http://www.palmbeachpost.com/news/state/dosed-in-juvie-jail-troubled-doctors-hired-to-1549240.html?viewAsSinglePage=true

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