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Pfizer To Introduce Generic Version Of Its Antidepressant Zoloft

June 30, 2006

Thursday, New York City-based healthcare company Pfizer Inc. deportedly revealed plans to introduce a generic version of its antidepressant drug Zoloft after the brand-name drug loses domestic patent protection tomorrow. Zoloft is the company’s third-biggest product, with U.S. sales of $2.57 billion last year, and the best-selling antidepressant in the nation.

Sources reported that Teva Pharmaceutical Industries has gained exclusive right to sell generic Zoloft, or sertraline for six months. This is under a settlement between Pfizer and patent challenger Ivax Corp., which was acquired by Teva in March.

Pfizer’s plans for generic Zoloft follow Merck’s move to challenge generic-drug makers who offer generic versions of its cholesterol drug Zocor when it lost patent protection last week. Pfizer is making and marketing generic versions of its drugs through a division called Greenstone Ltd, WSJ said.

The practice of producing identical drugs or authorized generics when the patent for a branded drug is ruled invalid or expired preserves sales for the original maker. However, in the eye of a generic-drug maker, who might have successfully challenged the brand-name drug maker’s patent on the product, it serves as a jab.

Commenting on Pfizer’s practice of producing authorized generics, Bruce Downey, chairman and chief executive of big generic maker Barr Pharmaceuticals Inc, said that Pfizer has turned Greenstone into a weapon to discourage companies from trying to challenge their patents.

While Johnson & Johnson is practicing Pfizer’s approach through a subsidiary called Patriot Pharmaceuticals, Schering-Plough Corp.’s (SGP | charts | news | PowerRating) Warrick generics subsidiary does the same in a broader manner, reports said.

Greenstone operates exclusively in the U.S. and sells only generic versions of Pfizer drugs. Greenstone’s other products include generic versions of blood-pressure pill Accupril, epilepsy medicine Neurontin and antibiotic Zithromax. According to data from IMS Health, Greenstone is holding seventh position among generics concern in the U.S, with sales that tripled to $722 million in 2005.

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Pfizer To Introduce Generic Version Of Its Antidepressant Zoloft

June 30, 2006

Thursday, New York City-based healthcare company Pfizer Inc. (PFE | charts | news | PowerRating) reportedly revealed plans to introduce a generic version of its antidepressant drug Zoloft after the brand-name drug loses domestic patent protection tomorrow. Zoloft is the company’s third-biggest product, with U.S. sales of $2.57 billion last year, and the best-selling antidepressant in the nation.

Sources reported that Teva Pharmaceutical Industries (TEVA | charts | news | PowerRating) has gained exclusive right to sell generic Zoloft, or sertraline for six months. This is under a settlement between Pfizer and patent challenger Ivax Corp., which was acquired by Teva in March.

Pfizer’s plans for generic Zoloft follow Merck’s (MRK | charts | news | PowerRating) move to challenge generic-drug makers who offer generic versions of its cholesterol drug Zocor when it lost patent protection last week. Pfizer is making and marketing generic versions of its drugs through a division called Greenstone Ltd, WSJ said.

The practice of producing identical drugs or authorized generics when the patent for a branded drug is ruled invalid or expired preserves sales for the original maker. However, in the eye of a generic-drug maker, who might have successfully challenged the brand-name drug maker’s patent on the product, it serves as a jab.

Commenting on Pfizer’s practice of producing authorized generics, Bruce Downey, chairman and chief executive of big generic maker Barr Pharmaceuticals Inc, said that Pfizer has turned Greenstone into a weapon to discourage companies from trying to challenge their patents.

While Johnson & Johnson (JNJ | charts | news | PowerRating) is practicing Pfizer’s approach through a subsidiary called Patriot Pharmaceuticals, Schering-Plough Corp.’s (SGP | charts | news | PowerRating) Warrick generics subsidiary does the same in a broader manner, reports said.

Greenstone operates exclusively in the U.S. and sells only generic versions of Pfizer drugs. Greenstone’s other products include generic versions of blood-pressure pill Accupril, epilepsy medicine Neurontin and antibiotic Zithromax. According to data from IMS Health, Greenstone is holding seventh position among generics concern in the U.S, with sales that tripled to $722 million in 2005.

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Labour MPs may block British ‘Megan’s law’, ex-minister warns

June 26, 2006

Labour MPs could block a British version of “Megan’s law”, which would allow the public access to a register of known paedophiles.

The former Home Office minister Angela Eagle said yesterday that the government could face “difficulty” if it tried to introduce the US-type law.

“Child abuse is an appalling cycle of violence. It needs to be stopped,” she said on the BBC’s Sunday AM programme.

“Above all, we need to protect children. I am not convinced Megan’s law does it.”

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Instead, more should be done to treat offenders, she said, and insisted that any plans to follow the US example “in this very difficult area” should be evidence-based.

“I think there will be difficulty in the parliamentary Labour party if attempts were made to introduce laws - like the education reform - which are based on assertion, not evidence.”

Last week the home secretary, John Reid, said he was considering importing a version of the law and would be sending his junior minister, Gerry Sutcliffe, to investigate how it has worked in the US since implementation in 1997. But yesterday Hazel Blears, the Labour party chairwoman, said: “We are trying to find out how these laws work and look coolly and dispassionately at them. I don’t think we should be driven by hysteria on this.”

She spoke as news emerged that the antidepressant drug Prozac could be given to sex offenders as part of a treatment programme.

Responding to Sunday newspaper reports, the Prison Service and the Home Office said the treatment programme for sex offenders was based on cognitive therapies, but they kept “an open mind” on whether drugs such as Prozac could be used in individual cases.

Phil Wheatley, director general of the Prison Service, said: “The sex offender treatment programme is based on cognitive- behavioural principles rather than drugs and has been shown to be the most effective method of reducing reoffending. Medical treatment of an individual sex offender would be decided on the basis of an individual’s clinical needs by a clinician. We keep an open mind and continue to liaise with Department of Health colleagues as to whether drugs may complement existing treatment programmes.”

Reports that chemical castration was being considered for sex offenders by the Home Office were denied.

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No-name option to cholesterol drug Zocor arrives

June 23, 2006

A generic version of the best-selling cholesterol-lowering drug Zocor becomes available today, creating millions in savings for Michigan insurers and consumers and reigniting a push for more people to use no-name drugs.

Zocor, which grossed $4.4 billion last year for Merck & Co. Inc., is the first in a string of blockbuster drugs set to lose patent protection in the next 18 months, making way for cheaper no-name versions that cost a fraction of the originals.

Blue Cross Blue Shield of Michigan, which fills about 1 million Zocor prescriptions a year, estimates it will save $70 million annually if its members switch to the generic version, called simvastatin.

“This is the largest opportunity ever when it comes to savings on generics,” said Atheer Kaddis, Blues director of clinical program development, referring to the wave of drugs set to lose their patent. “All of these medications are highly utilized.”

Nearly $12 billion in branded drugs will lose patent protection this year, and another $11 billion next year, according to pharmacy benefit manager Express Scripts. Of more than 10,000 drugs with Food and Drug Administration approval, about 6,000 have generic equivalents.

The Blues, Michigan’s largest insurer, is using the Zocor patent expiration as a chance to promote use of generics. The insurer estimates it has saved $300 million in drugs costs since it began its campaign, “Generics: The Unadvertised Brand,” in 2001.

Consumers will save money too. Some insurance policies charge lesser co-pays for generic drugs, an increasingly common practice. Uninsured patients who pay for their prescription drugs out-of-pocket also can save by buying generic.

The no-name version of Zocor will cost $1 or less per pill than the name brand, pharmacists say. Zocor typically retails for between $2 and $5 per pill. Even the name-brand version may be cheaper, since Merck in a virtually unprecedented move is lowering its prices for some insurers to compete with the generic brand.

The Blues’ Kaddis said this latest wave of soon-to-be-generic drugs is the first since a similar phenomenon in 2000 and 2001 that started when antidepressant Prozac lost patent protection. The savings this time will be even more, he said.

Humana Inc., one the nation’s largest insurers, will promote the use of generic drugs on its Web site, through newsletters and on explanation of benefit forms sent to consumers, said company spokesman Mark Mathis.

Humana’s most popular policy will charge $30 to fill a prescription for simvastatin, compared to $50 for Zocor.

“It makes economic sense for Humana to offer the generic at lower co-payments than the brand medication,” Mathis said.

Generics have their limits

With prescription drug spending topping $179 billion in 2003, the medical community has embraced generic drugs as safe and less expensive alternatives to brand-name drugs.

While many patients appreciate the cost savings, some don’t want their access to name-brand drugs restricted. Doctors, also, are sometimes frustrated by restrictions that prevent them from prescribing a name-brand drug. In some cases, a subtle difference in the medication may mean a patient is better suited for a specific name brand, doctors say.

Only about 6 percent of cholesterol-lowering drugs bought in Michigan are generic, since most drugs in that class aren’t available in no-name form.

Some will grumble

Several other drugs are on the verge of losing their patent. Among them are sleep aid Ambien, with $1.9 billion in annual sales last year; antidepressant Zoloft with $2.6 billion in sales; and antidepressant Wellbutrin XL with $1.3 billion in sales.

Several drugs set to lose patent protection come from Pfizer Inc., the world’s largest drug maker with its third-largest research hub in Ann Arbor. Cholesterol-lowering Lipitor, the best-selling drug ever, will lose patent protection next year.

Patients have become accustomed to generic drugs and likely won’t mind the switch, said Northville Pharmacist Fred Devantier. He expects to hear some grumbling from customers who are being forced by their insurer to switch from name-brands.

“The insurance company is going to make them go generic,” said Devantier, who works at Northville Pharmacy. “There will be a couple people who won’t want it. They’ll just have to pay more.

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Doubt over antidepressant risks

June 20, 2006

A common antidepressant may be safe for pregnant women to use, despite fears it could put babies at risk.

Seroxat had been linked to heart abnormalities, and the US watchdog issued a warning on the link last year.

But German researchers told a European fertility conference they had found no increased risk, and said women may have terminated pregnancies unnecessarily.

Experts say women with depression should talk to their doctor to find out what is best for them.

The science on Seroxat and pregnancy isn’t conclusive either way
Sophie Corlett

Pregnancies in women with untreated depression carry their own risks, including poor foetal development, premature birth and intellectual development problems.

The US Food and Drug Administration issued its warning on the drug - also known as paroxetine - on the basis of unpublished research from the makers, GlaxoSmithKline, which has since been revised.

The UK’s Medicines and Healthcare products Regulatory Agency said the drug should only be used in pregnancy when the benefits to the mother outweigh any potential risks to the foetus.

Terminations

The research carried out by the University of Ulm team studied 119 women treated with Seroxat between 1999 and 2005 and compared their pregnancies to 645 women not exposed to the drug.

Three abnormalities were reported after exposure to the drug: club feet, a large port wine mark and neck muscle spasms.

But, in the non-drug group, there was a similar rate of abnormalities, with 25 out of 557 babies affected.

The only way in which the Seroxat group differed was that more decided to terminate their pregnancies.

Eighteen out of 119 on the drug, just over 15%, opted to terminate their pregnancy compared to 17 out of 645 women in the control group (2.6%).

The researchers said most chose a termination because of their depression, but also because of confusion over the potential risk from the drug.

‘Information is crucial’

Dr Wolfgang Paulus, director of the Institute of Reproductive Toxicology at the University of Ulm, who led the research, said: “We found that the rate of congenital abnormalities was not increased after using paroxetine in early pregnancy.

“Women and their physicians should discuss this information and make an informed decision, whether or not to continue with paroxetine during pregnancy.

“Concerned patients can be offered ultrasound and echocardiogram, which can rule out foetal cardiac problems in early pregnancy.

“Antidepressants should never be stopped abruptly as this can have serious ramifications for the mother.”

Sophie Corlett, policy director of mental health charity Mind, said: “The science on Seroxat and pregnancy isn’t conclusive either way.

“It’s crucial that women are given all the information and options possible, so they can best weigh up the risks and benefits of taking this drug when they’re expecting a baby.

“We also don’t know yet what the effects could be of passing on any antidepressants through breastfeeding once the baby has been born.”

She added: “Many unpleasant side-effects have been reported with Seroxat, so it’s not just pregnant women who should be cautious when taking it.

“Mind fully supports the researchers’ call for close vigilance whenever Seroxat is prescribed.”

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Anti-Depressant Unsuccessful in Treating Anorexia Relapse

June 14, 2006

vanhoe Newswire) — A recent study revealed the anti-depressant drug fluoxetine was not successful in helping patients with anorexia nervosa avoid relapse.

The study participants included 93 anorexic women, between ages 16 to 45, who had regained their weight to a minimum body mass index (BMI) of 19. The women were randomly chosen to receive fluoxetine or placebo for one year.

The group taking fluoxetine did not have substantially different results from the placebo group.

After 52 weeks, relapse rates were almost equal. Of the patients taking fluoxetine, 43 percent had not relapsed, and 45 percent of the placebo group had not.

According to the study’s authors, “The current study has implications for both clinical practice and research. The present findings, coupled with those of previously published studies, indicate that the common practice of prescribing anti-depressant medication is unlikely to provide substantial benefit for most patients with anorexia nervosa, either when they are underweight or immediately upon weight restoration.”

Anorexia nervosa, an eating disorder linked to extreme dieting to the point of severe illness or even death, claims the highest suicide rate of any psychiatric illness.

High rates of relapse are a major source of the problem plaguing anorexics. Within a year of weight restoration, 30 percent to 50 percent of anorexia nervosa patients are back in the hospital.

“Future research on the utility of novel psychological treatments and innovative psychotropic and nonpsychotropic medications is obviously needed,” said the authors.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.

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NEW GENERIC DRUGS

June 7, 2006

Reported and Web Produced by: John Matarese
Updated: 06/06/06 17:54:30

Tri staters who use two of the most popular name brand medicines on the market may soon be saving some money.

For some patients, it could be hundreds of dollars..

A new report from the generic drugmaker “Express Scripts” claims consumers could save billions later this year, when two common prescription drugs go generic later this summer.

The government has recently approved generic versions of zZocor, an anti-cholesterol drug, and Zoloft, an anti-depressant.

How popular are they? In 2005, sales of non-generic Zocor and Zoloft totaled more than $5 billion.

If you want to learn more about their generic versions, check with your doctor or pharmacist.

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FDA Pre-emption Halts Suit Over Anti-Depressant

June 7, 2006

The widower of a woman who committed suicide after taking a generic version of the anti-depressant drug Paxil may not pursue product liability claims premised on an alleged failure to warn of suicide risks because the Food & Drug Administration strictly controls the content of such warnings and did not demand it at the time, a Pennsylvania federal judge has ruled.

In his 66-page opinion in Colacicco v. Apotex Inc., U.S. District Judge Michael M. Baylson found that the plaintiffs’ state law tort claims are pre-empted by the federal Food, Drug & Cosmetic Act.

In the suit, plaintiff Joseph Colacicco alleged claims against GlaxoSmithKline, the maker of Paxil, and Apotex, the manufacturer of the generic version of Paxil taken by his wife.

The suit cast blame on both manufacturers on the theory that GSK had authored the warnings used by Apotex.

Now Baylson has ruled that both defendants are entitled to dismissal of all claims against them because the FDA controls the content of warnings and because the Hatch-Waxman amendments to the FDCA explicitly require generic manufacturers to use the same labeling as approved for the drug’s innovator.

Because the 3rd U.S. Circuit Court of Appeals has never squarely addressed the question, Baylson asked the FDA to submit an amicus brief.

In response, the FDA’s lawyers filed a brief that urged Baylson to rule in favor of the manufacturers and dismiss the suit.

“To base a tort judgment on a drug manufacturer’s failure to warn in October 2003 of an association between adult use of paroxetine hydrochloride [the generic term for Paxil] and suicide or suicidality, despite FDA’s judgment at the time that there was not reasonable evidence of such an association, would be to demand a warning statement that would have been false and misleading, and thus contrary to federal law,” the FDA’s brief said.

“Although the FDA has the deepest sympathy for the plaintiff because of the loss of his wife, it is vital to ensure that state tort law does not undermine the FDA’s authority to protect the public health through enforcement of the prohibition against false or misleading labeling of drug products… . In such a case, federal law must prevail,” the FDA’s brief said.

Baylson agreed, saying “we must afford deference to the FDA’s position that the claims are pre-empted.”

The ruling is a victory for GSK’s lawyers, David J. Stanoch and Joshua G. Schiller of Dechert in Philadelphia, along with Thomas Bayman, Erica M. Long and S. Samuel Griffin of King & Spalding in Atlanta, and Apotex’s lawyers, Arthur B. Keppel and Charles A. Fitzpatrick III of Mylotte David & Fitzpatrick’s Broomall office.

Colacicco’s lawyers — Harris L. Pogust, Derek T. Braslow, Robert N. Wilkey and T. Matthew Leckman of Cuneo Pogust & Mason in Cohshohocken, Pa. — argued that there were several reasons the suit should not be pre-empted.

The FDCA merely establishes “minimum standards,” the plaintiff’s team argued, and permits manufacturers to unilaterally strengthen warning labels.

Deference to the FDA’s position would be wrong, the plaintiff’s team said, because the FDA’s policy has been inconsistent, and would violate the principle forbidding retroactive application of new rules.

Under Pennsylvania law, the plaintiff’s team said, both GSK and Apotex owed a duty of care to Lois Ann Colacicco.

The plaintiff’s team also urged Baylson to reject the defense arguments to dismiss the suit under the “learned intermediary doctrine,” arguing that such a defense requires an analysis of the adequacy of the warnings, which is a question of fact that may not be determined prior to discovery.

According to the suit, Lois Colacicco complained to her oncologist of mild fatigue and depression and was given a prescription for Paxil in October of 2003.

Soon after, she began taking the generic version of the drug, paroxetine hydrochloride, which is a bio-equivalent of Paxil and manufactured by Apotex.

On Oct. 28, 2003, after 22 days of ingesting the drug, Lois Colacicco committed suicide in her home.

Paxil is one of a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs, which are prescribed for the treatment of depression and anxiety.

The suit alleges that despite peer-reviewed scientific literature published from the mid-1990s onward linking SSRIs to an increased risk of suicidality, the FDA-approved label did not include any warning of suicide risk.

But the manufacturers’ lawyers moved for dismissal of the entire suit, arguing that allowing the case to proceed would thwart the purpose of, and actually conflict with, the FDCA, and that the court must afford deference to the FDA’s position that its regulations pre-empt state tort claims.

GSK also argued that, as an innovator drug manufacturer, it owes no legal duty of care to a consumer of the generic equivalent of its drug.

Apotex argued that, under the statute governing FDA approval of generic drugs, it was not responsible for the form or content of the paroxetine hydrochloride labeling, and therefore it, too, did not owe a duty of care to the plaintiff.

Now Baylson has ruled that the case hinged on the “threshold issue” of pre-emption, and specifically “whether regulations of a federal agency, promulgated pursuant to a federal statute, and implementing that statute, require the court to dismiss this pharmaceutical products liability suit based on common law tort principles alleging that inadequate labeling of a prescription drug led to the suicide of plaintiff’s wife.”

The answer, Baylson said, is “yes,” because when Congress passed the FDCA, it granted control to the FDA over the regulation of the prescription drug industry, and vested the agency with authority to regulate “the specifics of drug labeling, making important judgments of what is required for safety of the consuming public, what new drugs may appear in the marketplace, and what warnings their instructions and labels must carry.”

In his research, Baylson said he found “many conflicting court decisions on this topic,” but that a series of decisions from the U.S. Supreme Court “point this court in the direction of deference, and require dismissal of this case.”

Baylson also found that the FDA’s view, as expressed in its amicus brief, was “critical to this court’s analysis” because U.S. Supreme Court precedent dictates that an agency’s interpretation of the statute and regulations it administers is entitled to deference.

In the context of pre-emption specifically, Baylson said, the Supreme Court held in its 1985 decision in Hillsborough County v. Automated Medical Laboratories Inc. that, in the absence of clearly expressed congressional intent or subsequent developments that reveal a change in that position, the FDA’s position on the pre-emptive scope of its regulatory authority “is dispositive.”

And in its 2000 decision in Geier v. American Honda Motor Co. Inc., Baylson said, the Supreme Court “made clear that such pre-emptive intent may properly be communicated in amicus briefs.”

In recent years, Baylson noted, “each time the Supreme Court has confronted the question of whether the FDCA pre-empts state law, it has deferred to the FDA’s pre-emption position.”

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Wyeth Suicide drug

June 5, 2006

CHILDREN under 10 years of age are being placed on antidepressant drugs in the thousands despite clear Federal Government warnings of dangerous side effects.

A The Daily Telegraph investigation can reveal that use of these drugs by children of that age is linked to at least two suicides and another death from heart failure.

Therapeutic Drug Administration documents show there have been 827 notified adverse reactions reports — in 380 separate cases — for antidepressant use among under 10s.

Apart from the deaths, these included convulsions, self-harm, muscle spasms, tremors, hallucinations, deafness, paralysis and tourette’s disorder.

Has your child had a reaction to an antidepressant?

A further 833 adverse health responses, in 385 cases, have been linked to use by youths aged between 10 and 19 years. The reactions include links to three deaths.

These antidepressants, known as selective seratonin reuptake inhibitors (SSRIs), have never been approved for treating depression in anyone under 19 years of age.

Despite this, 220,000 scripts were issued for their use by under 19s, with about 15,000 of those going to under 10s.

SSRIs include popular brands such as Prozac, Zoloft, Aropax, Lexapro and Luvox.

The drugs have proved safe and effective in adult clinical trials and, because of this, can be prescribed to any age group.

Following a series of alarming studies on side effects for children, federal health authorities issued a notice on October 15, 2004 which said: “there is evidence of an increased risk of suicidality, including suicidal ideation, suicide attempts and self harm”.

Minutes obtained from the Australian Adverse Drug Reactions Advisory Committee show there has been close monitoring of SSRIs scripts to children since 2005.

Last September consideration was given to notice in the Schedule of Pharmaceutical Benefits stating they were not approved for under 19s.

Royal Australian and New Zealand College of Psychiatrists spokesman Dr Phil Brock said there was evidence GPs were not careful enough with proscribing of SSRIs.

Dr Brock, an adolescent mental health specialist, said SSRIs should only be prescribed on a “case by case basis” under the care of an adolescent psychologist.

“A pill may be seen as a short cut, particularly when we are being bombarded by the claims of the pharmaceutical industry,” he said.

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Ped Med: Anti-depressants in adolescents

June 3, 2006

SAN FRANCISCO, CA, United States (UPI) — The use of anti-depressants in adolescents has kicked up a psychotropic dust-storm of controversy.

In what many consider a vindication of their minority viewpoint, a team from the Stanford University School of Medicine in California has dug up evidence of potential misuse of the medicines in young patients in the years preceding the 2004 federal warning of a doubled risk — from 2 percent to 4 percent — of suicidal thinking and behaviors in some medicated adolescents.

Surprised at how little data existed about depression treatments in this age group, the Stanford sleuths began their own investigation.

The probe uncovered a troubling trend of physicians taking liberties with their own clinical guidelines, often bypassing psychotherapy as a component of first-line treatment. Instead, the study shows, in the years 1995 to 2002 they increasingly relied solely on the drugs that were supposed to support, not supplant, counseling.

The Stanford team, led by Dr. Randall Stafford, also found although federal regulators have deemed only one anti-depressant, Prozac, to be sufficiently studied for safety and effectiveness in minors to warrant their seal of approval for such use, doctors were prescribing a variety of other, unsanctioned mood-altering medications.

It should be pointed out some 30 percent to 40 percent of children fail to fully respond to Prozac, so other options may be needed.

Also, the ‘off-label’ doling out of drugs is routine in the underage population so, in that respect at least, anti-depressants are not that different from many other medicines prescribed to minors without benefit of federal authorization.

However, the guidelines of the American Academy of Child and Adolescent Psychiatry call for trying talk treatments first in depressed children and, in the most severe cases, combining pharmaceuticals with psychotherapy. Part of the reason for this recommendation is to increase the odds the physician will monitor the medicines` effects and ensure patients` compliance.

But what the Stanford team found was that while office visits by depressed teens more than doubled over the seven years studied — soaring from 1.4 million in 1995 to 3.2 million in 2002 — the use of psychotherapy in that period sank from 83 percent of the visits to 68 percent. At the same time, reliance on drugs increased from 47 percent to 52 percent of the cases.

That may not seem like such a big change — until you consider the dramatic increases in the diagnosis of depression in children and realize the actual number of youngsters on anti-depressants more than doubled during the period studied, the scientists said.

What`s more, as the drugs took center stage, they shoved talk therapy to the back burner, they said. So much so that it was forsaken altogether in between 42 percent and 52 percent of doctor`s visits by anti-depressant-using children, the Stanford team reported.

Among other issues, the cutback raises the question of adequacy in patient monitoring, which serves as a crucial safeguard — especially during the first critical months after drug treatment begins, when suicidal behaviors and other serious side effects are most likely to appear, researchers said.

Some of the figures in the report, published in December 2005, may be dated because anti-depressant use in adolescents appears to have started to decline in the wake of the Food and Drug Administration suicidal-risk alert, issued March 22, 2004.

Nevertheless, no long-term trends have been established yet, and the basic findings still apply.

The reports add fuel to the debate over the medicating of young minds.

If some 84 percent of teens are erroneously judged in screening tests to be suicidal, as some studies suggest, if they then have to undergo a second potentially embarrassing or stressful evaluation, if any are needlessly referred for treatment, as can happen in an imperfect system, if that treatment tends to rely exclusively on drugs carrying FDA warnings of raised risk of suicidal behavior, the calls for caution begin to look like words of wisdom, critics contend.

In ’setting the record straight,’ a Web site for a popular mental-health screening program for adolescents, called TeenScreen, emphasizes fewer than 10 percent of the teens referred for further services end up receiving psychotropic treatment. To the critics, however, even one unnecessarily medicated child is too many.

There is no foolproof way to determine in advance who will opt to opt out early. All healthcare providers can do is use their expertise and experience in estimating the odds a teen will decide to take his or her own life.

That they don`t have the art down to a science is reflected in some estimates, including from studies conducted in Denmark and Sweden, that suggest as many as one in five of those who commit suicide were getting professional help at or around the time of their death.

‘We`re still trying to get basic information to tell us how many of those who die by suicide are in treatment currently or ever were in treatment because, depending on the answer, there will be different implications,’ said Richard McKeon, special expert on suicide prevention at the Substance Abuse and Mental Health Services Administration in Rockville, Md., an arm of the federal Department of Health and Human Services.

‘The information we have currently, which is not as good as it could be, would suggest probably somewhere between 15 percent and 20 percent of those who die by suicide are in treatment at the time or had been in treatment sometime within the last year,’ he said.

Such research is scarce, so no one really knows the actual numbers, but some clues are trickling in.

A Utah study found anti-depressants in none of the 49 teens who had committed suicide, a New York survey detected the drugs in 10 percent of the 66 adolescents who died by their own hand, and most post-mortems on adults indicate nearly 20 percent are on medication when they cut their life short, according to a task force report by the American College of Neuropsychopharmacology, which concluded in favor of anti-depressant use.

‘It is not possible to prevent all suicide,’ McKeon noted. ‘Patients can get good treatment but still die of suicide, just like there can be death during surgery.’

And that is something every parent and patient should be fully aware of before treatment begins, the critics emphasize.

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