First of all, a disclaimer:  I’m not a medical professional.  I don’t even play one on TV.

And since I’m not qualified to make recommendations on health or mental health, please take this post as an informational piece and not a position piece.  That being said, I’m hoping my medical professional colleagues have some opinions on the issue, so here goes.

This article comes via a friend of mine who is a post-doc in NeuroScience at Baylor University.  The abstract of the article is as follows:

What is attention-deficit hyperactivity disorder (ADHD)? Why are so many children being diagnosed with ADHD and prescribed medication? Are stimulant drugs an effective and safe treatment strategy? This article explores the current state of scientific research into ADHD and the key social and ethical concerns that are emerging from the sharp rise in the number of diagnoses and the use of stimulant drug treatments in children. collaborations among scientists, social scientists and ethicists are likely to be the most promising route to understanding what ADHD is and what stimulant drugs do.

The article goes on to explore such issues as: the validity of diagnoses, alternative treatments, ethics of medicating children, etc.  A couple of excerpts I found interesting:

Diagnoses of psychiatric disorders are controversialbecause they are based on clinical assessment of behavioural symptoms: there are no laboratory tests to determine no unequivocally whether a subject has the disorder. In the case of ADHD, this problem is exacerbated by the fact that ADHD symptoms are difficult to distinguish from normal childhood behaviours. As long as there is no clear and indisputable scientific rationale for the growing rates of ADHD diagnosis and treatment in children4, the validity of ADHD diagnosis will continue to come under social and ethical scrutiny.

and:

In the future, better diagnoses and more comprehensive understanding of ADHD aetiology are likely to have a positive impact on treatments for ADHD. At this time, however, the state of scientific understanding is not sufficient to overcome the problem of over-diagnosis of ADHD and overuse of stimulant drug treatments. In this context, it is necessary to evaluate the ethics of medicating children for ADHD.

Safety is a paramount ethical issue in psychotropic drug treatments for children with ADHD. children are not small adults; nevertheless, most of the psychotropic drugs that are prescribed to children have only been tested on adults. Although stimulants have been used to treat childhood behavioural problems since the 1930s, there have been few systematic longitudinal scientific studies of the long-term effects of stimulant drug use in children. Moreover, an increasing number of children are taking not just a single psychotropic drug, but a combination of these drugs. The fact that there are no safety data available for drug cocktails does not dissuade parents and clinicians from using these drugs off-label in children, in increasing quantities and in ever younger populations of children. The FDA has attempted to resolve this problem by providing 6-month patent extensions to drug companies that conduct follow-up studies in children. However, the pharmaceutical industry selectively reveals psychotropic drug trial results and has concealed unfavourable safety data. These are compelling reasons why careful, systematic follow-up of children taking psychotropic drugs is essential.

The main reason I post this is, of course, that a fairly sizable number of my clients and/or their children are taking or have taken medications for ADHD and it’s important that we all have as much information as conceivable.  Plus, since I have a kid of my own, I’m always thinking of what it’s going to be like a few years down the road when I get that note from the principal:  “Your kid is fricking crazy, put him in an institution for Pete’s sake!”

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Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705

It is easy to understand why, this time of year, many are struck with a case of the winter blues. We leave for work before the sun comes up and head home in the dark barely glimpsing daylight. As the days get shorter and colder many find themselves dealing with sadness, increased appetite and excessive sleeping. What they may be experiencing is more than a case of the winter blues, but rather seasonal affected disorder, or SAD. Many of my clients suffer from this disorder and often they just expect it is a part of the season that will pass, but there are treatments that can alleviate or lessen the symptoms.

SAD is a mood disorder associated with depression and related to seasonal variations of light. SAD has been linked to melatonin, a sleep-related hormone secreted by the brain’s pineal gland. This hormone, which can cause symptoms of depression, is produced at increased levels in the dark. So, as the days become shorter, these effects are felt by an estimated 6% of Americans. Eighty percent of those who suffer from SAD are estimated to be women, though the reasons for increased depression in women are not yet understood.

According to the National Institute for Mental Health, SAD symptoms include: (more…)

According to the Centers for Disease Control and Prevention, suicide is currently the 3rd leading cause of death among young adults and adolescents 15 to 24 years of age, following unintentional injuries and homicide.  Suicide is often a desperate attempt at escaping a seemingly impossible situation or to find relief from bad thoughts or feelings.  These feelings could be rejection, hurt, shame, guilt, despair, loneliness, isolation or a host of others.  According to the National Institute of Mental Health, scientific evidence has shown that almost all people who take their own lives have a diagnosable mental or substance abuse disorder.  Those who suffer from depression and other disorders are less able to cope with situations than others and treatment is necessary to help those suffering see that there are many alternatives and better ways to deal with their problems.  In other words, the feelings that often lead to suicide are highly treatable if the help is sought by the individual or if others can recognize the warning signs.

Researchers estimate that there are between 8-25 attempted suicides for each teen suicide death and that four out of five teens who attempt suicide have given clear warnings.  There are many behavioral indicators that can help parents or friends recognize the threat of suicide in a loved one. Since mental and substance-related disorders so frequently accompany suicidal behavior, many of the cues to be looked for are symptoms associated with such disorders as depression, bipolar disorder anxiety disorders, alcohol and drug use, disruptive behavior disorders, borderline personality disorder, and schizophrenia.

Some common symptoms of these disorders include: (more…)

None of you really want to hear my opinions on the general bailout package passed by the Senate last night, but I felt it my duty to inform you of the implications of the added section regarding mental health (since some of you are obviously crazy).

NAHU (National Association of Health Underwriters) sent me a good summary this morning, so I’ll give you some excerpts:

Modern Healthcare (10/2, DoBias) explains that the Senate measure “includes the already agreed upon mental-health parity language that passed the Senate as part of a tax-extenders package and the House as a stand-alone bill.” According to MedPage Today (10/2, Walker), an earlier mental health parity bill, passed by the House in March, “was dead on arrival in the Senate because of language that would have required insurance companies to give equal coverage to all mental illnesses outlined in the DSM [Diagnostic and Statistical Manual of Mental Disorders]. This was a far-reaching stipulation that made some conservatives squeamish,” according to Peter Newbould of the American Psychological Association’s Practice Organization. The new mental health parity language, included in the rescue plan, “removes any mention of the DSM.”

[...]

Meanwhile, the New York Times (10/1, A28) editorializes, “The bill is endorsed by President Bush, business groups, insurance companies, the medical community and mental health advocates. … But it requires a final shove because the measure is snarled in a broader legislative struggle over how to pay for tax revenues that would be reduced by this measure and others. Is there a statesman who can push this worthy parity legislation through to final passage before adjournment?

I’m not a mental health expert and I don’t even play one on TV, but “Mental Health Parity” is not something that I have always been an ardent supporter of.  It would be good for me, insurance companies, medical professionals, medical health advocates, etc.  I’m just not 100% sure that it’s good for patients.  This is most likely because I don’t believe that “medicine” is always the best approach to mental health problems, but if I talk any further I will begin to effectively display my ignorance on the matter.  I’m hoping to get some input from our “Behavioral Medicine” specialist.  If and when I do, I’ll post again or have him do so.

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Butch Porter
Goose Creek Financial
Loudoun County’s best source for Health Insurance Expertise
703-651-3705