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60 Minutes, Bipolar Kids, and Hyperbole

by Karoli on October 1, 2007

Well, it wasn’t as bad as I imagined it could be, though there were a few times where I imagined myself strangling Katie Couric for her leeeaaaading questions and sort of sneery attitude. Some of her classics:

“Did you ever think it was just the terrible twos?”
(Mom: Um, yeah, I suppose, but it was worse.)
(Me: Katie, you ignorant slut. Don’t you think a parent understands the difference between the terrible twos and behavior out of control?)

“Did you ever say to yourself, wow, that’s a lot of pills to be giving a little girl…”
(Mom: I did what the doctor told me.)
(Me: I’m sure, Katie, that she has asked herself that question over and over and over again)

Rebecca Riley’s case is tragic, extreme and a terrible case to try to make law out of. The axiom goes that bad cases make bad law, and Rebecca Riley’s is no exception. The parents were ignorant, no one really took the time to understand the medications prescribed and giving to this child, and she was inadequately monitored. I disagree with the choice to prosecute these parents for murder — they’re essentially being prosecuted for being stupid. With that said…here are some of the mistakes that I see. I’m listing them not because I want to pile on this mom or the prescribing doctor or anyone else, but because if someone comes by this blog with questions about what they should do as a parent when their child has been prescribed some pretty strong meds, I’d like to think there’s a resource here to help them. So here goes:

  1. The Diagnosis: It wasn’t altogether unreasonable for the doctor to consider a diagnosis of bipolar disorder, given the family history of depression and siblings diagnosed. They went to a psychiatrist for an evaluation and out of that, meds were recommended.
  2. The Meds: Depakote, Clonidine, Ritalin is a pretty hefty combo of meds. Back when Sticks was diagnosed, it was common for Clonidine to be prescribed alongside Ritalin to help wth the sleep issues that sometimes come from hyperactivity. However, I’d read enough about the dangers of Clonidine to not want it for Sticks — we chose to deal differently with the sleep issues.

    I know from situations with friends that Depakote has to be monitored carefully to make sure toxic levels don’t accumulate in the blood stream. This is not the responsiblity of the parents; it’s the responsibility of the prescriber. I didn’t hear anything in tonight’s report that says she was being monitored.

    Ritalin seems to be the meekest of the three, and certainly the least lethal.

  3. The Price of Ignorance: Even if all of these meds were monitored and properly dosed, the real issue is the mother’s cavalier attitude about when to medicate and how much to give, which is more a function of ignorance than malevolence. So if you’re one of those people that happens by this blog looking for info about these issues, don’t get it here. Take the time to educate yourself. Ask questions of your doctor, your pharmacist, and others who may be coping with similar issues. Don’t accept the diagnosis casually offered. Request a second opinion and approach the world of meds conservatively, because these ARE powerful medications, which shouldn’t be given without absolute confidence and certainty. Do your homework. Go to WebMD or search Google, or whatever resource you use for health information. Read the inserts that come with the medication. Log your child’s behavior, any side effects and talk to the doctor about anything that concerns you.

Rebecca Riley’s death was a tragedy, which I think is compounded by the prosecution of her parents. At the same time, it’s definitely the extreme, as were the other cases that Katie used to make her point tonight. There was not a particularly accurate balance — no interviews with parents of children who were diagnosed, carefully medicated with the least amount of medication approved for children. Instead she chose to make it sound like pediatric bipolar disorder is overdiagnosed and overmedicated, a la Rebecca Riley. While I’m sure there are some misdiagnoses made, I’m grateful that the doctors are coming to a greater understanding of bipolar disorder in children, because it’s possible that diagnosing them early means they might have a smoother transition through their teenage and young adult years. It’s a very difficult disorder to manage and one that is painful for all involved…I wish they’d shown some of that on 60 minutes alongside Rebecca Riley’s extremes.

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  • Larry Bone
    Karoli:

    Besides the tragedy of Rebecca Riley there have been other tragedies involving the experences of families across America with psychotropic drugs. You had mentioned that the parents should request a second opinion from another doctor when the parents are first approached to put their child on a psychotropic drug and that is good advice. The problem seems to be that it is apparently sometimes not that easy to get a second opinion. Here is a link to a trailer on a documentary concerning parents experience with this. A DVD of this documentary can either be purchased or arrangements can be made to show the documentary in your community.

    There are parents who want to tell other parents what happened so that these tragedies can be prevented.

    Here is the link:

    http://www.prescriptionsuicide.com/inde.htm

    Again, thanks for discussing this issue in your blog.

    Best,

    Larry Bone
  • Larry Bone
    Karoli:
    Thank you for the suggestion of http://clinicaltrials.gov. They are research studies but they appear not to be clinical trials for a specific drug or the original clinical trials for when a drug was being considered for approval by the FDA. I see the site is associated with the National Insitutes of Health which is reported to be closely affiliated with the pharmaceutical industry. Do you know if the FDA records for number and nature of adverse side effects for specific drugs are posted? That would give parents a better look at what their child might be facing. And on the guinea pig effect, I think side effects, particularly adverse side effects are the way a person's body is telling them danger, your body considers this drug toxic and potentially dangerous. If you feel "trying" these drugs is okay, I just hope nothing adverse results from having tried them.
  • Larry,

    Have you tried http://clinicaltrials.gov? For the past several years, all information related to clinical trials has been posted to that site.

    I disagree with you about the guinea pig effect. Each person is different and will react differently to a medication. Trying one in a low dose is the only way to know whether it's effectively treating the condition or not. Maybe someday there will be a way to simulate the effect, but for now, there's just...trying it.
  • Larry Bone
    Karoli:
    Thanks for your reply to my comment. I agree with you parents are the best stopping point, just as long as parents aren't put in jail for acting as a final stopping point or their kids taken away from them and drugged anyway. If your doctors have respected your rights as a parent and have not tried to interfere or intervene that's great, but some parents are not so fortunate. I would like to see results for clinical trials for the drugs given to Rebecca made public so they can be viewed by parents or summarized by an unbiased professional with no conflicts of interest. I also think that if we are talking about a "strong" drug, that a low-dose trial could cause an adverse side effect and that their could be damage from that especially if the side effect persisted well after use of the drug had stopped. The "guinea pig" aspect of trying out a "strong" drug is disturbing. Many parents are not aware that adverse reactions to drugs like the ones given Rebecca Riley can be reported directly to the FDA and I think those records should also be made public. I think the problem is when parents are ignored and kept in the dark about how "strong" or potentially dangerous these drugs can be. And to me that is criminal. You probably would not agree. But thanks so much for posting your thoughts on this on your website and for allowing me to contribute my views.
    This is an important issue and your post may help in saving a child's life.
  • Hi Larry,

    As a parent, I'm the last best stopping point for what will and won't be given to my child. I think doctors have my child's best interests at heart and have no reason to think they would prescribe something harmful. In fact, in every case where meds were prescribed for my kids, our doctors have been very forthright about what the possibilities for side effects and the like are.

    The mistake comes when the parents assume that doctors and pharmas are gods who have endless knowledge about how a specific person will respond to a specific medication. That's why I say that parents need to take ownership over what they do.

    It's unlikely that a low-dose trial of a medication will cause physical or mental damage. The harm is done when the parents don't watch for side effects or other problems with the medication and report them, or mingle over the counter meds (which these parents did) with prescription meds without clearing it through the doc or the pharmacy.

    The reason the parents are charged with a crime in this case is because the state views them as their child's protector and the state feels they (with whatever intent they assign) recklessly medicated their daughter.

    I think they stupidly medicated their daughter. They were ignorant, not well educated and didn't ask questions, choosing instead to accept at face value and then carelessly dispense, powerful medications to their little daughter.

    If the preschool was so concerned about her listlessness, why didn't they report it? They only spoke up when it was too late. It's that kind of hindsight reporting that does no one any good.
  • Larry Bone
    I think it is great you encourage parents to seek a second opinion and that you emphasize that these are "strong" drugs. There are extremes and there is maximum damage and minimum damage by which I mean "strong" drugs could cause minimal or minor physical and mental damage which damage kids so damaged, could carry with them for the rest of their lives. How come the experts are not taking any faintest shred of responsibility for any this damage prefering to continually maintain that it does not exist? Why does it fall to the parents to be blamed for anything connected with these drugs? If the parents are called to account then shouldn't the mental health experts also be called to account? Because if these experts had not started sanctioning and advocating these drugs massively for little kids, there wouldn't be maximal or minimal physical/mental damage to worry about that could affect kids for the rest of their lives.
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