Two Sides of the Debate Around Screening for Teen Suicide Risk
Relating to my previous entry on suicide in young people, there is a debate around screening for suicide risk via psychological evaluations.
Because of the concern for teen suicide, psych evaluations are growing and critics say that this has not been shown to prevent suicides. Critics also say that these screenings often lead to the teens receiving prescription medications. Many of these medications including antipsychotics have not bee approved for use in children and teens, yet the use of psychiatric drugs in young people have dramatically increased.
This of course, has economic implications for the drug industry.
On the other hand, proponents of screening programs include those who had lost loved ones to suicide. The more controversial proponents include antipsychiatry parties like scientology and its visible celebrity spokesman (we know who he is).
FDA Approves Wellbutrin XL for Seasonal Affective Disorder - First Drug Approved for SAD
On Monday, June 12, 2006 US Food and Drug Administration (FDA) approved bupropion XL (brand name Wellbutrin XL) for the prevention of depression in seasonal affective disorder (SAD). This approval was notable not only because this makes Wellbutrin XL the first drug approved for SAD, but also because the approval was for prevention of depression associated with SAD.
Seasonal Affective Disorder is depression that correlates with the time of the year when the amount of daylight changes. Therefore, depression episodes occur during the fall and winter, when daylight hours decrease.
The approval was based on 3 double-blind, placebo-controlled trials in adults with a history of major depressive disorder in autumn and winter. Response rate was 84% Wellbutrin treated and 72% Placebo treated.
There is a black box warning for suicide risk with Wellbutrin XL, as with other antidepressants, on its use in vulnerable populations including in children and teens.
Insurance Policies Often Set Up Patients to Fail
Dennis Romboy and Lucinda Dillon Kinkead’s article, “Struggle for control: Mental-health care coverage is lacking” gives us a glimpse of how our view of mental illness as “something different from physical illness” spills over to our healthcare system.
For insurance companies, coverage policies give mixed signals to patients. Often, that signal is, “You’d get coverage if you were catatonic and completely non-functional, but if you’re trying to function and live a normal life - well - good luck.”
A high number of suicides occur in patients suffering from a mental illness but were not receiving treatment. Sometimes, the insurance policies can set up a dangerous situation to happen because it forces doctors to play a numbers game with patients so that the patient can continue to get coverage.
I remember when I was undergoing treatment, my doctors had to play the same game to help me get insurance coverage. At the time I was a starving grad student and couldn’t afford therapy if insurance didn’t cover it. My psychologist offered to cut her rate so that I didn’t have to pay too much out of pocket. I was making progress and she didn’t want me to fall by the wayside.
However, the game was “You need to get well, so the insurance company could see progress and continue to cover you. But you can’t get too well, because insurance companies would see no point in continuing to cover you.”