40 Percent in U.S. Use Prescription Drugs
Associated Press, 12/2/2004

WASHINGTON -- More than 40 percent of Americans take at least one prescription drug and one-in-six takes at least three, the government reported Thursday. ``Americans are taking medicines that lower cholesterol and reduce the threat of heart disease, that help lift people out of debilitating depressions, and that keep diabetes in check,'' Health and Human Services Secretary Tommy G. Thompson said in a statement.
      The annual report on Americans' health found that just over 44 percent of all Americans take at least one prescription drug, and 16.5 percent take at least three. Those rates were up from 39 percent and 12 percent between 1988 and 1994, the Centers for Disease Control and Prevention reported. The report, ``Health, United States 2004,'' presents the latest data collected by CBC, the National Center for Health Statistics and dozens of other Federal health agencies, academic and professional health associations, and international health organizations.
      Americans' life expectancy increased to 77.3 years in 2002, a record. And deaths from heart disease, cancer and stroke -- the nation's three leading killers -- are all down 1 percent to 3 percent, the analysis said. The study also found that spending on health climbed 9.3 percent in 2002 to $1.6 trillion.
      Prescription drugs, which make up about one-tenth of the total medical bill, were the fastest growing expenditure. The price of drugs rose 5 percent, but wider use of medicines pushed total expenditures up 15.3 percent in 2002. Drug expenditures have risen at least 15 percent every year since 1998. The report said prescription drug use was increasing among people of all ages, and use increases with age. Nearly half of all women were taking prescription drugs -- 49 percent -- compared to 39 percent of men. Usage peaked at 84 percent for people aged 65 and over, with the top rate at 89 percent for black women over 65. Even for people under age 18, however, nearly one-fourth -- 24.1 percent -- were taking at least one prescription medication. The rate rose to 34.7 percent between age 18 and 44; for those ages 45 to 64, it was 62.1 percent.

WASHINGTON -- Only three states -- Maine, Delaware and Mississippi -- are spending money on anti-smoking efforts at the minimum levels recommended by federal health officials, a coalition of public health groups said Thursday. Altogether, the states have set aside $538 million for smoking prevention for fiscal 2005, which began in October and runs through September. That is just a third of the $1.6 billion minimum the Centers for Disease Control and Prevention say should be spent nationwide, says the report. The CDC's minimum funding recommendations for each state are based on population and other factors.
     The states are expected to receive an estimated $7.1 billion this year from the tobacco industry through legal settlements they reached with cigarette makers in the late 1990s, according to the report released by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society and American Lung Association. The settlements were meant to help the states recoup the cost of treating sick smokers, and the states pledged to fund tobacco prevention programs.
      Meanwhile, states in recent years have been raising cigarette taxes, and they are slated to get nearly $13 billion in tobacco tax revenues this year, the report says. ``The states are receiving more and more revenue related to tobacco but doing far too little to fund programs to reduce tobacco use, particularly among children,'' said Matthew Myers, president of the Campaign for Tobacco-Free Kids. ``They're using the money to fill short-term budget shortfalls, build roads and every other conceivable political purpose.''
      States that have allocated no significant funding for tobacco prevention are: Michigan, Missouri, New Hampshire, South Carolina and Tennessee, the report said. The District of Columbia also has not set aside money for that purpose, the report stated.
      On the Net:
Campaign for Tobacco-Free Kids: http://www.tobaccofreekids.org/
CDC: http://www.cdc.gov/

WASHINGTON -- Many teen drivers believe it's less dangerous to drive after smoking marijuana than after drinking alcohol, a perception the government wants to change. ``Driving sober means no alcohol, no marijuana, no drugs,'' John Walters, the Bush administration's drug policy director, said Thursday as he showed a new television ad aimed at stopping teens from driving after smoking pot.
Walters' office is spending $10 million on the ad and other efforts to teach teens and their parents about the danger of drugged driving. There also are brochures that are being distributed in high schools and state motor vehicle offices.
      Marijuana can affect concentration, perception and reaction time up to 24 hours after it's smoked, Walters said. Yet teens have gotten the message that it's a benign drug. In a recent study, 30 percent of teens said ``planning to drive'' was a reason not to drink. But only 18 percent cited ``planning to drive'' as a reason not to take drugs. The survey questioned 3,574 middle and high school students nationwide in spring and was conducted for Students Against Destructive Decisions and Liberty Mutual Insurance. A 2004 study of patients admitted to the trauma unit at the University of Maryland found that 19 percent of crash victims under 18 tested positive for marijuana.
      Allison Whitney, 25, a drug counselor and recovering addict from Atlanta, said she got into several accidents as a teenager because she was smoking pot while driving. Sometimes she would get pulled over for swerving but police would let her go when she didn't test positive for alcohol. Whitney said part of the allure of marijuana for teens is that it's easy to hide. ``You can get high in less time than you can get drunk, and your parents won't detect it,'' she said.
      Dr. Jeffrey Runge, the head of the National Highway Traffic Safety Administration, said states are training police to recognize the effects of various drugs, but said more training is needed. Runge also encouraged states to test drivers for drugs after a crash so officials can understand the scope of drugged driving. Now, drivers rarely are tested for drug use, Runge said. One-quarter of the 3,657 drivers age 15 to 20 who were killed in accidents in 2003 had a blood-alcohol level of 0.08 or higher.
      Runge said teens are at special risk because they are inexperienced drivers and they often have a dangerous combination of alcohol and drugs in their systems. He said teens must understand the dangers and designate a driver before they go out. ``Every driver has a personal responsibility not to get behind the wheel while impaired,'' Runge said. ``A designated driver does not mean the least drunk or stoned person at a party.'' In the television ad, which will run through the end of the year, a young female driver keeps having visions of an older man after she hits him in a crosswalk. ``You'll never forget the people you hurt when you were high,'' the narrator says.
      On the Net:
White House Office of National Drug Control Policy: http://www.freevibe.com
National Highway Traffic Safety Administration: http://www.nhtsa.dot.gov




Accused Mother Described As Gentle Soul
Associated Press, 12/2/2004

DALLAS -- The woman who severed her baby's arms is described by her stepfather as a gentle soul who could have done such a thing only in the grips of mental illness. Dena Schlosser, 35, of Plano faces a capital murder charge for the death of 10-month-old Margaret, whose body was found in her crib in a bedroom. Schlosser called 911 and told an operator what she had done. She was in her apartment when police arrived, still holding a knife and listening to a church hymn.
      ``If you'd taken a hundred acquaintances at random and said to me, 'who would be the least likely to do anything involving violence?' I would have put Dena at the head of that list,'' her stepfather, Mick Macaulay, said Wednesday in a telephone interview from Canada, where he and Schlosser's mother live. ``This is a woman who takes birds' wings, if they're broken, and splints them and nurses them back to health,'' he said. ``Just a very gentle person.''
      Macaulay, who is a mental health counselor, has no doubt that Schlosser's behavior was brought on by what he termed ``postpartum psychosis.'' Generally speaking, according to a Web site sponsored by federal health agencies, a psychotic loses touch with reality, typically having delusions and/or hallucinations. ``It's the only explanation that makes sense,'' Macaulay said.
      Defense attorney David Haynes is looking into whether Schlosser's mental state could have been affected by several surgeries she had in childhood to drain fluid from her brain. Haynes has said his client, who has a history of postpartum depression, is disoriented and incompetent to stand trial. She remains in jail, pending a bond hearing Monday. Macaulay said the surgeries left Schlosser dependent on her mother and unable to do several things at a time. He said she was also stressed at the time of the killing, trying to cope with the baby, her mother's suffering from Parkinson's Disease and financial problems brought on by her husband's layoff.
      Schlosser was accused of child neglect earlier this year, but a state investigation found she did not pose a risk to the baby or her other two daughters. A judge granted temporary custody of the girls, ages 6 and 9, to Texas Child Protective Services after the agency determined their father, John Schlosser, had failed to protect them from their mother. Macaulay said family members are considering whether to seek custody of the girls. John Schlosser did not return e-mail or telephone messages seeking comment.

Anti-Psychotics Treat Kids' Illnesses But Pose Other Risks
Ofelia Casillas, Chicago Tribune- 12/2/2004

The same drug that helped Rachel Mason graduate from 8th grade by controlling her bipolar disorder caused her to weigh more than most girls at the ceremony. The drug that eased Rachel's rages also sparked insatiable hunger. By the time she slipped into a white-flowered red skirt for graduation, the teen who stands only a few inches taller than 5 feet weighed 243 pounds. "It's in my head," said Rachel, 14, a high school freshman in Mt. Pulaski, Ill. "In my stomach, I usually don't want to eat anything."
      Apprehensive about severe side effects associated with the first generation of drugs approved to treat psychosis--including tremors, muscle contractions and involuntary movements that can cause disfigurement--doctors have embraced a new group of drugs during the last decade, among them Risperdal and Zyprexa.
      As time passes, however, adverse effects also have emerged for these new drugs--including a ravenous hunger that leads to obesity in children and makes them susceptible to diabetes. The dramatic weight gain can be emotionally difficult for teens at a time when social pressures are especially intense. Doctors said the weight gain can be hardest on girls who in many cases already struggle with body image. Some refuse to take a drug that causes weight gain even when it works.
      Although the U.S. Food and Drug Administration has approved these second-generation anti-psychotic drugs to treat mentally ill adults, the agency has not agreed to their use in youths. Doctors prescribe the drugs based on clinical trials, experience and limited data.

Serious side effects
Some of these newer drugs have other side effects as well--one drug causes a decrease in white blood cells, for example; others cause tremors, sedation and low blood pressure. This year the FDA added a warning label about increased diabetes risk to the anti-psychotic drugs, which doctors find also are connected with increased cholesterol and triglyceride levels.
      Estimates of how many children are taking these drugs are hard to come by, but a study of nearly 1 million youngsters published last year showed the percentage treated with anti-psychotic drugs doubled in a managed-care population and tripled in the Medicaid population from 1987 to 1996. "It's a huge problem. All of these medications right now are double-edged swords," said Dr. Michael Naylor, University of Illinois at Chicago director of child psychiatry. "You're kind of left with a dilemma: Do I choose a medication that can harm me or an illness that can harm me? It's a terrible choice."
      Rachel's parents, Stephen and Michelle Mason, knew early on that something was wrong. In 2nd grade, Rachel would crawl under her desk at school. She would yell and scream, chew on erasers and eat paper. Other children were afraid. After her rages, Rachel never remembered what happened. Rachel saw four psychiatrists in six months and was diagnosed with bipolar disorder at age 8. She took different medications, but none worked as well as the Zyprexa she started in 6th grade.
       While Rachel had always been at the higher end of the weight scale compared with her peers, her weight soon ballooned out of control. She never felt full. Rachel could eat macaroni and cheese after school, a full dinner and still snack later. In June she weighed 253 pounds. "She'd eat and eat and eat," her mother said. "It was an all-of-the-time thing. She'd get home and it was like `I need this, I need that' and she'd shovel it in."
      Dr. Christoph Correll, a research psychiatrist at The Zucker Hillside Hospital in Glenn Oaks, N.Y., has followed 360 children ages 4 to 19 starting on second-generation anti-psychotic drugs. Interim results found children gained mostly fat, some of it deposited on their abdomens, which increases the risk of future heart illness. With many putting on more than 7 percent of their baseline body weight, they also were at risk for future heart attacks, strokes and diabetes. "The gateway to these serious complications in the future is the weight gain," Correll said. "The numbers we found were very surprising and sobering."
      A 12-week study of 50 youths published in the 2002 Journal of the American Academy of Child and Adolescent Psychiatry found Zyprexa and Risperdal were associated with "extreme weight gain in adolescents, much higher than that reported in adults."

Risk of depression
Experts say the increased weight can also trigger depression. "Oh gosh, it puts their self-esteem to the floor," said Dr. Louis Kraus, Rush University Medical Center chief of child and adolescent psychiatry.
      Pharmaceutical companies, some of which have been criticized for minimizing these drugs' negative effects, say they are working to eliminate the weight gain problem. Eli Lilly and Co., which makes Zyprexa, is looking into which patients gain the most weight, said spokeswoman Marni Lemons. "It's possible that a receptor that improves your functioning, improves your appetite," Lemons said. "Is it possible to create a drug that doesn't have weight gain as a side effect? We don't know. We have researchers looking into that."
      Doctors also say they worry about how the drugs work in growing bodies since long-term effects have not been extensively studied in children. "We are learning about the safety issues as we are using the drugs in children," said Dr. Julie Zito, a University of Maryland pharmacy and psychiatry associate professor who led the study showing the soaring use of these drugs in youths. "In my mind, there is not sufficient data that establishes them as effective and safe in children for long-term use." The FDA has requested that five of these drugs be evaluated in children, a spokesman said.
      In the meantime, parents like Michelle Mason struggle to balance the drugs' risk with their control over paranoia, delusions, aggression, and, in Rachel's case, violent rages. These often-destructive symptoms cannot be left untreated, experts say. "If a child is psychotic they can't be in school, OK?" said Suzanne Andriukaitis, executive director of the National Alliance for the Mentally Ill in Chicago. "Overweight kids can be in school and will have plenty of company."
      On Zyprexa, Rachel was calm enough to make friends--but she also felt alienated because she was larger than her peers. She felt most like an outsider in 7th grade, when athletes ruled the popular crowd. Rachel tried out for the cheerleading squad but didn't make it. She ate by herself at lunch as some peers called her names, making her cry. By 8th grade, Rachel had learned to stay away from them and found friends like Becky Bradesku, a year younger, whom Rachel met in church. They ate pizza and collected stationery. Becky, attractive and thin, defended Rachel at school. Once, when Rachel wished she were thin like Becky, the girl reminded Rachel that God made her. "There's nothing wrong with that," Becky said.
      In May, Rachel graduated from grammar school. Waiting backstage among peers, she felt her place on the edge of the social hemisphere was evident--seldom invited into pictures, sitting off alone as girls examined one another, handing out compliments that others did not always return. During the ceremony, a speaker noted that years from now it would not matter how popular, pretty or thin they all were.
      In June, Rachel stopped taking Zyprexa and began Risperdal. She had gained 50 pounds since the previous August, and Rachel's psychiatrist feared she would be at risk for diabetes and more teasing at school if she stayed on the drug. On the new drug, Rachel has been in a good mood, but sometimes she still can't stop eating, and her mother worries. "I would like to see her lose weight, not just for her looks but for her health," the mother said. Rachel's weight peaked in August at 266 pounds.
      That same month, she started high school--the "new world" she had been hoping for. She became an officer in her first club--the Family, Career & Community Leaders of America. She is getting good grades and has helped out as a greeter for visiting volleyball teams. On Risperdal, Rachel's mood is better even than her mother had expected. And since August, she has lost 2 pounds. Best of all, Rachel has found new friends--not cheerleaders, but girls who accept her. She plans to wear a navy blue satin dress when they attend the homecoming dance next week, together.

Worried Colleges Step Up Efforts Over Suicide
Karen W. Arenson, New York Times- 12/3/2004

Nicole Thompson had been at Columbia University for only a few weeks when she went out drinking with a group of friends downtown last year and became separated from them. She had skipped her medication for bipolar disorder. Now it was 3 a.m. and, crying and in a panic, she called friends; she told them, she said, that she "just wished the traffic would take me out."
Although she made it back to campus safely, her friends had already notified Columbia that they were worried about her. For Columbia officials, it was the first clue that Ms. Thompson faced any kind of mental health problems. "I wasn't on Columbia's radar at all," said Ms. Thompson, who is back on campus now after being forced to take a medical leave.
      Increasingly, college officials and mental health experts have come to realize that many of the most vulnerable students -- the ones prone to self-injury and suicide -- are like Ms. Thompson: they never go near the counseling centers or reveal anything about their experience before college. As a result, colleges are stepping up efforts to find them and to get them into treatment, sometimes forcing them to leave temporarily.
      The goal is to help students like Ms. Thompson. But colleges have more at stake. Suicide -- the second-biggest cause of death among college students -- can be costly, injuring reputations and prompting litigation. The suicide of a student at the Massachusetts Institute of Technology, Elizabeth Shin, in 2000, and strings of suicides at New York University, George Washington University and the University of Illinois, have drawn wide attention. There has also been a rise in lawsuits involving student suicides.
      Ann H. Franke, a vice president of United Educators, a company that insures 1,200 universities, colleges and schools, said suicide prevention had risen in priority as claims had risen; her company, Ms. Franke said, now has a "handful" of claims, up from none six years ago. "They can be very severe claims financially," Ms. Franke said, "not to mention the emotional and reputational impact they can have on a school." In a closely watched case, the family of Elizabeth Shin has sued M.I.T. for $27 million.
      One study of suicides on college campuses, based on a dozen universities in the 1980's, found a rate of about 7.5 per 100,000 students, which is about half the rate for young adults not in college and represents about 1,100 suicides a year for the entire college population. Although there have not been comparable studies since then, most mental health experts say they believe the rate has remained at about that level.
      To address the problem, Emory University and the University of North Carolina are inviting students to fill out anonymous mental health questionnaires. Duke University is asking faculty members to be alert to changes in behavior -- noticing, for example, when a student suddenly becomes sullen or quiet, or stays away from class. Columbia, New York University and Cornell now place counselors in residence halls. The University of Illinois and the University of Puget Sound in Tacoma, Wash., are requiring any student who threatens or attempts suicide to attend counseling sessions.
      But the best way to reach these students remains unclear, and students do not always welcome the intervention. Some experts fear that forcing students to enter treatment or to take a medical leave can dissuade others from asking for help and discourage their friends from sounding the alarm, even though students who take such leaves generally come back and graduate.
      The recent forced withdrawal of a freshman at N.Y.U. was front-page news in the student newspaper, Washington Square News. The student, Sue Schaller, told the paper that although she had been briefly hospitalized for depression and suicidal thoughts, she felt much better when she returned to campus and wanted to stay in school, but that the university would not let her. An editorial in the newspaper called for the university to "do everything it can, including requiring therapy and regular check-ins, to ensure that troubled students who wish to remain on campus can stay and that they pose as little risk as possible," adding, "Pushing those students out of the university community is not the answer." In retrospect, Ms. Thompson, the Columbia student, said she had mixed feelings about how the university treated her. She said she still felt wounded by the process -- she called it a "charade" -- that ejected her from school.
      Even with things going smoothly, Ms. Thompson, whose dark hair is tinted purple and who speaks with energy and humor, said her mind sometimes wandered to what she missed last year, while she was on leave, and to the possibility of running into new trouble. "I am so scared about screwing up," she said, "and of being sent home again." Columbia officials declined to comment on Ms. Thompson's case. They said that the university did not keep statistics on how many students were forced to go home, but that there were few of them.
      For years, colleges and universities have been grappling with a growing flood of students with histories of mental illness. Most have expanded the number of counselors and the hours they are available. But now they are going further. Some are turning to the Internet as a way to bring troubled students in for help. The American Foundation for Suicide Prevention has developed an anonymous online mental health questionnaire and a program to steer troubled students to counseling, which is being tested at Emory and the University of North Carolina. Those involved say the initial results seem promising.
      At Emory, which started using the program in 2002, only 8 percent of the students who received the survey filled it out, but 85 percent of those students were deemed at moderate or high risk of suicide or other severe problems based on their responses to the questionnaire. They are encouraged to speak to a counselor on or off campus, or to consult anonymously with a counselor online. "The yield is relatively small," said Ann Haas, research director for the suicide-prevention foundation. "However, we are absolutely convinced that those kids would not have gotten into treatment. We think we are reaching the right kids."
      Many campuses, including Duke and M.I.T., are asking faculty and staff members and students to tell a dean or the counseling office if they see students who show signs of depression or potential suicide. At Duke, when faculty members or parents relay concerns about students to Larry Moneta, the vice president for student affairs, he and members of the residence hall staff check up on the students, sometimes surreptitiously. "Many times I've called the residence hall staff and asked if they can dispatch a paraprofessional to inadvertently drop by a student's room as if it were a casual encounter," Dr. Moneta said. "I do that all the time."
      After Ms. Shin's suicide, M.I.T. began running training sessions for faculty members, departmental administrators, athletic coaches, dormitory personnel, fraternities and sororities to help them spot people showing signs of problems -- one of several steps recommended by a mental health task force created after the suicide.
      Cornell is making a special effort to reach out to Asian and Asian-American students. Of 16 students there who have committed suicide since 1996, 9 were of Asian descent. The university created a task force to explore those students' experience at Cornell and how to help them when they have problems, since they do not use Cornell's counseling services at the same rate as their classmates, said Susan H. Murphy, the university's vice president for student and academic services. Often when they do seek help, "they are in real crisis," Ms. Murphy said.
      Colleges are also leaning more heavily on students who show suicidal tendencies to enter counseling. Several are examining or adopting a program developed by the University of Illinois at Urbana-Champaign, requiring any student who threatens or attempts suicide to attend at least four counseling sessions. Paul Joffe, the program's director, said the results had been good: all but one of nearly 2,000 students in the program over 20 years remained at the university during the counseling sessions, and none committed suicide. And although the university has had suicides among students not in the program -- including six in the last academic year -- it says its suicide rate is about half of what it was before the program started.
      While some college officials question whether students should be forced into counseling, others favor the heavy-handed approach. The University of Puget Sound, one of the campuses that recently began using the Illinois approach, bluntly describes the program as "a public statement that suicide is unacceptable here." "We don't know what it is about that model that is so effective," said Donn Marshall, director of counseling, health and wellness services at Puget Sound. "Is it that somebody stands up and says suicide is unacceptable? Or is it that somebody says, 'I care'? Or is it something about what happens in the four sessions with a psychologist?"
      When Ms. Thompson arrived at Columbia last year from Nashville, she had been struggling with bipolar disorder and problems with drinking and drugs, and she had a cabinetful of medications. She had planned to contact the counseling service to find someone to talk to, but three weeks into the school year, she had not gotten around to it. She said she had arrived confident she could succeed. "There was a big to-do before I went to school to ask my doctors if I was ready," she said. "They all said yes." What most put her off about the way Columbia handled her case, she said, was the quick interview with a university psychologist that she thought was intended to figure out what she needed to do to stay at school, but that she later learned was to decide whether she should be allowed to remain. She said she had been totally candid in talking to him, because "I've talked to a lot of psychologists, and realized that if you tried to butter them up, you don't get the help you need." But she said she did not believe the university had been equally candid. "He worked for the school, not the patient," she said. "If they don't tell you that, you lose trust. The kids they are dealing with are smart enough to understand the dynamic after the fact."
      Margo D. Amgott, assistant vice president for health services at Columbia, said the university tried to make sure students understood that the interview was for the university's evaluation purposes and even required that they sign a document saying they understood. Ms. Thompson said that while she did indeed signed papers, she had had no choice, and thought that the decision to stay or leave would still be up to her and her family. But when she and her father talked about lining up support for her in New York, they learned that it was not their call, and she was given four days to move out of her room. Being sent home to Nashville just three weeks into her freshman year made her feel worse rather than better, she said, and she ended up in a psychiatric hospital.
      She said that now that she was back at Columbia, she was doing well. She is majoring in anthropology and has a late-night radio program, "Zombies vs. Ballerinas," that features groups like Mogwai. And while she is in regular touch with a college adviser assigned to her, she has not sought psychological help, either at Columbia or outside. "Last year's treatment was so expensive that it has driven my father into debt," Ms. Thompson said. "It makes me feel guilty."

Meth's Sexual Effect Explains Addictions
Associated Press, 12/3/2004

CHATTANOOGA, Tenn. -- At a recent task force meeting on the epidemic of methamphetamine use in Appalachia, Gov. Phil Bredesen winced when a federal prosecutor described the illegal drug as an aphrodisiac. Doctors and government officials don't like to talk much about it, but there is an obvious reason people get hooked on methamphetamine: sex. Meth eventually destroys the sex drive, but for a short while it can boost sexual appetite and performance more powerfully than drugs such as cocaine, doctors say. ``Who wouldn't want to use it? You lose weight and you have great sex,'' Assistant U.S. Attorney Paul Laymon said sarcastically at the meeting of the Tennessee task force.
      For obvious reasons, government officials want to focus on the misery meth causes. Use of the addictive drug can cause brain damage, violent behavior and hallucinations, and exposure to the potentially explosive vapors during the manufacture of meth can cause respiratory problems, headaches and nausea. In many gay clubs in New York City and elsewhere, meth is often injected, putting users and their partners at risk for HIV, hepatitis C and other sexually transmitted diseases.
      As for why the drug has such a hold on people, Dr. Mary Holley, an obstetrician who runs a Mothers Against Methamphetamine ministry in Albertville, Ala., and has interviewed men and women addicted to meth, said sex is the No. 1 reason people use it. ``The effect of an IV hit of methamphetamine is the equivalent of 10 orgasms all on top of each other lasting for 30 minutes to an hour, with a feeling of arousal that lasts for another day and a half,'' she said.
      The effect doesn't last long. ``After you have been using it about six months or so you can't have sex unless you are high,'' Holley said. ``After you have been using it a little bit longer you can't have sex even when you're high. Nothing happens. It doesn't work.'' Dr. John Standridge, an addiction specialist with the Council for Alcohol and Drug Abuse Services in Chattanooga, said meth and other stimulants initially ``rev up the dopamine nervous system in the brain. They rev it up and burn it out.''
      A National Institute on Drug Abuse survey on drug use and health in 2002 found that 12.4 million Americans at least 12 years old -- or about 5 percent of the population -- had tried meth at least once in their lifetimes. In a measure of how serious the problem is in Appalachia, a total of 1,083 clandestine methamphetamine labs were cleaned up in Tennessee in 2003 -- more than in any other state. A meth task force appointed by Bredesen is recommending tougher penalties and expanded treatment for addicts.
      Meth's reputation as a sex drug is not unique. ``All substance abuse is frequently marketed as enhancing sex life or making you more attractive or a better social companion,'' said John Walters, the drug czar for President Bush. But he added that buying meth as an aphrodisiac is ``buying under false pretenses.'' ``Hair falls out. Teeth fall out,'' Walters said. ``That's not sexy.''
      On the Net: Mothers Against Methamphetamine: http://www.mamasite.net

Antidepressant Use By U.S. Adults Soars
Shankar Vedantam, Washington Post- 12/3/2004

One in 10 American women takes an antidepressant drug such as Prozac, Paxil or Zoloft, and the use of such drugs by all adults has nearly tripled in the last decade, according to the latest figures on American health released yesterday by the federal government. Those numbers are among a broad array of changes in health and health care use in the United States identified in the report. It confirmed that prescription drug costs are soaring faster than any other area of medical care as ever-increasing numbers of Americans take drugs for psychiatric conditions, to lower their cholesterol, to control asthma and for a wide range of other reasons.
      In 2002, the latest year for which data were available, the total tab for health care soared to $1.6 trillion -- of which prescription drugs accounted for $162 billion, the report found. Drug costs rose by 15 percent over the year before, driven by a combination of more expensive medicines and increased use.
      The report comes at a time when questions are growing about the costs and safety of many prescription drugs. The Food and Drug Administration recently concluded that antidepressants can increase the risk of suicidal behavior among children, and the manufacturer of Vioxx abruptly recalled the popular painkiller for safety reasons. A senior FDA official testified in Congress last month that he believes five other approved drugs are dangerous and should be taken off the market.
      Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) showed some of the largest increases in use, the report said. By 2000, the proportion of adults using such drugs had nearly tripled, compared with the data set that ended in 1994.
      In 2002, more than one in three doctor's office visits by women involved a prescription for an antidepressant, said Amy Bernstein, project director for the report issued by the Center for Mental Health Services of the Centers for Disease Control and Prevention. "It gives you an idea of what is happening during these visits," said Bernstein, who explained that the statistic included patients already on the drugs and those getting a new prescription.
      The number of children getting psychiatric drugs also soared. In 2002, about 6 percent of all boys and girls were taking antidepressants, triple the rate in the period 1994-96. And about 14 percent of boys -- nearly one in seven -- were on stimulant drugs in 2002, double the number in 1994-96, the report found. Stimulant drugs are usually used to treat attention deficit disorder. The number of adults taking cholesterol-lowering statin drugs nearly quadrupled from 1995-96 to 2001-02, the report found. Overall, 44 percent of all Americans, including children, were taking at least one prescription drug in 1999-2000, a statistically significant 5 percent increase since 1994. The proportion taking three or more prescription drugs increased from 12 to 17 percent during that same time, Bernstein said.
      "Factors affecting the recent increase in utilization of medications include the growth of third-party insurance coverage for drugs, the availability of successful new drugs, marketing to physicians and increasingly directly to consumers, and clinical guidelines recommending increased utilization of medications for conditions such as high cholesterol, acid-reflux disease, and asthma," the report concluded.
      Julie Zito, a pharmaco-epidemiologist at the University of Maryland at Baltimore, said it is difficult to characterize as good or bad the increased use of drugs without studies that ask how people are faring as a result. "As the numbers keep growing year after year after year, and larger proportions of the population appear to be suffering from conditions or getting treatments they may or may not be benefiting from, that would be an argument to follow large cohorts of patients in community studies to assess effectiveness and safety," she said.
      The drug industry's umbrella trade group said the increased use of medications is a good thing. "We have more medicines and better medicines for more diseases, and patients are being more effectively treated," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America. "They are living longer largely because of new treatments, and that is good news." Trewhitt said there are numerous examples of how increased use of drugs -- such as cholesterol-lowering statins -- reduce overall health care costs by controlling heart disease and reducing more expensive hospitalizations. On the increase in antidepressant use, Trewhitt said, "I don't know how to read that. We just don't have any information -- it's not something we have studied."

Dad Cites Boy's Antidepressants in Deaths
Associated Press, 12/4/2004

COLUMBIA, S.C. -- Authorities say three years ago, Christopher Pittman, then 12, shot his grandparents as they slept because they had scolded him for fighting. But Christopher's father, Joe Pittman, thinks his son killed because his sense of right and wrong was clouded by the anti-depressant Zoloft. Joe Pittman spoke out against the drug in a Food and Drug Administration hearing early this year. The boy, who had threatened suicide, was put on the drug three weeks before the slayings, and his dose was doubled just two days earlier. Joe Pittman's hands shook as he read his son's confession to a roomful of strangers during the hearing. ``I took everything out on my grandparents, who I loved so very much,'' wrote then-12-year-old Christopher Pittman. ``When I was lying in my bed that night, I couldn't sleep because my voice in my head kept echoing through my mind, telling me to kill them.''
      But prosecutors and police say Christopher's actions during and after the November 2001 slayings show he clearly knew what he was doing was wrong. The boy waited until his grandparents were sleeping and took a pump-action shotgun from a gun cabinet. He crept into the couple's dark bedroom, first shooting 66-year-old Joe Frank Pittman in his open mouth, then firing into the back of 62-year-old Joy Pittman's head. Christopher then set the house on fire and drove off in the family car. When he got stuck on a dirt road 20 miles away, he told hunters he was kidnapped by a man who killed his grandparents, set the fire, drove him into the woods and ran away. Christopher was living with his father's parents in hopes of turning his life around. He told defense experts he felt abandoned by his mother and his relationship with his father was rocky. No one answered phone calls to Joe Pittman's home.
      A month before the slayings, Christopher was hospitalized in Florida, where his father lives, after he threatened to kill himself. The boy was prescribed the anti-depressant Paxil, but another doctor soon put him on Zoloft instead. Pittman decided to send the boy to live with his grandparents in Chester County, a rural area between Columbia and Charlotte, N.C.
      Christopher, who turns 16 in April, is being prosecuted as an adult and faces 30 years to life in prison if convicted at his trial, set to start next month. His lawyers argue that his case should be moved to Family Court, where if convicted, he could only be kept in custody until he turns 21. Karen Menzies, one of Christopher's lawyers and an attorney specializing in lawsuits against anti-depressant makers, said medical research is available to support the Zoloft defense.
      In the three years the teen has spent in jail awaiting trial, the FDA has become increasingly wary of doctors prescribing Zoloft and other antidepressants for children. In October, the agency ordered the drugs to carry ``black box'' warnings -- the government's strongest warning short of a ban -- about increasing the risk of suicidal behavior in children. ``The science has been out there for a while. The prescription drug companies have been able to hide it,'' Menzies said.
      On the other side is Pfizer Inc., the maker of Zoloft, which has aided the prosecution, according to Solicitor John Justice, who has since taken himself off the case for health reasons. The company has vigorously fought cases claiming antidepressants cause violent or suicidal behavior. A spokesman responded to inquiries by pointing out an October statement on the company's Web site addressing concerns of suicide attempts, saying studies show ``no statistically significant difference'' between children using Zoloft and nonusers. The statement, though, does not discuss any possible link between the drug and violent acts against others.
      Trying to blame a drug for causing someone to commit a crime is an uphill fight, but it has been done successfully. In April, a Santa Cruz, Calif., jury acquitted a man of attempted murder after he beat his friend, then blamed the episode on Zoloft.
      National Association of Criminal Defense Lawyers spokesman Jack King said the ``Zoloft-made-me-do-it'' defense likely means that the Pittman case will come down to defense vs. prosecution experts. ``It's going to be a battle of whose experts the jury believes,'' King said. Christopher's maternal grandmother, Delnora Duprey, of Wildwood, Fla., said her grandson is no longer on any medication and is the ``sweet, quiet, laid-back'' boy she knew growing up. ``He's the old Christopher again.'' Menzies said the teenager is getting good grades and behaving behind bars.
      Duprey says the ``whole entire family is behind Christopher 150 percent.'' She thinks Zoloft had to have caused Christopher to kill his grandparents because he loved them both, especially the grandfather he called ``Pop-Pop.'' ``We used to joke that he was his Pop-Pop's shadow,'' Duprey said.
      However, those who dealt with the boy after the crime feel differently. ``Anybody who could kill his grandparents in the fashion he did shouldn't be let loose on the public at age 21. And that would have been the best-case scenario,'' said former prosecutor Justice, who pushed to move the case to adult court. The current prosecutor, Barney Giese of Columbia, said through his office that he doesn't talk about cases before they go to trial. Chester County Sheriff Robbie Benson said interviews with Christopher left him shaken because he could not believe the lack of remorse. ``This was cold-blooded.'' Menzies said those observations might help her case. ``The boy was still suffering from the side-effects of this medication after the incident,'' she said. ``I think we see a different Christopher now.''

Pastor Decried After Child's Arms Severed
Asssociated Press, 12/5/2004

PLANO, Texas -- Long before Dena Schlosser took a blade to her baby's arms, her parents had begun to worry. In the years after she moved to Texas with her husband and children, their gentle, dependent daughter had become increasingly isolated. And, according to her stepfather, she was dangerously consumed by a self-described prophet and his church. Dena's stepfather, Mick Macaulay, said that although he blames mental illness for Schlosser severing the arms of 10-month-old daughter Margaret and leaving her to die, he believes the teachings of Doyle Davidson also played a role. ``I don't think there's any question that what we saw happen here is postpartum psychosis,'' Macaulay said in a telephone interview. ``But that doesn't mean there aren't dynamics in force to push the person toward the psychotic break.''
      Schlosser was charged with capital murder after police found the 35-year-old mother on Nov. 22 covered in blood in her living room, still holding a knife. Macaulay said Schlosser had been emotionally dependent on her mother since childhood, when she had several operations to remove an abnormal amount of fluid from her brain. After the surgeries, Schlosser's brain functions seemed normal. She went on to college in Illinois, married her husband John and became a mother. The Schlossers moved to Texas about five years ago. John soon lost his job and began working for himself as a consultant. The family had to trade their spacious home for a small apartment, and a midwife delivered Margaret because they had no health insurance. The stress of money, a new baby and a mother who has Parkinson's disease affected Schlosser. Child Protective Services investigated her for neglect in January after she left the newborn alone and her 5-year-old daughter was seen chasing her mother down the street on a bicycle. Schlosser received psychiatric treatment for postpartum depression and the agency determined she was stable in August.
      By then, though, Schlosser's association with Davidson's church had intensified, Macaulay said. He said Davidson used violent imagery and told women they possessed a rebellious ``Jezebel'' spirit, and that they should submit to their husbands, he said. '`I'm not saying that anybody suggested 'Go cut your baby's arms off,''' said Macaulay, a mental health counselor who lives with Schlosser's mother, Connie, in Canada. ``This diminishing of women, this diminishing of women's powers, women's importance, referring to women as jezebels, I think, further undermines an already fragile ego state that Dena's experiencing.''
      That's absurd, the 72-year-old minister said. ``I'm an apostle and I'm a prophet,'' Davidson said. ``I only teach what's in the Bible and that's what makes them mad.'' Davidson, a former veterinarian, said God told him to start Water of Life Ministries in suburban Dallas in the early 1980s. His sermons, based on literal interpretations of the Bible, are available on his Web site and broadcast on TV and radio in several states. He refers to Methodist, Catholic and Baptist denominations as cults and believes the Ten Commandments apply only to the disobedient, not the righteous. Davidson doesn't deny his teachings are unconventional. He said he avoids violent imagery, but he does teach that women are weaker and should submit to their husbands. He also said he isn't well-liked by much of the religious community, and he was removed from the Daystar Television Network, a major Christian broadcaster, after his sermons offended top officials.
      In September, Davidson was arrested on a public intoxication charge after a couple, longtime members of his church, called 911, alleging the minister attacked them at their home. Davidson said he was only trying to cast the devil out of the wife, who had become rebellious and rejected his teachings. He said he entered the home with the permission of her husband. The couple told police Davidson choked the woman. The couple declined to press assault charges and several calls by the AP to their home went unanswered. Davidson said he believes the incident was a ``setup of Satan himself to try and destroy my ministry.''
      Davidson claimed he's had little interaction with Dena since the Schlossers began attending his roughly 200-member church in 2002. But Macaulay said Schlosser, who spoke to her mother almost daily by phone, talked incessantly about Davidson, urging them to listen to sermons on his Web site. Macaulay said they listened to about 60 hours of sermons, which only fed their concern. Macaulay said Schlosser started using prayer instead of antibiotics when her children were sick and was convinced Davidson could cure her mother of Parkinson's. When Connie Macaulay visited two years ago, Schlosser had Davidson ``lay hands on'' her mother to drive out evil spirits and disease. ``Dena was so confident that Connie was cured that they threw out her medicine,'' Macaulay said. Schlosser's husband, John, also supported the minister. His personal Web site contains several Bible passages and a link to Davidson's Web site. He has refused to give media interviews.
      Macaulay said that as he and his wife struggle to understand their daughter's unthinkable crime, the minister is ever-present on their minds. ``(Connie) looked at me somewhat plaintively after she had a good cry the other day and said 'I hope Dena won't go back to that church,''' he said.

DALLAS - A mother who has appeared disoriented since she was charged with capital murder for severing her baby's arms is improving under medication she is receiving in jail, her attorney said today. Dena Schlosser, 35, who was hospitalized early this year for postpartum depression, was arrested Nov. 22 after she told a 911 operator she cut off the arms of 10-month-old Margaret. Police found Schlosser in her living room, covered in blood and holding a knife. Attorney David Haynes, who has said Schlosser is incompetent to stand trial, said she is responding to medication that she's been taking for several days. "I see some signs of improvement, but I think she's still pretty confused," Haynes said.
      Schlosser remained in the Collin County Jail on a $1.25 million bond set late Friday, Haynes said. Her first appearance in court was set for Dec. 14. Haynes said it could be next year before the district attorney's office decides whether to pursue the death penalty. Haynes would not provide details about his discussions with Schlosser or say how much she understands about her situation. Schlosser's stepfather, Mick Macaulay, said he has not been in contact with his stepdaughter. But he said her husband, John Schlosser, told him in a phone conversation that she was "very, very sad."
      Texas' Child Protective Services had investigated Schlosser for neglect in January after she left the newborn alone and her 5-year-old daughter was seen chasing her mother down the street on a bicycle. CPS closed the investigation in August after Schlosser received psychiatric treatment for postpartum depression and the agency determined she was stable. CPS took temporary custody of Schlosser's two older girls, ages 6 and 9, after the baby was killed, pending an investigation.

Tracking Stress and Depression Back to the Womb
Laurie Tarkan, New York Times- 12/7/2004

By listening intently to movements and heartbeats, researchers are finding that the fetuses of mothers who are stressed or depressed respond differently from those of emotionally healthy women. After birth, studies indicate, these infants have a significantly increased risk of developing learning and behavioral problems, and may themselves be more vulnerable to depression or anxiety as they age.
      The studies, researchers caution, are preliminary. Stress or depression during a mother's pregnancy is only one among many influences that affect an infant's development. Even among mothers who are depressed or highly stressed, the rate of emotional and behavioral problems in children is still very low. "The last thing pregnant women need is to have something else to worry about," said Dr. Janet DiPietro, a developmental psychologist at the Johns Hopkins University Bloomberg School of Public Health.
      The studies reflect growing evidence that stress and depression can have early and lasting effects on a child's life. If the findings hold up, experts say, they could eventually lead obstetricians, midwives and other health professionals who care for pregnant women to include mental health screening as a routine part of prenatal examinations. Such screening could allow doctors to recommend therapy or treatment for pregnant women who suffer from depression or other disorders. "We could be intervening earlier," said Dr. Catherine Monk, an assistant professor in the psychiatry department at the College of Physicians and Surgeons at Columbia. "Prenatal care is an optimal time to do mental health screening, but we don't."
      The effects of stress on a fetus have been well documented in animal studies. In rats, researchers have found, babies born to stressed mothers show permanent changes in brain chemistry and behavior. For example, rat pups exposed prenatally to elevated levels of the stress hormone corticosterone were born with reduced numbers of corticosterone receptors in the brain, and the animals showed exaggerated responses to stress. In humans, there is convincing evidence that mothers who are stressed in pregnancy are more likely to give birth to preterm or infants with low birth weights.
      In recent years, scientists have begun to home in on more subtle effects, studying how unborn fetuses respond to their mothers' anxiety or depression, the emotional health of the infants after birth and how they fare later in childhood. Some studies have offered unusual glimpses into the symbiotic relationship between a mother and a developing child.
      Dr. Monk has looked at the increase and decrease in a fetus's heart rate when its mother is under stress. In one study, women who were in the third trimester of pregnancy went through psychological screening for depression and anxiety. They were then asked to perform a series of stress-inducing computer tasks. As expected, all the women showed increases in heart rate, respiration and blood pressure. The responses of the fetuses were more varied. The fetuses of mothers who were depressed or had anxious personality styles showed increases in heart rates. In contrast, the heart rates of fetuses whose mothers were emotionally healthy showed no fluctuations. Dr. Monk said the fetuses were not simply mimicking their mothers' responses. "What this leaves us with is another interpretation," she said. "The fetuses of depressed or high anxious women are more reactive to stimuli than other fetuses." She compared the fetuses' responses to the way people in a waiting room might react differently to a door being slammed. In this case, a fetus might be reacting to the mother's increased heartbeat or breathing, or to a jolt of stress hormones.
      Dr. Monk said depressed women tended to have more difficulty handling stress, which leads to higher levels of stress hormones like cortisol. She speculated that those higher levels, in turn, might make the fetus more jumpy "My hypothesis is that over the course of gestation, they have been exposed to an altered in utero environment, which includes increased levels of stress hormones," Dr. Monk said. "This may make fetuses more susceptible to stressors in the future, and by extension, because stress plays a role in the development of depression, may make them more vulnerable to depression in the future."
      Though stress and depression are closely intertwined, researchers believe that stress is the more potent player in affecting prenatal development. In a study by Dr. DiPietro, pregnant women who perceived their lives, and in particular their pregnancies, as stressful, had fetuses who were more active in an ultrasound test. Other studies have linked higher levels of stress hormones in the mother with a more active fetus. Dr. DiPietro has found that more active fetuses tend to become more active 1-year-olds, providing some evidence that the effects are not transient.
      In newborns, researchers have also found that the effects of a mother's depression lingered. A study published this year in Infant Behavior & Development compared 70 depressed pregnant women with 70 women who were not depressed. The study found that compared with the infants of the healthy mothers, the newborns of mothers with depression symptoms had higher cortisol levels and lower levels of dopamine and serotonin, two neurotransmitters that have been tied to depression. The newborns also had less developed learning skills, they were less responsive to social stimulation, and they were less able to calm themselves when agitated, said Dr. Tiffany Field, the author of the study and director of the Touch Research Institutes at the University of Miami School of Medicine.
      In another study, Dr. Monk put newborn babies in specially designed bassinets that were tilted 30 degrees up or down, a standard method of testing a newborn's responsiveness. When a baby's head is down, the heart rate normally decreases in response to the stress. But newborns with depressed mothers showed a smaller decrease in heart rate, suggesting that they were less able to adapt to stress.
      What begins in the womb persists into childhood, researchers find. In a study published in 2002 in The British Journal of Psychiatry, researchers asked 7,448 women in England to assess their level of stress while they were pregnant and answer questionnaires about their children's behavior at age 4. The study found that children whose mothers reported high levels of anxiety in late pregnancy were more likely to have behavior problems - most notably attention difficulties - as 4-year-olds. "Women who scored in the top 15 percent of anxiety had double the risk of having a child with severe behavioral problems," said Dr. Thomas O'Connor, a professor of psychiatry at the University of Rochester, who is an author of the study. The children in the study had a 10 percent chance of having such problems, Dr. O'Connor said, compared with a 5 percent risk among children in the general population.
      Dr. Vivette Glover, a perinatal psychobiologist at Imperial College London and another author of the study, noted that even though the children of stressed mothers were at increased risk, the rate of behavior problems remained very low. "Even with this anxious group of women, 90 percent of children don't have these behavioral problems," Dr. Glover said. "So even if a woman is pretty anxious, her children are probably going to be fine."
      Screening pregnant women for mental health problems is quite likely to be controversial. "In terms of public health, it's very important if we could reduce the incidence of behavioral problems by treating women during pregnancy," Dr. Glover said. She noted that cognitive behavioral therapy had proven highly successful in treating adults who suffer severe anxiety.
      Some researchers say that any recommendation for screening and treatment during pregnancy is premature because the research is still preliminary. They point to studies suggesting that a mother's stress may in some cases be beneficial to her fetus. In one study, 2-year-olds whose mothers reported high levels of anxiety in pregnancy had better motor and cognitive skills than children whose mothers did not report being highly anxious. Some experts say a fetus's awareness that its mother is stressed may serve an evolutionary purpose, preparing it for entry into a difficult world. "If a fetus is constantly going to be threatened after he is born, and there's danger to its well-being, it may make sense for it to develop a system that produces big responses to stress," said Dr. Pathik D. Wadhwa, director of the Behavioral Perinatology Research Program at the University of California, Irvine.