Research studies and clinical experience certainly influence prescribing practices. However, in recent years the media has had a profound effect on public opinion and ultimately on clinical practice.
In the late 1980s, negative attention was focused on the drug Ritalin (methylphenidate), a widely prescribed stimulant used in the treatment of attention-deficit/hyperactivity disorder (ADHD).
Andrew Brotman, summarizing the work of others stated, “The media attack was led by major national television talk show hosts and in the opinion of the authors, allowed anecdotal and unsubstantiated allegations concerning Ritalin to be aired. There were also over 20 lawsuits initiated throughout the country, most by a lawyer linked to the Church of Scientology”.
In a study of the effects of this negative media and litigation blitz, conducted in Baltimore County, Maryland, researchers found that the use of Ritalin had dropped significantly. From 1981 through 1987, the use of Ritalin had increased fivefold.
However, in the two-year period during and just following the negative media attention, there was a 40 percent decrease in prescriptions for Ritalin. And this decrease occurred at a time when research on ADHD and stimulant treatment continued to strongly support the safety and efficacy of such medications.
In fact, 36 percent of children who discontinued Ritalin experienced major academic maladjustment (such as failing grades or being suspended), and an additional 47 percent who discontinued encountered mild to moderate academic problems.
Tricyclic Prescriptions Rise
Concurrently, as Ritalin use (especially new prescriptions) decreased, there was a significant (fourfold) increase in the prescription of tricyclic antidepressants among ADHD children. It is important to note that tricyclics, although often used to treat ADHD, tend to have more troublesome side effects than Ritalin, and have been implicated in six reports of cardiac fatalities.
More recently, following wide acclaim as a new “breakthrough drug for depression” Prozac (fluoxetine) came under attack by consumer groups and, again, the Church of Scientology.
The negative attention was sparked by an article documenting the emergence or re-emergence of suicidal ideas in six patients treated with Prozac. The six patients had been diagnosed as suffering from severe depressive disorders, and in no case were there actual suicide attempts following the onset of treatment with Prozac.
Prozac Thrust Into Limelight
But suddenly Prozac was thrust into a very unfavorable light and was the next drug in line to find itself the topic of television talk shows.
Subsequent studies have failed to find any evidence that Prozac is more likely to be associated with suicidal feelings than any other antidepressant. In fact, in one study the incidence of suicidal ideations was greater in patients treated by placebo or imipramine (a tricyclic antidepressant) than by Prozac.
The Church of Scientology attempted to convince the Federal Drug Administration (FDA) to pull Prozac from the market. However, the FDA ruled against taking such action because there was no scientific evidence to support the claims made by the Church of Scientology.
All medications produce some side effects. Reports of adverse effects, even if very infrequent, must be taken seriously and investigated systematically. There is a place for skepticism and scrutiny. However, one must consider the negative effect of unsubstantiated reports in the lay press.
For example, the risk of Prozac-induced suicide appears to be extremely low, and the suicide rate in untreated major depression is reported to be nine percent. Clearly, failure to treat carries the graver risk.
It is very likely that many seriously depressed people and parents of ADHD children have been understandably, and unnecessarily, frightened by negative, sensationalistic reports in the media.
*This article is based on Dr. Moore’s latest book “Handbook of Clinical Psychopharmacology for Therapists” published by New Harbinger Press and coauthored by John Preston, John O’Neal, and Mary Talaga.
Preston, J., O’Neal, J., Talaga, M., & Moore, B. A. (in press). Handbook of Clinical Psychopharmacology for Therapists-Ninth Edition. Oakland, CA: New Harbinger Press.