"Public fears about kids killing themselves [are] sometimes, I think, worse than the medication itself," Dr. Sheela Gade told an audience of child development students at a colloquium yesterday at the Eliot Pearson Children's School.
As mood disorders have increasingly been thrust into the limelight through media coverage and the use of medications to treat them, they have inspired mounting controversies. Gade offered insights gleaned from her research in the field.
A child psychiatry fellow at the Tufts-New England Medical Center, she advocated for a "multi-axial" approach to dealing with bipolar disorder, schizophrenia, Attention Deficit Disorder, anorexia and alcoholism, among other conditions.
"We try to look at biological, social and psychological factors," she said.
But even a complex approach makes diagnosing disorders in children difficult.
"Depression in children is not as clear cut as with adults," she said. "What do you do with a kid who's ten who isn't able to identify the feeling?"
Most of her remarks were focused on the symptoms of various disorders and how to diagnose them, but she also ventured into the field of medication.
While some have shied away from prescribing medication to children due to fears of adverse side effects, Gade said that these medicines serve a useful purpose.
She said, for example, that most patients who experience depression are put on medication for six to eight months after their first "episode." If the condition persists, doctors may recommend continuing medication for the duration of the patient's life.
"A lot of people are not excited with this, but when they have that episode again, it's better to be on the medication," she said.
Many of the current concerns about prescription medication stem from a 2004 Food and Drug Administration mandate requiring drug manufacturers to put "black box warnings" on medications.
These warnings indicate that the use of antidepressants could lead to increased suicidal thoughts and behaviors in children and adolescents.
Awareness of the warnings and the studies that prompted them caused many parents to rashly take their children off of their medication, according to Gade. "People went berserk," she said.
Still, she stressed that doctors must be very careful when diagnosing patients with certain mood disorders. Symptoms of bipolar disorder, for example, are mimicked by many other conditions and behaviors, such as Attention Deficit Hyperactive Disorder, anxiety, drug addiction and alcoholism.
"There are many things you want to rule out before you diagnose someone with bipolar disorder," she said.
Child Development Professor Donald Wertlieb, who invited Gade to speak to his developmental psychopathology class, was pleased with the presentation.
"It was an exceptional opportunity to have the important scholarly resources of the Tufts-New England Medical School made available to students in Medford," he said. "I wish this was a more common and typical aspect of the Tufts education, but I'm glad [my students] got this opportunity."
Senior Hailey Fitzgerald echoed Wertlieb's praises. "It was really interesting to see [her] perspective," she said.
Fitzgerald was particularly interested in Gade's warnings about how easy it is to misdiagnose certain conditions.
"Any kid with hard life experiences that misbehaves could potentially be diagnosed wrongly, and this makes me very uncomfortable," she said.
