Antibiotics and increase in symptoms

My son got strep last week and is on antibiotics until the end of the week. Interestingly, I don’t know if it’s because of the antibiotics, lack of exercise and fresh air (it’s either snowing or too cold to go outside), boredom, or what, but we’ve seen some increase in symptoms recently — much more distractibility and fidgeting, some “strange” behavior (high pitched “chanting,” licking things, hanging off the sofa with head upside down). It’s like his brain is going haywire.

It has been a pattern in the past, when he was little, that whenever he was on antibiotics his hyperactivity would go through the roof. This time there are other things happening as well.

I wonder if it’s the red #40, or the antibiotics in general. Or something entirely else… I guess we’ll find out when we stop the medicine.

I’m curious whether anyone has done studies on the influence of antibiotics on the brain, if there are any subgroups of people for whom antibiotics changes their behavior. Or maybe it is the disappearance of the beneficial gut bacteria? I think I’ve read somewhere a theory that antibiotics may increase the severity of autistic behavior, but I don’t remember the explanation of why it would happen and who worked on that. I’ll have to try to look for it…

Report on Medications and Choices

PAL, the Parent/Professional Advocacy League, and Institute for Community Health (both based in Massachusetts), have just published Medications and Choices: The Perspective of Families and Youth: What Parents and Children Tell Us about Psychiatric Medications which they call “a ground breaking, family-driven study of the decision making process families go through when they choose to use psychotropic medication to treat their child’s mental health needs.”

PAL, the Parent/Professional Advocacy League, is “an organization of parents and professionals who advocate on behalf of children with mental, emotional or behavioral special needs and their families in order to effect family empowerment and system change” founded in 1980s.

Institute for Community Health, is a collaboration of the Cambridge Health Alliance, Mt. Auburn Hospital CareGroup, and Partners Healthcare, founded in 2000 “to improve the health of Cambridge; Somerville, and surrounding cities and towns.”

The 40-pages-long report presents data from a 2006 survey of 274 parents of children who have been taking psychiatric medications and more than 80 teens.

The foreword to the report was written by Joseph Gold, MD, Chief Medical Officer at McLean Hospital, Director of the Community Child Psychiatry Services at Partners Health Care, and Medical Co-Director of the Massachusetts Child Psychiatry Access Project (MCPAP). (for unexplained reasons in the report the foreword is called “Forward,” I don’t know who and how many people proofread the report before publishing it, but someone sure goofed)

What I found especially interesting is that “Parents reported that their health insurance was more likely to cover medication than therapy for their child.” 76% of the families said that “their insurance covered all of the medication visits their child needed” but only 53% said that “their insurance also covered all of the psychotherapy visits their child needed.” It seems health insurance companies think that once you take a pill, that’s it, the problem is fixed.

I also really liked the part covering the teens’ responses to the survey and what they say about being on medication.

Heart Conditions and ADHD

The American Heart Association recommends that children with ADHD should get “careful cardiac evaluation and monitoring, including an electrocardiogram (ECG) before starting treatment with stimulant drugs.”

Apparently, “studies have shown that stimulant medications like those used to treat ADHD can increase heart rate and blood pressure.” And while “these side effects are insignificant for most children with ADHD; however, they’re an important consideration for children who have a heart condition.”

What I found very curious is the following: “Surveys indicate that ADHD affects an estimated 4 percent to 12 percent of all school-aged children in the United States, and it appears more common in children with heart conditions. Studies report that, depending on the specific cardiac condition, 33 percent to 42 percent of pediatric cardiac patients have ADHD.” What is the link between heart conditions and ADHD?

Interestingly, during the recent American Psychiatric Association, a pediatric psychopharmacology researcher at Harvard, “emphasized that there’s no evidence that stimulant or non-stimulant medication for ADHD causes sudden death.” By the way, his talk was sponsored by drugmaker Abbott Laboratories, which is working on a new drug for ADHD.

What’s the issue here? Money, of course. It’s expensive to do ECG on every child diagnosed with ADHD. And then if a heart condition is detected (in a whooping 33 to 42 percent of the cases) the parents will be told about the risk of side effects and as a result may decide to avoid medications. This recommendation obviously is not in the financial interest of both insurance companies and drug makers.