Some of you who took an early July 4th holiday might have missed Brooke Shields’ fantastic rant in the NY Times Op-Ed section last Friday. The title alone is certainly my nominee for pun-of-the-year.
The bitter clash between Brooke and Tom (Cruise, in case you are new to the whole Matt Lauer/Today debacle) is ostensibly about the treatment of depression with medications, but it also touches on several issues relevant to integrative pediatrics.
To set the stage, here are some of Cruise’s ramblings: “I’ve never agreed with psychiatry, ever. Before I was a Scientologist I never agreed with psychiatry. and when I started studying the history of psychiatry, I understood more and more why I didn’t believe in psychology.” He goes on to say the psychiatry is a “pseudo science.” O-K. You can’t make this stuff up.
Certainly, there are problems with the inappropriate study and use of psychiatric medications in children. One has to look no further than the recent FDA warnings about ADHD meds Concerta, Adderall and Strattera. Then there’s the “black box” warning on antidepressants for children. I am all for natural approaches for treating mental health issues, and for providing psychological and educational support as first line measures. The idea that one size fits all, a common conventional pharmaceutical approach, stands in direct contradiction to one of integrative medicine’s main tenets, that individualizing therapy is key. This is true of both antidepressants and St. John’s Wort. However, it must be noted that much more research is needed for all therapies, including CAM approaches, before any can be recommended without reservation.
Shields’ piece also brings to mind the all-important ethics principle of autonomy, that it is the individuals right to choose, all else being equal. She lambastes Cruise with this zinger: “While Mr. Cruise says that Mr. Lauer and I do not ‘understand the history of psychiatry,’ I’m going to take a wild guess and say that Mr. Cruise has never suffered from postpartum depression.” Ouch. But oh so true – and what of those suffering from postpartum psychosis? Infanticide, a subject well-reviewed by NYC psychiatrist Meg Spinelli, is the horrific end-point on the postpartum depression spectrum. Antidepressants may well save the lives of hundreds of infant and mothers per year. We must be careful about generalizing, as Cruise has so embarrassingly done.
Finally, Shields’ plea for mass screening for postpartum depression by OB’s and pediatricians is well-timed. New Jersey (Shields’ home state) is attempting to lead the way here, spearheaded by the Northern NJ Maternal-Child Health Consortium‘s PPD task force development project. Dr. Cheryl Beck, noted researcher, has developed a great tool for quick office-based screening. Shields concludes: “After all, during the first three months after childbirth, you see a pediatrician at least three times. While pediatricians are trained to take care of children, it would make sense for them to talk with new mothers, ask questions and inform them of the symptoms and treatment should they show signs of postpartum depression.” I couldn’t agree more.