From Bloomberg.com:

Late nights may make teenagers more prone to depression and suicidal thoughts by depriving them of sleep, according to a study by researchers at Columbia University.

Teens whose parents let them go to bed past midnight were 24 percent more likely to be depressed and 20 percent more likely to have contemplated suicide than peers whose parents set bedtimes at or before 10 p.m., the researchers said today in the journal Sleep. Earlier set bedtimes may be protective because they increase the likelihood of getting enough sleep, they said.

The study is the first to show that sleep deprivation may cause depression and suicidal thoughts in adolescents. Previous research has shown a link, though the relationship wasn’t clear because insomnia can be a symptom of depression.

“Our results strengthen the argument that lack of sleep can cause depression as opposed to simply being a symptom of depression,” James Gangwisch, the study’s lead author and an assistant professor at the university’s medical center, said in an e-mail. “Adequate quality sleep could therefore be a preventative measure against depression and a treatment for depression.”

About 4,400 Americans between the ages of 10 and 24 commit suicide each year, making it the third-most common cause of death in the age group, according to the Atlanta-based Centers for Disease Control and Prevention.

Gangwisch and colleagues studied data from 15,659 U.S. students, who were in grades seven to 12 between 1994 and 1996, and their parents. Seven percent of the teens were found to have depression and 13 percent said they seriously contemplated suicide during the preceding 12 months. The association was stronger for girls and older children, according to the study.

More Shuteye

Teenagers whose parents said they should go to bed at 10 p.m. or earlier slept for 8 hours 10 minutes on average, 40 minutes more than those with bedtimes set at midnight or later, the researchers found. That’s less than the nine or more hours of sleep for adolescents recommended by the American Academy of Sleep Medicine, a joint publisher of the journal.

Those who typically slept for five hours or less each night were 71 percent more likely to have depression and 48 percent more likely to have thought about taking their own lives than those who got eight hours of sleep, according to the study funded by Columbia University.

Lack of sleep may affect brain responses to negative stimuli, hinder a person’s ability to cope with stress and impair relationships with peers and adults, the researchers said. It may also affect judgment, concentration and impulse control.

Almost 70 percent of teenagers reported going to bed at the time set by their parents, and two-thirds of the rest said they usually went to bed within an hour after the limit, the study found. More than half of parents surveyed said they sent their children to bed by 10 p.m. or earlier on weeknights, and 25 percent said they allowed their kids to stay up until midnight or later.

From WebMD.com:

The abuse of attention deficit hyperactivity disorder (ADHD) drugs by teenagers is growing, according to a new study.

Researchers found calls to poison control centers for adolescent ADHD prescription drug abuse increased out of proportion to other poison center calls in recent years, which suggests a growing problem with abuse of these stimulant drugs.

The study, published in Pediatrics, tracked calls to U.S. poison control centers from 1998 to 2005 among 13- to 19-year-olds.

“Calls related to teenaged victims of prescription ADHD medication abuse rose 76%, which is faster than calls for victims of substance abuse generally and teen substance abuse,” write researcher Jennifer Setlik, MD, of Cincinnati Children’s Hospital Medical Center and colleagues.

ADHD affects between 8% and 12% of children and 4% of adults worldwide, and there has been a significant increase in the sale of stimulant drugs designed to treat the condition in recent years.

Overall, researchers say the sharp rise in ADHD drug abuse mirrored a similar increase in the prescription numbers among teens, but the abuse of certain types of ADHD drugs is outpacing sales.

There are two main types of stimulant ADHD drugs: methylphenidates and amphetamines.

During the eight-year study period, calls by teens to poison control centers for all types of stimulant ADHD drug abuse rose by 76%. During the same period, prescriptions for these medications for 10- to 19-year-olds rose by 86%.

But the percentage of poison center calls related to amphetamine ADHD drugs, such as Adderall, rose from 22% to 70%, which outpaced sales of these ADHD drugs.

Researchers say most adolescents use their ADHD drugs appropriately, but the growing popularity of these drugs is fueling a similar growth in the abuse of these drugs because more have access to the medicine

From ScienceDaily.com:

Picture this: A bunch of adolescent rats walk into a bar and start consuming Jell-O shots. Lots of them.

Then, three weeks later, some of those party rats are given the choice of pushing one lever that always will give them two sugary pellets or another lever that will give them a larger but uncertain reward of either four or zero treats. The alcohol-consuming rats tend to opt for uncertain rewards while a control group of teetotaling rodents match their choice well to whichever lever had the probability giving the larger reward.

That’s what happened in a scenario created by University Washington scientists investigating the neurobiological underpinnings of a link between adolescent alcohol abuse and later adult decision-making impairments. The research, being published this week in the online edition of the Proceedings of the National Academy of Sciences, appears to show a causal link between early heavy drinking and adult decision-making.

“We know early exposure to alcohol and other substances is a predictor of later substance abuse in humans. It is a novel concept to think that early exposure might have long-term cognitive effects. But we can’t test this on people. This model using rats lends support to causal link between early alcohol use and later increased risky decision making,” said Nicholas Nasrallah, a UW psychology doctoral student and co-author of the study.

“We can’t establish causal links based on existing human data but this animal model allowed us to establish this link,” said corresponding author Ilene Bernstein, a UW professor of psychology and faculty member of the program in neurobiology and behavior.

“Scientists believe regions of the brain, including those implicated in decision making, are slow to develop and development extends into adolescence. This study shows that these late-developing structures in rats are affected by high alcohol use.”

Rats typically do not drink alcohol, but researchers have found that they will consume ethanol when it is combined with gelatin. For this study, one group of rats was given 24-hour access to a 10 percent solution of ethanol in a tasty gel. The rats were 30 to 49 days old during the experiment, a time span that corresponds to human adolescence. These rats consumed the alcohol-laced gel each day, in amounts equivalent to a large number of drinks in human term,” Bernstein said.

A separate control group of rats was given a gel made without any alcohol. At the end of the 20 days the gelatin was withdrawn from both groups. Three weeks later, half of the animals from each group were trained to press the levers to receive the treats. Part of the training included what is called a forced choice where there was only one lever to press. This gave the rats an opportunity to sample the pay off schedule on the uncertain lever that day. Three days of trials were run with the payoff for the large but uncertain reward coming 75 percent of the time and then dropping to 50 percent and 25 percent on subsequent days.

The alcohol-exposed rats showed a strong bias toward the uncertain lever, even when the chance of receiving rewards on the third day diminished to only one in four. The control rats, however, behaved differently and adjusted perfectly to the changing conditions of the experiment, thus gaining more treats than the alcohol-exposed rats.

A second experiment tested whether effects of adolescent alcohol exposure were persistent by waiting three months after the gelatin was withdrawn before testing the remaining rats. The effects were the same suggesting that the influence of adolescent alcohol exposure on decision making does not diminish over time.

“The known association between behavior and high levels of alcohol use puts people at risk for a number of bad outcomes, particularly substance use,” said Bernstein. “Age of exposure to drugs is the No. 1 factor predictive of substance abuse later in life. Adolescent drinking is an epidemic today. This research raises a concern that if the brain is permanently changed by alcohol we need to place more emphasis on preventing adolescent alcohol use.”

The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism funded the research. Tom Yang, a former UW undergraduate student, was a co-author of the paper.

From news-medical.net:

A $4.15 million, four-year National Institutes of Health grant will enable researchers at the Indiana University School of Medicine to conduct the first health study of teenage boys using cellular telephones.
The researchers, led by Dennis Fortenberry, M.D., M.S., professor of pediatrics in the Division of Adolescent Medicine, will use text messaging to follow 72 males, ages 14-17 years, for three years. The adolescent males will be provided with cell phones and unlimited, free text messaging as long as they remain enrolled in the study.

A requirement of the study is that the teens answer a series of questions daily to enable the researchers to track and evaluate the behavior of the teens. Regular urine tests will be used to identify changes in microorganisms in the male genital tract.

“This is a fresh approach to behavioral studies our research group has used for a dozen years involving written daily diary entries used to track the behavior of adolescents,” said Dr. Fortenberry. “That NIH-funded research has provided insights into young people’s health risk and health protective behaviors.”

The objective of the study is to identify and characterize changes in the microorganisms in the urethra of the adolescent male. The urethra connects the male bladder to the outside of the body. Participants will submit urine samples to be analyzed. The answers from the daily questions transmitted by their cell phone will be coordinated with the urine tests to determine how behavior influences changes in the microorganisms of the urethra.

In the past, physicians thought that the male urethra normally didn’t have any microorganisms. It now is known this isn’t true, but little else in known, said Dr. Fortenberry.

Researchers will look at the microorganisms to understand what organisms or communities of organisms are normally present and how they change naturally as young men get older and through the course of initiating sexual activity. By understanding the normal variations, researchers hope to be able to determine how the communities of organism increase or decrease to make a person susceptible to infections. They also hope to determine how some kinds of medical treatment, such as antibiotics, will affect the organisms.

The research is part of the Human Microbiome Demonstration Project, which is part of the National Genomics Institute, and is focused on characterizing microorganisms that inhabit the human body to discover how they are involved in human health and disease.

Indiana University Adolescent Medicine researchers have successfully used daily dairies as a research tool for the past 15 years. By incorporating social media, such as cellular telephones, into the process, they hope to engage a new generation of adolescents.

“We certainly did not develop the methodology, but we are at the forefront of its use,” said Dr. Fortenberry. “Other studies with adults have used cell phones but this is one of the first large-scale studies with teens.”

To assure confidentiality and privacy, the Indiana University Division of Biostatistics has developed a program that will synchronize all the responses to a mainframe on the Indiana University-Purdue University Indianapolis campus. The responses will be removed from the cell phones as soon as the teen hits the “send” button.

In addition to Dr. Fortenberry, other Indiana University researchers participating are Sarah Wiehe, M.D., from the Division of Children’s Health Services Research; Mary Ott, M.D., from the Division of Adolescent Medicine; Barry Katz, Ph.D., director of biostatistics; Bobbie Van Der Pol, Ph.D., from the Division of Infectious Diseases, and Qunfeng Dong, Ph.D., from bioinformatics at IU-Bloomington. Also participating is George Weinstock, PhD., a molecular geneticist at Washington University in St. Louis.

From CBSNews.com:

For Ann Hohmann, Oct. 21, 2004, began just about like any other day.

On that morning, the 54-year-old mother of two living in McAllen, Texas, was preparing to take her eldest son to school. She had an early appointment, so her husband, Rick Hohmann, would be dropping off younger son, 14-year-old Matthew, at his school that day.

About a month earlier, Matthew had been diagnosed with attention deficit hyperactivity disorder, or ADHD. And like an estimated 2.5 million other children in the United States, he was taking medication for the condition.

It was Ann Hohmann who gave Matthew his Adderall XR pill that morning with a glass of water. But it was her husband who later found him after he had collapsed on the bathroom floor.

“To me, he seemed fine,” she recalled. “My husband had seen him walking around, brushing his teeth. Then he walked in and found him flat down on the floor in the bathroom.

“When he turned him over, his lips were blue,” Hohmann said.

She said that her husband called her first, and then he called 911. He performed CPR until the ambulance arrived. But it was too late.

“They worked on him for a while, but he was dead,” she said.

Ann Hohmann is one of a handful of parents across the country who believes that their children’s sudden death was due to the use of drugs to control ADHD. And she said she hopes a new study released this morning, which suggests that the use of stimulants is tied to an increased risk of sudden unexplained death among children and teens, will open the eyes of the public to what she sees as the cause of her son’s demise.

“When my doctor gave this to my son, I thought it was a light dose,” she said. “I had no idea that it was going to kill him. It ruined our lives. … There was no warning.”

Findings May Add Fuel to ADHD Drug Debate
In the study of 564 children and teens who died suddenly, researchers led by Madelyn Gould of the New York State Psychiatric Institute and Columbia University in New York City found that that those who died suddenly were 7.4 times more likely than not to have been taking the stimulant medications. The results of the study are reported online in The American Journal of Psychiatry.

“Although sudden unexplained death is a rare event,” the researchers said, “this finding should be considered in the context of other data about the risk and benefit of stimulants in medical treatment.”

ADHD Medication Concerns Have Arisen in Past
Reports of cases of sudden unexplained death among children taking stimulants for ADHD have raised concerns over use of the medications in the past. The U.S. Food and Drug Administration’s adverse event reporting system identified 11 sudden deaths in pediatric patients taking methylphenidate — the active ingredient in Ritalin and other ADHD drugs — from January 1995 to February 2005.

While this rate of sudden death appears very low, the researchers there may be more cases that go unreported.

In 2006, the issue saw two FDA advisory committees come to opposite conclusions regarding the need to include a boxed warning of the risk of sudden death on the labels of stimulants. Later that year, information was added to the regular warnings section of the medication labels noting the association between sudden death and stimulant use at standard doses in children with serious heart problems.

Currently, however, it appears unlikely that this new study will have an effect on the FDA’s approach to these drugs.

“Given the limitations of this study’s methodology, the FDA is unable to conclude that these data affect the overall risk and benefit profile of stimulant medications used to treat ADHD in children,” the FDA said in a statement released this morning. “Therefore, the FDA believes that this study should not serve as a basis for parents to stop a child’s stimulant medication. Parents should discuss concerns about the use of these medicines with the prescribing healthcare professional.”

The companies that manufacture these medicines maintain that these products are safe and that their risks are properly disclosed.

“Based on several reviews of these reports, the frequency of sudden cardiac death in children and adolescents taking a stimulant medication at the time of their death has not been shown to be higher than the incidence seen in the general population,” Shire Pharmaceuticals, which produces Adderall XR, said in a statement issued Friday before the study’s release.

A spokesperson for Novartis, the company that manufactures the ADHD drug Ritalin, said that a review of the company’s safety data “failed to detect an increased risk in sudden cardiac death associated with [Ritalin] use.” McNeil Pediatrics, the company that manufactures the ADHD drug Concerta, had no comment when contacted by ABC News.

Still, the findings will likely reignite a debate within the medical community over the safety and proper use of the popular medications.

“It is astonishing that these drugs are used so widely with children — 5 percent of the school-aged population on a daily basis,” said William Pelham, professor of psychology, pediatrics and psychiatry at the State University of New York at Buffalo. “When this study is published, I suspect that the professional and advocacy groups that continue to ignore the accumulating evidence showing absence of benefit on long-term outcomes will have a more difficult time defending the widespread practice of using stimulants as first line and sole treatment for ADHD in children.”

Controversy Remains Over Stimulant Drugs for ADHD
Other medical professionals said more research is necessary before making any conclusions. “As far as the study design goes, I’m reminded of the old adage that ‘correlation is not causation,’” said Jay Reeve, chief executive officer of the mental health services organization Apalachee Center Inc. in Tallahassee, Fla. “The downside of this study may be a wholesale rejection of the use of stimulants for children, which would be terrible.

“While caution is an excellent practice in child psychiatry, too many children are helped by the use of these meds … to abandon prescribing these meds entirely,” he said.

Daniel Cox, professor of psychiatry and neurosciences at the University of Virginia in Charlottesville, agreed, adding that he fears the study will have an overall negative effect on the health of these young patients if the public misinterprets its findings.

“This article cannot address a possible large question: How many lives are saved because of stimulant medications,” he said. “How many children do not impulsively run out in the street, are inattentive to a car turning into their lane of traffic, don’t climb out on a roof and fall because they are appropriately medicated and less impulsive and inattentive because of the therapeutic effects?”

Still, Ann Hohmann said that the circumstances behind her son’s death are hard to ignore.

“We didn’t know anything until we saw the death certificate, which said ‘sudden cardiac death, myocarditis,’” she said. “When I saw that, it blew me away. How can a healthy 9-year-old have a heart attack?”

And while Shire noted that it provides warning language about the use of these medicines by patients with serious heart problems, Ann Hohmann said that her son had no such history.

“He had seen doctors several times prior to that, and he had a physical a year before that. The last time he saw a doctor, they listened to his heart.”

Keeping Kids With ADHD Safe
Last year, the American Heart Association recommended considering routine heart screening tests known as electrocardiograms, or ECGs, prior to starting children with ADHD on stimulant drugs and called for future studies to assess the risk of sudden death.

Reeve said that he feels such testing could go a long way in determining which children should not be taking the medications.

Some Support Heart Screenings for Kids on ADHD Drugs
“I think that the AHA recommendations on ECG screening made a lot of good sense and go along with the idea that caution should be the first standard in medicating children,” he said.

Not all doctors agreed, however. “There is no evidence that suggests doing [ECGs] on all children taking stimulant medication will decrease incidences of sudden death,” noted Dr. Francisco Xavier Castellanos, professor of child and adolescent psychiatry at the New York University’s Langone Medical Center in New York City. “What we need is to move from spasmodic concern — ‘let’s do something fast’ — to an urgency to get targeted research going that will provide crucially needed knowledge about who is at risk.”

As for Hohmann, she said that she has started telling her friends to make sure that they do not put their children on stimulant ADHD medications. She added that she would advise any parents who had children who were taking an ADHD medication to have their children’s hearts checked on a regular basis, both prior to beginning treatment with the drug and while they are taking it.

“When you lose a child, it’s the most devastating thing you could ever, ever go through,” she said. “Something needs to be done.”