Meet the Queen of "Preschool Depression" -- and Her Drug Company Backers

Last Updated Nov 12, 2010 11:54 AM EST

The NYT Sunday magazine crowned Dr. Joan Luby as the queen of preschool depression this weekend, but failed to mention that Luby has taken cash from Johnson & Johnson (JNJ), Shire (SHPGY) and AstraZeneca (AZN) to study using atypical antipsychotics in young children. The article is significant because of the outsize role that the Times magazine plays in creating and naming new social trends. (Remember when you suddenly figured out that carbs make you fat but fatty meat doesn't? That was the NYT mag.)

In this case, the phenomenon is depression in children as young as three years old, and the trend is to treat it with drugs such as Risperdal, Zyprexa, Adderall and Seroquel. The article, by Pamela Paul, provides a useful roadmap into how parenting will be medicalized by Big Pharma:

"The idea is very threatening," says Joan Luby, a professor of child psychiatry at Washington University School of Medicine, ... "In my 20 years of research, it's been slowly eroding," Luby says of that resistance. "But some hard-core scientists still brush the idea off as mushy or psychobabble, and laypeople think the idea is ridiculous."
The "ridiculous" layperson who first pointed out that Luby had written medical journal articles urging the use of antipsychotics on preschool children without declaring her drug company payments was me. Luby was a paid speaker for AZ in 2003-2004 (AZ makes Seroquel), AZ told me last year; she received $2019 in a for a consultancy from Shire in 2004 (Shire makes Adderall and Vyvanse), the company told me; and prior to 2006 she received grant/research support from Janssen, the unit of J&J that markets Risperdal, according to her own disclosure in a journal article. Luby is also a member of a group of scientists who want greater study of potential new uses for psychiatric drugs in young children. That group has ties to 16 different drug companies. Some of these drugs have dangerous side effects. Luby did not immediately respond to two messages requesting comment.

The Archives of General Psychiatry (published by the American Medical Association) said it would investigate how Luby failed to disclose her past ties when it published "Preschool Depression," a study she did on 3- to 6-year-olds. Joseph Coyle, the editor of the AGP, did not immediately respond to an email requesting an update on its Luby probe. (The American Psychiatric Association, which publishes the American Journal of Psychiatry, has chosen to ignore the issue.) UPDATE: Luby later disclosed her conflicts in a letter to AGP.
If you have a troublesome preschooler, you'll find the Times' story pretty scary:

Though research does not support the use of antidepressants in children this young, medication of preschoolers, often off label, is on the rise. One child psychologist told me about a conference he attended where he met frustrated drug-industry representatives. "They want to give these kids medicines, but we can't figure out the diagnoses." As Daniel Klein warns, "Right now the problem may be underdiagnosis, but these things can flip completely."
Indeed, Big Pharma's entire business model relies on turning unapproved, off-label drug uses into new indications for their drugs, even when that's illegal. Some of those uses are vague: One of Luby's prospective diagnoses for children is "depressive disorder not otherwise specified," according to the Times.

In one Luby study a depressed 5-year-old plays with an adult who breaks a "favorite" teacup to deliberately invoke feelings of guilt. Here's what happened:

"Are you mad at me?" he asked, and then added, almost angrily, "I never want to do this activity again."

... "I am a bad boy," the boy said, ducking under the table. "I don't think you love me now." He started to moan from the floor, whimpering: "I'm so sad. I'm so sad."

I hope this experiment was properly cleared by the institutional review board at Washington University, where Luby works.

There is some good news, but the Times buries it at the bottom of the story: Luby recommends "Parent-Child Interaction Therapy" for melancholy kids. It consists of 10 to 16 weeks of weekly hourlong sessions in which parents encourage their children to regulate their emotions, and manage stress and guilt. For one kid, "a trip to his grandparents' farm last summer was particularly beneficial."

It's great that PCIT can give parents the skills to make their kids grow up happy and healthy. If it works, it should not be criticized. But in the old days, didn't PCIT used to be called "raising your children"?


Image by Flickr user Pink Sherbert Photography, CC.