Westroads Mall Shooter - history of psych drugs

[Guest guest]

Omaha World-Herald

http://www.omaha.com/index.php?u_page=2798 & u_sid=10221876

Published Wednesday | January 2, 2008

Teens can be tough to treat for mental illness

BY MICHAEL O'CONNOR

WORLD-HERALD STAFF WRITER

The case of Hawkins, who sporadically resisted taking psychiatric

medication, provides a glimpse into how tough it can be to treat teens for

mental illness.

Psychiatrists say it's often more challenging to treat teens than adults

because young people are more likely to skip or refuse medication, and they

are also less likely to understand the long-term benefits of treatment.

Hawkins, 19, had a lifetime of psychiatric troubles. He killed eight people

and himself at Westroads Mall on Dec. 5 and wounded others, two

seriously.

At the time of the shooting, Hawkins, 19, had therapeutic levels of diazepam

in his system, according to his autopsy. epam is a tranquilizer often

known by the trade name Valium. It isn't known whether he had been

prescribed the medication.

Hawkins had been prescribed psychiatric medication while he was a state

ward for mental health treatment, from 2002 to 2006.

Treating teens grew more complicated after the federal government warned

a few years ago about links between antidepressants and increased suicidal

thoughts and behaviors among children and teens.

Doctors say more parents became wary of the drugs even though they can

be effective in treating depression.

" Parents are aware about the potential problems, " said Dr. Arun Sharma,

chief of psychiatry for Alegent Health.

In 2003, at age 14, Hawkins was diagnosed with dysthymic disorder, a

depressed state that is more chronic but less intense than major depressive

disorder.

He also was diagnosed then with oppositional defiant disorder, which is a

persistent pattern of defying authority, and antisocial personality disorder,

which is a continual disregard toward the expectations and rules of society

and others.

Additional diagnoses over the years included attention-deficit disorder,

attention-deficit/hyperactivity disorder and major depressive disorder-single

episode, related to suicide attempts.

He tried to commit suicide at least four times before taking his life last

month.

A document from July 2006, six months after a suicide attempt, said

Hawkins " took himself off his medication against medical advice. " The

document also said he refused " further psychiatric involvement and

medication management. "

It's common for teens to refuse their medications, said Dr. Shaffer,

who serves on a research committee of the American Academy of Child and

Adolescent Psychiatry.

One reason, particularly for males, is that they don't like the sexual side

effects of antidepressants, which can include an inability to climax, Shaffer

said.

Sharma said teens often seek autonomy, making them more likely than an

adult to refuse medication.

Connie Hammitt of Omaha said she's faced struggles getting her daughter

to take medications.

" You beg, you scream, you yell, " Hammitt said. " What do you do? "

She said her daughter, who's 16, has been on and off psychiatric drugs for

11 years for such problems as anxiety.

Last year, her daughter was in a residential treatment program where staff

let her decide whether to take her medications, and that created problems,

said Hammitt, who's on the board of the Nebraska Family Support Network,

a nonprofit group in Omaha that helps families whose children have mental

and behavioral disorders.

She said her daughter is doing better now that she is in a residential

program where she is required to take her medication.

Sharma said the stigma of taking psychiatric drugs keeps some teens from

taking their medications. Teens seek acceptance from peers and might

worry that friends would know they are taking the drugs.

Sharma also said teens tend to live in the present and don't consider that

the medications and other treatment will help them avoid mental problems

as they head toward their adult years.

Teens and adults who begin feeling better after taking medications might

suddenly stop taking them, believing their mental illness is gone, Sharma

said.

But symptoms can recur, and a patient who had been feeling better can

relapse.

A court document from September 2005 said a psychiatrist reported that

Hawkins " continues not to require medication. "

Four months later, Hawkins tried to commit suicide. He was placed on

Effexor XR, an antidepressant; and Lamictal, typically used for severe mood

swings.

It's important to monitor patients who stop their medication or just started it,

particularly children and teens, Sharma said. That's partly because there is

less research data on the possible side effects that antidepressants can

have on teens.

Three years ago, the U.S. Food and Drug Administration ordered drug

companies to add strong " black box " warnings to the labels of

antidepressants. The move came after clinical trials suggested that some

drugs increased the risk of suicidal thinking and behavior in children and

teens.

The warnings must be carried on all antidepressants, including Effexor and

Zoloft, which court documents show Hawkins took.

Dr. Kratochvil, a pediatric psychiatrist at the University of Nebraska

Medical Center, said that since the warning was issued, the use of

antidepressants among children and teens has declined.

" Many primary care doctors became anxious about prescribing them, " he

said.

Prozac is the only antidepressant approved by the FDA for treating pediatric

depression. But the FDA restrictions don't make antidepressants illegal for

use by young people, and doctors commonly prescribe them.

Kratochvil, who testified at FDA hearings that led to the warnings, said that if

prescribed properly, antidepressants can be effective in treating depression

in children and teens.

He and others at UNMC were part of a federally funded study that

determined the most favorable way to treat depression in teens was a

combination of Prozac and cognitive-behavioral therapy, also called talk

therapy.

Effexor XR, one of the antidepressants Hawkins took, lists " homicidal

ideation " or homicidal thoughts as a " rare adverse event. " The finding is

included in information provided with the drug.

The FDA defines a rare adverse event as occurring in less than one in 1,000

people.

Homicidal thoughts were reported during the clinical trial on patients, said

Di Francesco, an FDA spokesman.

Wyeth Pharmaceuticals, which makes the drug, reported the finding to the

FDA, said Gwen Fisher, a Wyeth spokeswoman. At the FDA's request,

Wyeth included the finding in the prescription information for the drug.

Fisher said there is no scientific evidence of a causal link between Effexor

and homicidal thoughts. She said adverse events can be coincidental.

Hawkins' psychiatric medications

--------------------------------------------------------------------------------

March 2003: Unspecified medications for depression, impulse control and

anger management.

January 2004: Zoloft, an antidepressant; and Adderall, which is typically

prescribed for attention-deficit/hyperactivity disorder.

March 2004: Has refused to take medication for two months. Psychiatrist

says Hawkins shows " no signs or symptoms of experiencing any difficulties

as a result of not being on his medications. "

April 2005: Not taking any prescribed medication. But caseworker

confiscates a Seroquel pill, which is sometimes used to treat bipolar

disorder.

September 2005: Psychiatrist concludes Hawkins " continues not to require

medication. "

January 2006: Hawkins tries to commit suicide. Effexor XR, an

antidepressant; and Lamictal, typically used to treat severe mood swings,

are prescribed.

March 2006: Hawkins has not been taking his prescribed medication on a

regular basis.

July 2006: Hawkins is off medications against medical advice and refuses

further " psychiatric involvement " and medication management. During those

years, he regularly participated in therapy but sometimes refused to take his

medications, according to court documents released last week by Sarpy

County Juvenile Court.

World-Herald staff writer Karyn Spencer contributed to this report.

Contact the Omaha World-Herald newsroom

[Guest guest]

Omaha World-Herald

http://www.omaha.com/index.php?u_page=2798 & u_sid=10221876

Published Wednesday | January 2, 2008

Teens can be tough to treat for mental illness

BY MICHAEL O'CONNOR

WORLD-HERALD STAFF WRITER

The case of Hawkins, who sporadically resisted taking psychiatric

medication, provides a glimpse into how tough it can be to treat teens for

mental illness.

Psychiatrists say it's often more challenging to treat teens than adults

because young people are more likely to skip or refuse medication, and they

are also less likely to understand the long-term benefits of treatment.

Hawkins, 19, had a lifetime of psychiatric troubles. He killed eight people

and himself at Westroads Mall on Dec. 5 and wounded others, two

seriously.

At the time of the shooting, Hawkins, 19, had therapeutic levels of diazepam

in his system, according to his autopsy. epam is a tranquilizer often

known by the trade name Valium. It isn't known whether he had been

prescribed the medication.

Hawkins had been prescribed psychiatric medication while he was a state

ward for mental health treatment, from 2002 to 2006.

Treating teens grew more complicated after the federal government warned

a few years ago about links between antidepressants and increased suicidal

thoughts and behaviors among children and teens.

Doctors say more parents became wary of the drugs even though they can

be effective in treating depression.

" Parents are aware about the potential problems, " said Dr. Arun Sharma,

chief of psychiatry for Alegent Health.

In 2003, at age 14, Hawkins was diagnosed with dysthymic disorder, a

depressed state that is more chronic but less intense than major depressive

disorder.

He also was diagnosed then with oppositional defiant disorder, which is a

persistent pattern of defying authority, and antisocial personality disorder,

which is a continual disregard toward the expectations and rules of society

and others.

Additional diagnoses over the years included attention-deficit disorder,

attention-deficit/hyperactivity disorder and major depressive disorder-single

episode, related to suicide attempts.

He tried to commit suicide at least four times before taking his life last

month.

A document from July 2006, six months after a suicide attempt, said

Hawkins " took himself off his medication against medical advice. " The

document also said he refused " further psychiatric involvement and

medication management. "

It's common for teens to refuse their medications, said Dr. Shaffer,

who serves on a research committee of the American Academy of Child and

Adolescent Psychiatry.

One reason, particularly for males, is that they don't like the sexual side

effects of antidepressants, which can include an inability to climax, Shaffer

said.

Sharma said teens often seek autonomy, making them more likely than an

adult to refuse medication.

Connie Hammitt of Omaha said she's faced struggles getting her daughter

to take medications.

" You beg, you scream, you yell, " Hammitt said. " What do you do? "

She said her daughter, who's 16, has been on and off psychiatric drugs for

11 years for such problems as anxiety.

Last year, her daughter was in a residential treatment program where staff

let her decide whether to take her medications, and that created problems,

said Hammitt, who's on the board of the Nebraska Family Support Network,

a nonprofit group in Omaha that helps families whose children have mental

and behavioral disorders.

She said her daughter is doing better now that she is in a residential

program where she is required to take her medication.

Sharma said the stigma of taking psychiatric drugs keeps some teens from

taking their medications. Teens seek acceptance from peers and might

worry that friends would know they are taking the drugs.

Sharma also said teens tend to live in the present and don't consider that

the medications and other treatment will help them avoid mental problems

as they head toward their adult years.

Teens and adults who begin feeling better after taking medications might

suddenly stop taking them, believing their mental illness is gone, Sharma

said.

But symptoms can recur, and a patient who had been feeling better can

relapse.

A court document from September 2005 said a psychiatrist reported that

Hawkins " continues not to require medication. "

Four months later, Hawkins tried to commit suicide. He was placed on

Effexor XR, an antidepressant; and Lamictal, typically used for severe mood

swings.

It's important to monitor patients who stop their medication or just started it,

particularly children and teens, Sharma said. That's partly because there is

less research data on the possible side effects that antidepressants can

have on teens.

Three years ago, the U.S. Food and Drug Administration ordered drug

companies to add strong " black box " warnings to the labels of

antidepressants. The move came after clinical trials suggested that some

drugs increased the risk of suicidal thinking and behavior in children and

teens.

The warnings must be carried on all antidepressants, including Effexor and

Zoloft, which court documents show Hawkins took.

Dr. Kratochvil, a pediatric psychiatrist at the University of Nebraska

Medical Center, said that since the warning was issued, the use of

antidepressants among children and teens has declined.

" Many primary care doctors became anxious about prescribing them, " he

said.

Prozac is the only antidepressant approved by the FDA for treating pediatric

depression. But the FDA restrictions don't make antidepressants illegal for

use by young people, and doctors commonly prescribe them.

Kratochvil, who testified at FDA hearings that led to the warnings, said that if

prescribed properly, antidepressants can be effective in treating depression

in children and teens.

He and others at UNMC were part of a federally funded study that

determined the most favorable way to treat depression in teens was a

combination of Prozac and cognitive-behavioral therapy, also called talk

therapy.

Effexor XR, one of the antidepressants Hawkins took, lists " homicidal

ideation " or homicidal thoughts as a " rare adverse event. " The finding is

included in information provided with the drug.

The FDA defines a rare adverse event as occurring in less than one in 1,000

people.

Homicidal thoughts were reported during the clinical trial on patients, said

Di Francesco, an FDA spokesman.

Wyeth Pharmaceuticals, which makes the drug, reported the finding to the

FDA, said Gwen Fisher, a Wyeth spokeswoman. At the FDA's request,

Wyeth included the finding in the prescription information for the drug.

Fisher said there is no scientific evidence of a causal link between Effexor

and homicidal thoughts. She said adverse events can be coincidental.

Hawkins' psychiatric medications

--------------------------------------------------------------------------------

March 2003: Unspecified medications for depression, impulse control and

anger management.

January 2004: Zoloft, an antidepressant; and Adderall, which is typically

prescribed for attention-deficit/hyperactivity disorder.

March 2004: Has refused to take medication for two months. Psychiatrist

says Hawkins shows " no signs or symptoms of experiencing any difficulties

as a result of not being on his medications. "

April 2005: Not taking any prescribed medication. But caseworker

confiscates a Seroquel pill, which is sometimes used to treat bipolar

disorder.

September 2005: Psychiatrist concludes Hawkins " continues not to require

medication. "

January 2006: Hawkins tries to commit suicide. Effexor XR, an

antidepressant; and Lamictal, typically used to treat severe mood swings,

are prescribed.

March 2006: Hawkins has not been taking his prescribed medication on a

regular basis.

July 2006: Hawkins is off medications against medical advice and refuses

further " psychiatric involvement " and medication management. During those

years, he regularly participated in therapy but sometimes refused to take his

medications, according to court documents released last week by Sarpy

County Juvenile Court.

World-Herald staff writer Karyn Spencer contributed to this report.

Contact the Omaha World-Herald newsroom

[Guest guest]

Omaha World-Herald

http://www.omaha.com/index.php?u_page=2798 & u_sid=10221876

Published Wednesday | January 2, 2008

Teens can be tough to treat for mental illness

BY MICHAEL O'CONNOR

WORLD-HERALD STAFF WRITER

The case of Hawkins, who sporadically resisted taking psychiatric

medication, provides a glimpse into how tough it can be to treat teens for

mental illness.

Psychiatrists say it's often more challenging to treat teens than adults

because young people are more likely to skip or refuse medication, and they

are also less likely to understand the long-term benefits of treatment.

Hawkins, 19, had a lifetime of psychiatric troubles. He killed eight people

and himself at Westroads Mall on Dec. 5 and wounded others, two

seriously.

At the time of the shooting, Hawkins, 19, had therapeutic levels of diazepam

in his system, according to his autopsy. epam is a tranquilizer often

known by the trade name Valium. It isn't known whether he had been

prescribed the medication.

Hawkins had been prescribed psychiatric medication while he was a state

ward for mental health treatment, from 2002 to 2006.

Treating teens grew more complicated after the federal government warned

a few years ago about links between antidepressants and increased suicidal

thoughts and behaviors among children and teens.

Doctors say more parents became wary of the drugs even though they can

be effective in treating depression.

" Parents are aware about the potential problems, " said Dr. Arun Sharma,

chief of psychiatry for Alegent Health.

In 2003, at age 14, Hawkins was diagnosed with dysthymic disorder, a

depressed state that is more chronic but less intense than major depressive

disorder.

He also was diagnosed then with oppositional defiant disorder, which is a

persistent pattern of defying authority, and antisocial personality disorder,

which is a continual disregard toward the expectations and rules of society

and others.

Additional diagnoses over the years included attention-deficit disorder,

attention-deficit/hyperactivity disorder and major depressive disorder-single

episode, related to suicide attempts.

He tried to commit suicide at least four times before taking his life last

month.

A document from July 2006, six months after a suicide attempt, said

Hawkins " took himself off his medication against medical advice. " The

document also said he refused " further psychiatric involvement and

medication management. "

It's common for teens to refuse their medications, said Dr. Shaffer,

who serves on a research committee of the American Academy of Child and

Adolescent Psychiatry.

One reason, particularly for males, is that they don't like the sexual side

effects of antidepressants, which can include an inability to climax, Shaffer

said.

Sharma said teens often seek autonomy, making them more likely than an

adult to refuse medication.

Connie Hammitt of Omaha said she's faced struggles getting her daughter

to take medications.

" You beg, you scream, you yell, " Hammitt said. " What do you do? "

She said her daughter, who's 16, has been on and off psychiatric drugs for

11 years for such problems as anxiety.

Last year, her daughter was in a residential treatment program where staff

let her decide whether to take her medications, and that created problems,

said Hammitt, who's on the board of the Nebraska Family Support Network,

a nonprofit group in Omaha that helps families whose children have mental

and behavioral disorders.

She said her daughter is doing better now that she is in a residential

program where she is required to take her medication.

Sharma said the stigma of taking psychiatric drugs keeps some teens from

taking their medications. Teens seek acceptance from peers and might

worry that friends would know they are taking the drugs.

Sharma also said teens tend to live in the present and don't consider that

the medications and other treatment will help them avoid mental problems

as they head toward their adult years.

Teens and adults who begin feeling better after taking medications might

suddenly stop taking them, believing their mental illness is gone, Sharma

said.

But symptoms can recur, and a patient who had been feeling better can

relapse.

A court document from September 2005 said a psychiatrist reported that

Hawkins " continues not to require medication. "

Four months later, Hawkins tried to commit suicide. He was placed on

Effexor XR, an antidepressant; and Lamictal, typically used for severe mood

swings.

It's important to monitor patients who stop their medication or just started it,

particularly children and teens, Sharma said. That's partly because there is

less research data on the possible side effects that antidepressants can

have on teens.

Three years ago, the U.S. Food and Drug Administration ordered drug

companies to add strong " black box " warnings to the labels of

antidepressants. The move came after clinical trials suggested that some

drugs increased the risk of suicidal thinking and behavior in children and

teens.

The warnings must be carried on all antidepressants, including Effexor and

Zoloft, which court documents show Hawkins took.

Dr. Kratochvil, a pediatric psychiatrist at the University of Nebraska

Medical Center, said that since the warning was issued, the use of

antidepressants among children and teens has declined.

" Many primary care doctors became anxious about prescribing them, " he

said.

Prozac is the only antidepressant approved by the FDA for treating pediatric

depression. But the FDA restrictions don't make antidepressants illegal for

use by young people, and doctors commonly prescribe them.

Kratochvil, who testified at FDA hearings that led to the warnings, said that if

prescribed properly, antidepressants can be effective in treating depression

in children and teens.

He and others at UNMC were part of a federally funded study that

determined the most favorable way to treat depression in teens was a

combination of Prozac and cognitive-behavioral therapy, also called talk

therapy.

Effexor XR, one of the antidepressants Hawkins took, lists " homicidal

ideation " or homicidal thoughts as a " rare adverse event. " The finding is

included in information provided with the drug.

The FDA defines a rare adverse event as occurring in less than one in 1,000

people.

Homicidal thoughts were reported during the clinical trial on patients, said

Di Francesco, an FDA spokesman.

Wyeth Pharmaceuticals, which makes the drug, reported the finding to the

FDA, said Gwen Fisher, a Wyeth spokeswoman. At the FDA's request,

Wyeth included the finding in the prescription information for the drug.

Fisher said there is no scientific evidence of a causal link between Effexor

and homicidal thoughts. She said adverse events can be coincidental.

Hawkins' psychiatric medications

--------------------------------------------------------------------------------

March 2003: Unspecified medications for depression, impulse control and

anger management.

January 2004: Zoloft, an antidepressant; and Adderall, which is typically

prescribed for attention-deficit/hyperactivity disorder.

March 2004: Has refused to take medication for two months. Psychiatrist

says Hawkins shows " no signs or symptoms of experiencing any difficulties

as a result of not being on his medications. "

April 2005: Not taking any prescribed medication. But caseworker

confiscates a Seroquel pill, which is sometimes used to treat bipolar

disorder.

September 2005: Psychiatrist concludes Hawkins " continues not to require

medication. "

January 2006: Hawkins tries to commit suicide. Effexor XR, an

antidepressant; and Lamictal, typically used to treat severe mood swings,

are prescribed.

March 2006: Hawkins has not been taking his prescribed medication on a

regular basis.

July 2006: Hawkins is off medications against medical advice and refuses

further " psychiatric involvement " and medication management. During those

years, he regularly participated in therapy but sometimes refused to take his

medications, according to court documents released last week by Sarpy

County Juvenile Court.

World-Herald staff writer Karyn Spencer contributed to this report.

Contact the Omaha World-Herald newsroom

[Guest guest]

Omaha World-Herald

http://www.omaha.com/index.php?u_page=2798 & u_sid=10221876

Published Wednesday | January 2, 2008

Teens can be tough to treat for mental illness

BY MICHAEL O'CONNOR

WORLD-HERALD STAFF WRITER

The case of Hawkins, who sporadically resisted taking psychiatric

medication, provides a glimpse into how tough it can be to treat teens for

mental illness.

Psychiatrists say it's often more challenging to treat teens than adults

because young people are more likely to skip or refuse medication, and they

are also less likely to understand the long-term benefits of treatment.

Hawkins, 19, had a lifetime of psychiatric troubles. He killed eight people

and himself at Westroads Mall on Dec. 5 and wounded others, two

seriously.

At the time of the shooting, Hawkins, 19, had therapeutic levels of diazepam

in his system, according to his autopsy. epam is a tranquilizer often

known by the trade name Valium. It isn't known whether he had been

prescribed the medication.

Hawkins had been prescribed psychiatric medication while he was a state

ward for mental health treatment, from 2002 to 2006.

Treating teens grew more complicated after the federal government warned

a few years ago about links between antidepressants and increased suicidal

thoughts and behaviors among children and teens.

Doctors say more parents became wary of the drugs even though they can

be effective in treating depression.

" Parents are aware about the potential problems, " said Dr. Arun Sharma,

chief of psychiatry for Alegent Health.

In 2003, at age 14, Hawkins was diagnosed with dysthymic disorder, a

depressed state that is more chronic but less intense than major depressive

disorder.

He also was diagnosed then with oppositional defiant disorder, which is a

persistent pattern of defying authority, and antisocial personality disorder,

which is a continual disregard toward the expectations and rules of society

and others.

Additional diagnoses over the years included attention-deficit disorder,

attention-deficit/hyperactivity disorder and major depressive disorder-single

episode, related to suicide attempts.

He tried to commit suicide at least four times before taking his life last

month.

A document from July 2006, six months after a suicide attempt, said

Hawkins " took himself off his medication against medical advice. " The

document also said he refused " further psychiatric involvement and

medication management. "

It's common for teens to refuse their medications, said Dr. Shaffer,

who serves on a research committee of the American Academy of Child and

Adolescent Psychiatry.

One reason, particularly for males, is that they don't like the sexual side

effects of antidepressants, which can include an inability to climax, Shaffer

said.

Sharma said teens often seek autonomy, making them more likely than an

adult to refuse medication.

Connie Hammitt of Omaha said she's faced struggles getting her daughter

to take medications.

" You beg, you scream, you yell, " Hammitt said. " What do you do? "

She said her daughter, who's 16, has been on and off psychiatric drugs for

11 years for such problems as anxiety.

Last year, her daughter was in a residential treatment program where staff

let her decide whether to take her medications, and that created problems,

said Hammitt, who's on the board of the Nebraska Family Support Network,

a nonprofit group in Omaha that helps families whose children have mental

and behavioral disorders.

She said her daughter is doing better now that she is in a residential

program where she is required to take her medication.

Sharma said the stigma of taking psychiatric drugs keeps some teens from

taking their medications. Teens seek acceptance from peers and might

worry that friends would know they are taking the drugs.

Sharma also said teens tend to live in the present and don't consider that

the medications and other treatment will help them avoid mental problems

as they head toward their adult years.

Teens and adults who begin feeling better after taking medications might

suddenly stop taking them, believing their mental illness is gone, Sharma

said.

But symptoms can recur, and a patient who had been feeling better can

relapse.

A court document from September 2005 said a psychiatrist reported that

Hawkins " continues not to require medication. "

Four months later, Hawkins tried to commit suicide. He was placed on

Effexor XR, an antidepressant; and Lamictal, typically used for severe mood

swings.

It's important to monitor patients who stop their medication or just started it,

particularly children and teens, Sharma said. That's partly because there is

less research data on the possible side effects that antidepressants can

have on teens.

Three years ago, the U.S. Food and Drug Administration ordered drug

companies to add strong " black box " warnings to the labels of

antidepressants. The move came after clinical trials suggested that some

drugs increased the risk of suicidal thinking and behavior in children and

teens.

The warnings must be carried on all antidepressants, including Effexor and

Zoloft, which court documents show Hawkins took.

Dr. Kratochvil, a pediatric psychiatrist at the University of Nebraska

Medical Center, said that since the warning was issued, the use of

antidepressants among children and teens has declined.

" Many primary care doctors became anxious about prescribing them, " he

said.

Prozac is the only antidepressant approved by the FDA for treating pediatric

depression. But the FDA restrictions don't make antidepressants illegal for

use by young people, and doctors commonly prescribe them.

Kratochvil, who testified at FDA hearings that led to the warnings, said that if

prescribed properly, antidepressants can be effective in treating depression

in children and teens.

He and others at UNMC were part of a federally funded study that

determined the most favorable way to treat depression in teens was a

combination of Prozac and cognitive-behavioral therapy, also called talk

therapy.

Effexor XR, one of the antidepressants Hawkins took, lists " homicidal

ideation " or homicidal thoughts as a " rare adverse event. " The finding is

included in information provided with the drug.

The FDA defines a rare adverse event as occurring in less than one in 1,000

people.

Homicidal thoughts were reported during the clinical trial on patients, said

Di Francesco, an FDA spokesman.

Wyeth Pharmaceuticals, which makes the drug, reported the finding to the

FDA, said Gwen Fisher, a Wyeth spokeswoman. At the FDA's request,

Wyeth included the finding in the prescription information for the drug.

Fisher said there is no scientific evidence of a causal link between Effexor

and homicidal thoughts. She said adverse events can be coincidental.

Hawkins' psychiatric medications

--------------------------------------------------------------------------------

March 2003: Unspecified medications for depression, impulse control and

anger management.

January 2004: Zoloft, an antidepressant; and Adderall, which is typically

prescribed for attention-deficit/hyperactivity disorder.

March 2004: Has refused to take medication for two months. Psychiatrist

says Hawkins shows " no signs or symptoms of experiencing any difficulties

as a result of not being on his medications. "

April 2005: Not taking any prescribed medication. But caseworker

confiscates a Seroquel pill, which is sometimes used to treat bipolar

disorder.

September 2005: Psychiatrist concludes Hawkins " continues not to require

medication. "

January 2006: Hawkins tries to commit suicide. Effexor XR, an

antidepressant; and Lamictal, typically used to treat severe mood swings,

are prescribed.

March 2006: Hawkins has not been taking his prescribed medication on a

regular basis.

July 2006: Hawkins is off medications against medical advice and refuses

further " psychiatric involvement " and medication management. During those

years, he regularly participated in therapy but sometimes refused to take his

medications, according to court documents released last week by Sarpy

County Juvenile Court.

World-Herald staff writer Karyn Spencer contributed to this report.

Contact the Omaha World-Herald newsroom