Without speaking to me, my ex-wife decided that she was going to put our 16-year-old daughter on Prozac (fluoxetine) for anxiety. Thankfully I found out about it before my daughter began taking the medication. I asked to speak to the physician that interviewed my daughter, diagnosed her and prescribed the Prozac. I called the number for the Pediatric Partners SC Practice in Highland Park, IL and the answering service said they would have her call me back.
I received a call back from Anamarie a short while later and asked her to walk me through my daughter's assessment. As she did so and I asked a few basic questions, it became clear that Anamarie was very inexperienced and not very knowledgeable, particularly with the diagnosis and treatment of anxiety in teenagers. It turned out that Anamarie was a nurse and not a doctor. I probed further and asked the nurse why she was comfortable prescribing Prozac "off label" for anxiety when it was only FDA approved for treating depression in teenagers and has a black box warning (the strongest warning the FDA gives and signifies that medical studies indicate the drug carries a significant risk of serious or even life-threatening adverse effects) even for a depression diagnosis. She responded that it was not at all uncommon for her practice to prescribe psychotropic drugs "off label" for kids.
I asked her if other treatment options were considered and exhausted before medication was decided on and she said that therapy was considered and exhausted as she believed my daughter had been seeing a therapist weekly for several months. When I explained that was incorrect and that my daughter had only seen the therapist a few times in the last several months, would she still consider this option to have been exhausted. She responded that she did.
I asked her if she prescribed Prozac for teenagers for anxiety often and she said it wasn't necessarily often but it wasn't at all uncommon.
I then mentioned to her that the black box FDA warning on Prozac warned of serious side effects including suicidal ideation at the beginning of a course of treatment and when dosage was modified and I asked her if in her experience she had ever seen those side effects. The nurse said she had never seen those side effects. That seemed odd so I asked her how long she had been a nurse that could prescribe Prozac and she responded "only a year."
I then asked to speak with the supervising physician that the nurse said she had consulted with (but that had not examined or interviewed my daughter).
Later that day I was called back by Dr. Laurie Hockberg, the supervising physician. I started off by saying that I wanted to have my daughter's records updated so that my daughter could not be prescribed psychotropic drugs without my knowledge and consent (as I have joint legal custody.) The doctor said that was my problem to workout out with my ex-wife and they couldn't help me and that they would not amend my daughter's records as I had requested.
I asked her if she was comfortable with a nurse with only one year's worth of experience prescribing a black box warning psychotropic drug for an "off label" diagnosis to a teenager that the doctor hadn't personally interviewed. With her voice dripping with condescension the doctor told me she was totally comfortable with it.
I recounted to her that the nurse had not been careful in her conversation with my daughter's therapist and had mistakenly understood that my daughter had received 4-5x more therapy than she had actually received. I asked Dr. Hockberg if knowing that this information had been misunderstood, would that not change the doctor's level of comfort with the drug being prescribed so quickly. The doctor said it didn't change her opinion at all and that she was completely comfortable with what had been decided. Honestly, I was stunned. The level of arrogance and cavalierness Dr. Hockberg displayed was unbelievable.
She went on to tell me how there simply aren't enough pediatric psychiatrists to serve the huge increase in demand so pediatricians and even nurses have to fill the void.
The doctor's lack of knowledge about how SSRIs (Prozac is an SSRI) work and what research and studies had been done with adolescences and SSRIs was frightening. In a weekend of research and no medical background, I knew significantly more than Dr. Hockberg did.
Needless to say I am changing pediatric practices immediately so buyers beware. The level of unprofessionalism and carelessness with something so critically important was breathtaking.