New Views on Antidepressants and Children
By: Dr. Victoria Carrington
|Over the past year, developments in pharmaceutical research and public policy—both in the United States and abroad—have changed physicians' views about antidepressant use in children. Formerly mainstays in the treatment of children with depression, antidepressants have come under fire recently for not being as safe for children as was originally thought. Why the sudden change in thinking? How did a once widespread treatment begin to cause so much concern?|
A Recent History
A fast-growing phenomenon in the United States, the use of antidepressants in children had almost tripled over the past few years and was quickly approaching the prescription rate for adults. In 2002, more than 10 million antidepressant prescriptions were written for between one and two million children in America.
Additionally, an Express Scripts Inc. study of two million children released in April 2004 found that the fastest growing group of children being prescribed antidepressants is children under the age of five, with use among girls doubling and use among boys increasing by 64 percent. Despite the fact that the only antidepressant with Food and Drug Administration (FDA) approval for use in children with depression is Prozac, children were prescribed a wide range of the common antidepressants in an "off-label" use. The most commonly prescribed antidepressant for young people is Zoloft; Prozac ranks second.
Antidepression Medication-Suicide Link?
In June 2003 researchers in the U.K. announced their discovery that children taking the selective serotonin reuptake inhibitor (SSRI) paroxetine—also known as Paxil—had an increased risk of suicide. Doctors in the U.K. were cautioned against prescribing Paxil, as well as six other anti-depressant medications, to patients under the age of 18. In the U.S., the FDA began its own investigation—an investigation similar to one it conducted in the 1980s when suicide concerns arose in connection with adult use of Prozac. In that case, after widespread publicity and numerous studies, the Prozac-suicide link was dismissed as unfounded. The link between Paxil and suicide in children, however, has held up under scrutiny thus far.
|In the wake of months of investigation, the FDA released a report in September of 2004 acknowledging the increased risk of suicide in children who take antidepressant medication. Studies suggest that children on antidepressants have twice the risk of suicidal behaviors as those on sugar pills. An estimated two to three percent of children taking antidepressants will have suicidal thoughts or behaviors, now believed to be caused by the medication.|
Doctors Strongly Cautioned
In the statement it issued in September, the FDA warned physicians to exercise caution in prescribing antidepressants to children and urged manufacturers to include "black box" warnings on all antidepressants. Black box warnings are strong cautions that accompany certain medications, alerting physicians to the possibility of any serious risks known to be associated with the drugs. In this case, the black box warning advises doctors to monitor their young patients closely for signs of worsening depression, suicidal thoughts, or suicidal behaviors.
All antidepressants currently prescribed for children, including Zoloft, Effexor, Celexa, Wellbutrin, Remeron, Serzone and Luvox* will bear the warnings. While making safety a priority is responsible, child mental health advocates worry that the black box warnings have the potential to do more harm than good for some young patients: If the warnings stop physicians from prescribing these drugs even when they are truly needed, some children may be left untreated and therefore at risk for suicide anyway—due to their depression.
Practical Advice for Families
So how does all this new thinking about antidepressants and children add up for your family? If you have a child who takes antidepressants, speak to your healthcare provider to determine how recent developments affect your child's particular course of treatment, if at all. It is not always wise to discontinue drug therapy suddenly, as children can experience side effects and withdrawal symptoms when coming off some medications. At home, you can monitor your child carefully for signs of worsening depression or suicidal thoughts. Also, be alert for personality changes or bizarre, unusual behavior in the child. Seek emergency care if your child mentions suicide. Never allow your child unsupervised access to his or her medication.
Under the care and advice of a healthcare provider, you might want to consider whether alternatives to medication might be effective for your child. Some suggestions:
|In today's world, children face increased pressures, less family stability than in previous generations, and decreased community support. Given these social trends, it's no surprise that depression in children is diagnosed more than ever. Families with children affected by depression need to be aware that they might have treatment options in addition to or other than anti-depressants that can offer promising results. Given the most recent findings, for some patients, a drug-free approach might be the safest choice.|
|*Brand names of medications are the registered trademarks of the manufacturers.|