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Childhood Depression: Matter of Life or Death

Because some depressed children appear happy, depression in children can be difficult to diagnose. But many depressed children become suicidal, making diagnosis crucial.

No Magic Pills

As difficult as it is to diagnose depression, treatment can be even more challenging, says Naylor.

He tells WebMD that most psychiatrists follow the "Texas Children's Medication Algorithm," which outlines a step-by-step approach to treatment. He says the plan recommends Prozac as the first-line drug treatment, because there is so little research into the efficacy and safety of antidepressant drugs in children that "the research is really only unequivocal in one drug, and that drug is Prozac, which has demonstrated that it is more effective than placebo."

He says another study suggested that Zoloft is also more effective than placebo, but the difference was not as great as in the Prozac studies.

But recently, antidepressants have been in the news because of concerns that they may be linked to increased suicidal thoughts or actual suicide in children and teens. The concerns prompted the FDA to require makers of 10 antidepressants to include warning labels on their products. The new labels, which will appear on Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Effexor, Serzone, and Remeron, warn of possible suicide, worsening depression, anxiety, and panic attacks in adults and children. The FDA said in a news release that it was not yet clear whether antidepressants contribute to the emergence of suicidal thinking and behavior, but they recommended close monitoring of all patients taking antidepressants.

Earlier this month, the British Medical Journal published an analysis of six studies that included 940 children and adolescents taking Paxil, Effexor, Zoloft, Prozac, or placebo. In that analysis, the researchers reported that the benefit of antidepressants was overstated. They also voiced some concern that drug treatment, often considered easier and less labor intensive, was too often being substituted for proven techniques such as cognitive behavioral therapy.

All of the experts interviewed by WebMD agree that it takes more than a pill -- even a very good pill -- to treat depression in children.

Good Medicines With Careful Monitoring

Victor Fornari MD, associate chairman for education and training in the department of psychiatry at North Shore University Hospital on Long Island, says he doubts any psychiatrists would consider medication alone as a good treatment plan.

He tells WebMD that the depressed child needs a comprehensive approach that includes supportive care, family therapy, and medication. Moreover, children taking antidepressants require very close monitoring. "When I start antidepressants in a child, I tell them to come in the next day, then again in three days and then every week." He says weekly visits continue until he is confident that the drug is working and the dose is correct.

But Fornari says that antidepressants are an important part of the treatment in most children and "can mean the difference between a child who is in school and one who is not."

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