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
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
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
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."