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 continued...
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."
Michael Faenza, president and CEO of the Alexandria, Va.-based
National Mental Health Association, tells WebMD that his group estimates that
"one in eight adolescents is affected by depression. Think about it, that's
kids in every classroom."
He agrees that antidepressants do appear to work in most
children, although he notes that it is still unclear if the drugs are
associated with an increased risk of suicide. "We have had a tripling of
the suicide rate in young people since 1960," he says. "Much of that
increase occurred in the absence of antidepressant treatment."
Faenza says his group is worried that recent headlines about
suicide and antidepressants will keep parents from seeking treatment for their
children, which could have disastrous effects since "only about one in
three children who need mental health care are currently receiving it."