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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 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 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."

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."

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