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Depression: Is Your Child Depressed?

Depression in children can have dire lifelong consequences. Do you know the signs?
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Antidepressants and the FDA's Black Box continued...

The FDA meant to urge doctors to watch young patients carefully for suicidal tendencies during the first few months of treatment, but their warning seems to have done a lot more than that.

Before the FDA released its first advisory in March 2004, antidepressant use in children and teens had been rising steadily for years. By the end of June 2005 there was a 20% drop in antidepressant prescriptions for kids aged 18 and under.

Now some mental healthmental health professionals worry that the FDA's action could result in a terrible irony. Frightened parents and doctors might withhold needed medication from depressed youth, leading to an increase in suicide deaths.

"It's much more risky for someone not to be treated for depression than it is for them to take their antidepressant," Jefferson Prince, MD, a psychiatrist at Massachusetts General Hospital in Boston, tells WebMD.

Antidepressants: Research Behind the Black Box

The FDA's black-box warning is based on a review of 24 studies, which found that in the first four months of treatment, kids on antidepressants were twice as likely to think about suicide or have suicidal behavior compared with kids taking a placebo. There were no actual deaths by suicide in the studies, however.

The suicide death rate for kids aged 10-19 fell by about one-third from 1993-2003. Many things could explain the decrease, but evidence suggests the rise in antidepressant drug use may have been partly responsible. Researchers compared antidepressant prescriptions for this age group to suicides in hundreds of U.S. ZIP codes. The study, published in the Archives of General Psychiatry, shows that in places where more kids got antidepressants there were fewer suicides.

Other recent studies have shown that only about 2% of children and teens who killed themselves were taking an antidepressant at the time.

Prince says he thinks some good could also come from antidepressants carrying suicide warnings. "It's really a mixed bag," he says.

He shares concerns that the black-box label may scare people away from the medications, but it has raised awareness about the danger of suicide in depressed children and teens.

"It's also probably a good thing, although uncomfortable, that we actually have to talk about it with families," he says.

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