Kids and Antidepressants: A Growing Problem
No. 3 of the Top 10 Stories of 2004: The FDA warned of a drug-suicide link this year. Are we rushing to medicate our kids or rushing to judgment about drugs that may truly help some of them?
Watch Out for Bipolar
The risks are higher in depressed children with a family history of bipolar disorder (formerly called manic depression) or who have existing symptoms of mania.
A doctor who served on the FDA Pediatric Advisory Committee tells WebMD that the risk of increased suicidality with antidepressants is incontrovertible. The unanswered question, says Thomas Newman MD, MPH, is whether the drugs work well enough in adolescents to justify taking the risk.
"There's no question that in the short term the drugs increase suicidality, but that doesn't really answer the question about benefits vs. risk. I think that we do need more data to know how effective they are ... whether there is some way of predicting in whom they will have favorable vs. adverse effects, and the whole area of what happens after you've been taking them for a long time or how you should stop them. Anything beyond the short-term trials that have been done we need more data on."
In an article in the Oct. 14 issue of The New England Journal of Medicine, Newman wrote that when FDA staff members analyzed results from randomized trials of antidepressants, "the results were striking. When all the pediatric trials were pooled, the rate of definite or possible suicidality among children assigned to receive antidepressants was twice that in the placebo group."
Psychotherapy Suicide Risk
Miriam Kaufman, MD, associate professor in the department of pediatrics at the University of Toronto and author of a book on helping teens overcome depression, agrees that there is evidence to show an increased risk of suicidality among teens who are started on therapy for depression. She notes, however, that increased suicidality is also seen among adolescents who have just started psychotherapy.
"The risk of suicidality is highest at the beginning of a depressive episode, regardless of treatment," agrees David. A. Brent, MD, professor of psychiatry, pediatrics, and epidemiology at the University of Pittsburgh School of Medicine. "We have data in press now showing that the incidence rate of suicidality in a psychotherapy trial we did is comparable to what has been reported in people treated with medication."
According to an article in the journal Pediatrics, about half a million children and adolescents in the United States each year receive prescriptions for SSRIs. From 1993 to 1997, the number of prescriptions for preschool and school-age children of three drugs, Prozac, Paxil, and Zoloft, grew threefold.
This phenomenon isn't limited to the United States, a Toronto-based child psychiatrist tells WebMD.
"In Canada, just under 2% of the pediatric population is prescribed antidepressants. Sounds small, but it's actually quite large, and the rate of prescribing psychotropic medications has risen dramatically over the last 10 years, even though rates of depression have not. So in other words, the rate of prescribing has gone up much more quickly than the prevalence rate of the disorder, so we have to ask why," says Marshall Korenblum, MD, associate professor in the department of psychiatry at the University of Toronto.