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?
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.
Korenblum tells WebMD that aggressive marketing by drug companies, including direct-to-consumer advertising (banned for prescription drugs in Canada, but not in the U.S.) may account in part for the explosion in sales of antidepressants for kids. But for doctors who prescribe them, the relative safety of newer generation antidepressants like SSRIs compared with older antidepressants known as tricyclic agents was a big selling point.
"If you take the SSRIs in overdose, they're safe. Teenagers would die if they took tricyclics because they have effects on heart, basically heart rhythm, whereas large, large amounts of SSRIs are quite safe. So physicians heard that and said, 'OK, these drugs are safe in the sense that if you overdose on them you're not going to die, and they were showing equal efficacy to the older generation. That's what the early [clinical] studies showed, and I think as a result, prescribing rates kind of took off."