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?
What About Psychotherapy?
Brent is a pioneer of a form of psychotherapy known as cognitive behavioral therapy (CBT), which is based on the idea, backed by clinical evidence, that helping people to change the way they think can also help them change the way they feel. The technique has been shown to be effective in the treatment of depression and anxiety disorders.
But even he acknowledges that at least one SSRI, Prozac, appears to work well both in concert with psychotherapy and when used alone. He points to the recently published Treatment for Adolescents with Depression study (TADS) in which the investigators found that a combination of Prozac and CBT was most effective at treating teens with depression. In the study, however, CBT proved to offer only modest additional benefit, Brent says.
"[Prozac] alone produced almost as good results as the combination of [Prozac] and cognitive behavioral therapy. CBT alone was 10% better than placebo, and you got another 8% response when you added it to the medication. There wasn't an interaction -- the medication didn't work better because they were also getting CBT," he says. "The part that worries us is that there are not a lot of people that can do CBT, and now you're going to be telling people that the standard of care is something that most people can't get."
Not All Evidence Points to Antidepressant, Suicide Link
Other researchers have questioned whether antidepressants are even really at fault.
As reported by WebMD on Dec. 15, researchers at the University of Colorado Health Science Center analyzed insurance claims on more than 24,000 teens with depression and found that when the data were broken down by severity of depression and other risk factors for suicidality, the use of antidepressants did not account for the increase.
The researchers, led by Robert J. Valuck, PhD, RPh, director of pharmaceutical outcomes research at the UCHSC, found that teens who were on antidepressants for six months were less likely to attempt suicide than their nonmedicated counterparts. They reported their findings in the December 2004 issue of the journal CNS Drugs.
"People see that crude relationship between antidepressants and suicide attempts and say antidepressants are bad," Valuck told WebMD. "But what if we adjust for all these factors that may contribute to the person's likelihood of attempting suicide? When we do that, the relationship goes away. There are a lot of things going on in teens who attempt suicide. It is not just the antidepressant drugs."
Brent, writing in the Oct. 14 New England Journal of Medicine, argues that banning or severely curtailing the use of antidepressants in children "would turn the clock back 25 years to a time when the only thing we could offer the families of suicide victims was the hope that someday we would have effective treatments. Ideally, the FDA, families, and clinicians will find the right balance between the risk of suicidality and another, greater risk: the risk that lies in doing nothing."
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