Depression Drugs' Risks to Kids Kept Secret
Unpublished Studies Show Most Antidepressants Risky, Ineffective in Children, Teens
April 22, 2004 -- For children and teens suffering from depression, most antidepressant drugs are riskier and less effective than commonly thought, unpublished data show.
Doctors rely on medical-journal studies for information on how to treat their patients. But when it comes to treating depression in children and teens -- a life-threatening condition -- much of this information never sees the light of day.
Antidepressants for Kids -- Hidden Truths?
An analysis of clinical trials of antidepressants in depressed children and teens appears in the April 24 issue of The Lancet. It is a rare document, because it includes unpublished studies obtained by a British government advisory committee. The studies focused on the popular type of antidepressants known as SSRIs. Older antidepressants don't work well in children, so nearly all of the 11 million U.S. children who take antidepressants get SSRIs.
Published studies show that only one SSRI -- Prozac -- works well in kids. They find that other SSRIs -- Paxil, Zoloft, Celexa, and the non-SSRI Effexor -- may not be particularly effective, but aren't harmful, either.
Unpublished studies paint a different picture, says study co-author Tim Kendall, MD, PhD, psychiatrist and co-director of Britain's National Collaborating Centre for Mental Health. They show that with the single exception of Prozac -- for which there were no unpublished studies -- the risks of the other SSRIs outweigh their benefits.
"My worry is that we doctors might look at the published data and come to wrong conclusions," Kendall tells WebMD. "There are reports that pressure is placed on researchers not to publish negative findings. We know some drug companies prohibit publication of negative data. We just don't know how big this is."
Reporting only good news -- and stifling bad news -- strikes at the trust people put in their doctors and in drug companies, Kendall says.
"Until this is resolved, there is a huge problem hanging over the medical and pharmaceutical professions," he says. "I don't know why these things are happening, but we have enough to suggest the selective reporting of data is problematic."
Doctors need to know not just when and why drugs work, but when and why they don't work, says Glenn Hirsch, MD, medical director of New York University Child Study Center.
"We really need to have that information. It is becoming clearer and clearer," Hirsch tells WebMD. "Traditionally, negative studies are not published. The negative studies commissioned by drug companies, we don't have that information. That is important. ... If we see only positive studies, we make the assumption that a medicine works all the time. But all kinds of things make a real difference in what happens to real patients in the real world."
Antidepressants for Children and Teens
Based on the data from the published and unpublished studies, British authorities have banned new prescriptions for all child and teen use of SSRI antidepressants except for Prozac.