Depression Drugs' Risks to Kids Kept Secret
Unpublished Studies Show Most Antidepressants Risky, Ineffective in Children, Teens
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Based on the data from the published and unpublished studies, British authorities have banned new prescriptions for all child and teen use of SSRI antidepressants except for Prozac.
But if a kid is already taking one of these drugs, Kendall says, it's important NOT to stop without medical advice.
"The evidence we have appears not to support the use of SSRIs with the exception of Prozac in children who are depressed," he says. "Having said that, if a child is being successfully treated with one of these drugs, they shouldn't stop without talking to their doctor."
Hirsch, however, does not want to see a U.S. ban on child use of SSRIs.
"I would not want the FDA to tie my hands," he says. "I see some seriously ill kids. Not all of them respond to Prozac. A kid who is depressed has a potentially terminal illness. For that, I have to try something. I need to be able to try whatever is available."
Hirsch is quick to point out that this doesn't mean writing a prescription and telling the parents to bring the child back in six months.
"Depression is a serious illness, and antidepressants are serious drugs," he says. "Dr. Kendall is right -- There isn't a whole lot of science to guide us. Unfortunately, we have two options. We can sit back and do nothing. But depression is one of the major triggers for suicide. To do nothing is to do lots of harm."
The other option is to use these drugs -- carefully. No child or teen should receive an antidepressant, Hirsch says, unless at least three things are done first:
- Suicide evaluation. Not only the child, but also the family should be thoroughly evaluated for suicide risk and suicide history.
- Full discussion of the pros and cons of antidepressant treatment.
- Monitoring. "This is the most important thing," Hirsch says. Any child or teen taking antidepressant medications must be closely monitored for side effects and suicidal thinking.
Expect to hear more about this issue. An FDA panel is looking into the question of how SSRIs should be regulated for children and teens. So far, they've advised only caution -- and the FDA immediately responded by strengthening the warning labels on SSRIs.
The panel has asked an expert committee at Columbia University to review drug-company data and to develop a working definition of suicidal thinking and suicidal behavior. That committee's report is due this summer -- in time for the panel's next meeting -- and will strongly influence the FDA's final decision.