Depressed Teens: Antidepressants and psychotherapy

If you pay attention to the news at all, you will have heard the published fears about the use of antidepressant medications in teens and children purportedly increasing the risk of suicide. Since the original warnings in an unpublished and as yet non-replicated British study, a number of reports have emerged with, at first glance, a somewhat confusing array of findings. One of those studies was reported in several newspapers internationally, with the same study under headlines proclaiming that the study proved the orgininal fears to be true, proved them to be false, or proved them to be true in the first few days or weeks of beginning medication.The following study is I think of interest because it lays out a more reasoned and less hysterical view of the dilemma.

A depressing dilemma

Experts warn that depression in children needs treatment, yet questions remain about link between antidepressants, suicide The new generation of antidepressants launched by the arrival of Prozac in 1987 ushered in an era of help for depression without many of the serious side effects of the older drugs. But concerns have mounted in the last two years over whether the popular drugs are safe for children and adolescents.U.S. and British health regulators warned last year that questions remain about whether the drugs increase suicidal thoughts in some younger patients. Mental health experts also agree that because of a lack of study, inadequate proof exists showing the new antidepressants, except Prozac, work in children and adolescents. The situation has put parents in a quandary because many American psychiatrists believe the 4 percent of severely depressed adolescents won’t get better without medication.

Severe depression is a known cause of suicide, while the risk from the drugs is theoretical, they have said. “What a difficult spot to be in,” said Dr. Tom Vaughan, a child and adolescent psychiatrist at Children’s Hospital. “It’s really unfair not to treat the depression because you know that’s associated with suicide.”

Prozac, the first to raise alarm bells over a possible link between teenage suicide and antidepressant use, has been largely cleared. After several studies in patients younger than 18 showed its safety and effectiveness, the U.S. Food and Drug Administration last year granted Prozac approval for use in children.

The other antidepressant drugs known as SSRIs – or selective serotonin reuptake inhibitors – do not have FDA approval for use in patients younger than 18, although many doctors prescribe them anyway. Other SSRIs include Paxil, Zoloft, Celexa, Lexapro and Fluvoxamine….

The most recent concern was sparked last year over a study of Paxil showing a possible increase in suicidal thoughts among some children and adolescents, although no suicides were reported. British drug regulators in December urged doctors not to prescribe new patients SSRIs, except for Prozac. Data did not show that benefits of the drugs outweighed the risks, they said. The FDA continues to review the situation and has recommended caution in prescribing the antidepressants to patients younger than 18. The National Institute of Mental Health is spearheading several studies of the issue, and drug makers recently warned doctors to watch patients closely for increased suicidal behavior, especially when they first start medication.

Dr. Jim Cullinan, a child and adolescent psychiatrist, said the British approach was extreme, especially since there is no evidence showing a link between the antidepressants and suicide. On the other hand, Cullinan and Vaughan point to data showing both an increased use of SSRIs in patients younger than 18 and a corresponding decrease in teenage suicide. The data do not prove a cause-and-effect relationship between the two trends, although the doctors both say many of their patients get better with medication.

Vaughan said research has shown that the best treatment for severe depression is a combination of therapy and medicine. “Combined interventions are most effective,” he said. Cullinan, medical director for inpatient child and adolescent psychiatry at Children’s Hospital and UAB Hospital, said he doesn’t want concern over a slight risk with antidepressants to keep parents from getting help for their children.

“Depression is a real disease that teenagers and children can get,” Cullinan said. “Depression is a brain disorder. Children suspected of having depression need to be seen by a professional. … We don’t want people scared and trying to ride it out on their own.”

I think that with time we will see increasing evidence that on balance these medications are beneficial to the vast majority of depressed patients who use them. Does that mean that everyone who is depressed should be taking antidepressant medications? Of course not. Does it mean that the medications are without side-effects? Again of course not. But to me it does say that depressed patients are best served when given information about the benefits and side-effects and should be encourages to give careful consideration to the use of such medications in combination with counselling or psychotherapy. And in my opinion scaring depressed individuals away from something that may well be beneficial and may in some cases save lives is fundamentally unethical.

depression, medication, SSRI, antidepressant, teens, teenagers, adolescents, children, suicide

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