Kids and Antidepressants: A Growing Problem (cont.)

In March 2004, the FDA issued a public health advisory about the potential for increased suicidal thoughts and actions among people who take antidepressants, particularly drugs in the relatively new subclass of agents known as "selective serotonin reuptake inhibitors," or "SSRIs" for short. They work by allowing the body to make more effective use of the brain chemical serotonin, which is a messenger involved in the regulation of mood, emotion, appetite, and sleep. Widely prescribed brand-name drugs in this class include Celexa, Lexapro, Paxil, Prozac, and Zoloft.

In October 2004, the FDA, following recommendations of the advisory committee, ordered makers of all antidepressant medications - not just SSRIs -- to include a "black box" warning and cautionary statements on drug labeling that will "alert health care providers to an increased risk of suicidality (suicidal thinking and behavior) in children and adolescents being treated with these agents."

Britain's Medicines and Healthcare Products Regulatory Agency issued similar warnings in early December, urging doctors to consider alternative therapies and, when prescribing an antidepressant, to prescribe only low doses and monitor patients carefully.

Warning Signs

In the pharmaceutical industry, a black box on a product's label is a stark reminder that for every benefit, every "miracle drug," there is a risk. In the case of widely prescribed and heavily marketed antidepressants, the benefits of relief from symptoms of major clinical depression must be weighed against the relatively infrequent but potentially devastating risks of worsening of depression or suicide.

There is little dispute that antidepressants have helped millions of adults with major depression and other debilitating mental disorders. There is also, however, growing concern among doctors, child safety advocates, and parents that these heavily marketed mind-altering agents are being used too freely and with too little research into their effects in children and adolescents.

In a statement praising the FDA's action in March, Martha Hellander, JD, executive director of the Child and Adolescent Bipolar Foundation, called it "a wake-up call that these powerful and lifesaving drugs used to heal depression may trigger a paradoxical response in some children that parents need to know about."

Watch Out for Bipolar

The risks are higher in depressed children with a family history of bipolar disorder (formerly called manic depression) or who have existing symptoms of mania.

A doctor who served on the FDA Pediatric Advisory Committee tells WebMD that the risk of increased suicidality with antidepressants is incontrovertible. The unanswered question, says Thomas Newman MD, MPH, is whether the drugs work well enough in adolescents to justify taking the risk.


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