Warning labels on antidepressants linking their use to suicidal tendencies among children has led to a sharp decline in the number of children on antidepressants. Due to the serious side effects, most doctors and psychiatrists are resorting to non-medication therapies to treat kids suffering from depression.
As a result, antidepressant prescription for children has fallen by 25 per cent ever since black box warnings were introduced on the medications in 2003, a market research by Medco Health Solutions, a prescription management and drug information company, found.
Overall, use of antidepressants has fallen by a whopping 20 per cent among children between March and June 2004, NDC Health Inc, which provides stats on healthcare trends said. The figures are significant if one takes into account the 2002 figures, which saw about 11 million prescriptions for antidepressants being handed out to children in the United States.
According to David Fassler, a child psychiatrist from Burlington, not every depressed child needs medication and counseling is enough to get him or her out of a gloomy state of mind. This is especially true for those whose depression is a mild one. However, in many cases medication is required, Fassler said, adding that he hoped that the black box warnings didn't result in doctors shying away from prescribing antidepressants to children when required.
The instances of suicide among teenagers went down by one-third between 1990 and 2002. However, it is not known if mental health among youngsters has improved. “We'll need to continue monitoring the situation closely over coming months and years. The most important question is not how many are taking antidepressants, but whether or not kids are getting the most appropriate treatment possible,” Fassler added.
Meanwhile, Dr Amir Raz, of the department of child and adolescent psychiatry at Columbia University, has questioned the role played by SSRI antidepressants like Prozac for treating child and adolescent depression (CAD). Use of SSRIs in studies using mice has shown that exposure to such medication in adolescence can lead to altered emotional behaviors in adulthood. “Some exploratory findings suggest that artificial perturbation of serotonin function in early life may alter the normal development of brain systems related to stress, motor development, and motor control,” Dr Raz said.
He added that the FDA's guidelines about the antidepressants did not give a clear picture of their side effects. “The recent history of SSRIs is replete with inconsistent verdicts about their safety,” he said, urging doctors to 'demand stronger evidence for the efficacy of antidepressants' for use among children.
In 2003, the FDA had analyzed studies conducted on children on the effects of the antidepressant Paxil and had found increased risk of suicidal thoughts, following which it issued two public health advisories in February 2004. “It now seems clear that the drugs do indeed increase the risk of suicidality in the trials, from about 2 per cent to about 4 per cent,” Robert Temple, director of the FDA's Office of Medical Policy, had said in a statement in February 2005.
But Thomas P Laughren of the FDA's Division of Neuropharmacological Drug Products, in the same statement, had added that this did not mean that the use of the drugs was to be completely avoided by youngsters. “We're not telling prescribers not to use these drugs. But if they do, they have to watch these kids,” Laughren had said.
