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Antidepressants Help More Kids Than They Harm

Largest review of its kind finds benefits outweighing risks

MONDAY, April 16, 2007 (HealthDay News) -- Whether depressed or troubled kids should take antidepressants has been the question at the center of an intense public debate in recent years, and the latest evidence suggests the answer is "yes."

A study in the April 18 issue of the Journal of the American Medical Association found that the benefits of antidepressants outweighed the risks for children and adolescents under the age of 19.

Anecdotal reports released over the past few years suggest that antidepressants raise suicide risk in children and teens. But the drugs may also prevent deaths by curbing depression, experts say.

"Our study shows that, at least in the short-term, treatment benefits appear to outweigh the risks," confirmed study author Jeffrey A. Bridge, an investigator with Columbus Children's Research Institute, in Ohio.

The findings seem to tip the scale more in favor of antidepressants, which include widely used selective serotonin reuptake inhibitors (SSRIs) such as Celexa, Paxil, Prozac and Zoloft.

"They're saying that, yes, there is a slightly increased risk but it's not as big as we thought and the risk-benefit ratio is favorable. But that's a decision that every family has to make. It's not a generalized decision," said Dr. Jane Ripperger-Suhler, an assistant professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine and a psychiatrist with Scott & White Mental Health Center in Temple.

"This leans us more toward the middle -- that we don't have to say these are terrible medicines, that this looks like a fairly good option. and let's not take them off the table," she said.

Antidepressants, particularly SSRIs, have been the subject of intense controversy in recent years.

In October 2003, the U.S. Food and Drug Administration issued a public health advisory, warning of an increased risk of suicide attempts or suicide-related behavior among children and teens taking SSRIs.

One year later, the FDA directed manufacturers of those drugs to revise their labeling to include a black-box warning. The warning alerts health-care providers to an increased risk of suicide and suicidal thoughts in children and teens.

On the other side of the argument, a major new study found that SSRIs have actually saved thousands of lives by preventing suicides since they were introduced in 1988.

The negative press SSRIs received may have had a chilling effect on their use in the pediatric population, however. One recent study found that the number of U.S. children being prescribed the antidepressants has dropped since warnings about suicidal behavior associated with the drugs emerged. This trend could be worrisome if it means that young patients who might benefit from SSRIs aren't getting them, experts have said.

The only SSRI approved by the FDA for use in pediatric patients is Prozac, but others are prescribed on an off-label basis.

In 2004, an FDA review of 24 placebo-controlled trials involving antidepressant medication in more than 4,400 children and adolescents found that the medications spurred a twofold (4 percent vs. 2 percent) increased risk for suicidal behavior or ideation (thoughts of suicide), although no completed suicides were reported.

The current paper was a large review of all of the published and unpublished randomized clinical trials involving the use of antidepressants by children and adolescents younger than 19. The youngsters were being treated for major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and anxiety disorders other than OCD. In all, 27 trials were reviewed and 5,310 patients were followed.

For every 100 children and adolescents treated with antidepressants, about one child would have thoughts of suicide or would attempt suicide beyond the risk associated with the underlying condition, the researchers found.

This was a number that was lower than the FDA's review, which found two instances of suicidal ideation or attempted suicide per 100 patients.

The study also found that the only antidepressant effective in treating depression in children under 12 was Prozac. Several medications were effective in older children.

The effects of the drugs were most pronounced for non-OCD anxiety disorders, followed by OCD and then MDD.

But the new findings are unlikely to be the last word on the subject.

"There are a few studies that are ongoing right now and that will certainly inform our findings," Bridge said.

"It doesn't seem like they have resolved the issue completely," added Ripperger-Suhler. "I'm hoping that someone will do a prospective study."

More information

The National Library of Medicine can tell you more about adolescent depression.

SOURCES: Jeffrey A. Bridge, Ph.D., investigator, Columbus Children's Research Institute, and assistant professor, pediatrics, Ohio State University; Jane Ripperger-Suhler, M.D., assistant professor, psychiatry and behavioral science, Texas A&M Health Science Center College of Medicine and psychiatrist, Scott & White Mental Health Center, Temple, Texas; April 18, 2007, Journal of the American Medical Association
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