BMJ: Study Advises Against Drugs for Children in Depression

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Study Advises Against Drugs for Children in Depression

By GARDINER HARRIS

http://www.nytimes.com/2004/04/09/health/09DRUG.html

ediatricians and family physicians should not prescribe antidepressants

for depressed children and adolescents because the drugs barely work and

their side effects are often significant, Australian researchers have

concluded.

The researchers analyzed data from five published trials of three

antidepressants, Prozac, Zoloft and Paxil, in depressed patients under

age 18. They found that the drugs offered only a " very modest " benefit

over placebos.

At the same time, the drugs carry significant risks, the researchers

said in their report, published in today's issue of the British medical

journal BMJ.

" If the drugs were highly advantageous over placebo, then you'd live

with the risks, " Jon Jureidini, a child psychiatrist in Adelaide and the

study's lead author, said in an interview. " If the drugs were completely

safe, then you might argue that there's nothing wrong with giving

something that's only slightly better than a placebo. "

However, Dr. Jureidini said, neither is true, so antidepressants should

not be prescribed for children and adolescents except in extreme

circumstances.

" We strongly want to say that non-child-psychiatrists should not be

initiating the prescribing of " the antidepressants known as selective

serotonin reuptake inhibitors or S.S.R.I.'s, a class that includes Eli

Lilly's Prozac, Pfizer's Zoloft, and GlaxoKline's Paxil, Dr.

Jureidini said.

The study is the latest salvo in an increasingly bitter war over whether

prescribing antidepressants to children and adolescents is appropriate.

Dr. ph Glenmullen, author of " Prozac Backlash " and a fierce critic

of the pills, said the latest study further vindicated his view that

antidepressants can be dangerous. " What this shows is that, on balance,

there is no good reason to prescribe these pills, " Dr. Glenmullen said.

However, Dr. Graham Emslie, a professor of psychiatry at the University

of Texas Southwestern Medical Center, who was an author of some of the

studies reviewed in the article, said the study was " illogical. "

" I wish the effect size of these drugs was bigger, but at least there's

some effect, " Dr. Emslie said. " Some of these kids are severely

depressed and we've got to do something. "

Dr. Emslie, like many psychiatric researchers, is a consultant to

pharmaceutical companies.

The Australian researchers suggested that psychiatrists offer children

talk therapy in place of the drugs. But Dr. Emslie said that only one

study had shown that talk therapy was beneficial.

" If people could offer better treatments than drugs, it'd be great, " Dr.

Emslie said.

British drug regulators have cautioned doctors against using any

antidepressant but Prozac to treat depressed children and adolescents

because the drugs have not proved effective against depression and may

increase the risk of suicidal thoughts and behavior.

The Food and Drug Administration recently issued a warning that all

patients taking antidepressants should be closely monitored by doctors,

especially in the first weeks. But the agency emphasized that it had not

concluded that the drugs caused suicidal thinking or behavior.

Dr. ce Greenhill, a professor of clinical psychiatry at Columbia

University, said neither side in the debate had a monopoly on truth.

" I think that these medications are neither as much of a silver bullet

as the advocates would have it nor as terrible as the critics would

say, " Dr. Greenhill said.

c NYT 2004

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