The vast majority of antidepressants given to kids and teens are ineffective and potentially dangerous, according to a new study in The Lancet.
Of 14 regularly prescribed drugs, only one — Prozac — proved effective enough to justify giving to children and teens, the researchers found.
If medications are given at all, Prozac should be the drug of choice, the study concluded.
“No one should be on any other antidepressant, and I think it’s doubtful that people should be on Prozac, as well,” said Dr. Jon Jureidini, a child psychiatrist at the Robinson Research Institute at the University of Adelaide in Australia, who wrote a commentary that ran with the study. “The case for Prozac is quite weak.”
Prozac was found to significantly benefit children and teens with major depression, though the magnitude of benefit ranged from almost nothing to a dramatic improvement.
Other drugs the researchers analyzed — including Zoloft, Paxil, Celexa, and Cymbalta — showed no benefit over placebo for this age group.
About 3 percent of children under 12, and 6 percent of teens worldwide are believed to have depression. It’s not clear how many of them are on medication.
Forms of talk therapy, including cognitive behavioral therapy, have been shown to be effective against depression in young people, and regular exercise and adequate sleep can also make a difference, Jureidini said. The vast majority of children do not need to be medicated for their depression, he said, but many are.
“What we’re up against is the marketing enterprise of the pharmaceutical industry combined with wishful thinking on the part of doctors and parents that there might be a good, simple solution for adolescent distress,” he said. “It’s something we need to take very seriously, but we don’t need to make it into a medical condition when it most times isn’t.”
A different kind of depression
Questions have been raised before about the usefulness of antidepressants in young people whose brains are still developing. More than a decade ago, the Food and Drug Administration added a black-box warning to a number of antidepressants used by teenagers, saying that they might increase suicidal thinking.
In older people, antidepressants like Prozac are believed to trigger the growth of new brain cells and new connections among them, but there is no obvious biological benefit to the developing brains of children and adolescents.
Depression also looks different in young people, often showing up as aggressive behavior, irritability or poor school performance, rather than an obviously depressed mood, said Dr. Andrea Cipriani, the University of Oxford psychiatrist who led the new study.
Several doctors warned that patients shouldn’t stop taking their medications because of this study. Abruptly stopping medication can cause problems, including suicidal thinking. And some individuals might still benefit from the other drugs, Cipriani said.
“If the patient’s responding to one treatment, they have to keep the treatment, of course. But on average, if I have to start a treatment, probably the best one is fluoxetine [Prozac] and not the others,” Cipriani said.
Medication as the only option
The new paper, a so-called meta-analysis, looked at 34 previously conducted studies. Those studies included more than 5,200 children and teens who took one of 14 antidepressants or a placebo an average of 8 weeks. The study did not consider long-term use of the drugs because there hasn’t been enough previous research to analyze, Cipriani said.
Although several of the studies claimed to include patients as young as 6, Cipriani said there was virtually no data on children younger than 9.
Dr. Carl Bell, a community psychiatrist and clinical professor emeritus at the University of Illinois at Chicago, said that until recently, he doesn’t remember seeing children younger than 13 who were suicidal or severely depressed. “I don’t know what happened, but now I see it all the time,” he said.
In his experience, antidepressants work well on his preteen and adolescent patients.
Bell said he would be happy to refer his inner-city patients to social services and therapy, but they’re “pretty much nonexistent” in the communities he serves. “That only leaves one choice,” he said: medications.
Others raised concerns about the methods used to conduct the study.
Prozac looked the best merely because it has been the subject of the most research, said Dr. Maurizio Fava, a psychiatric researcher at Massachusetts General Hospital in Boston.
“I think the conclusion is a conclusion that is biased,” he said.
Many of the other drugs would have been seen as effective if the study’s authors had properly considered the impact of placebos, he said. Because of the powerful placebo effect in treating depression, only a small number of participants in each of the 34 studies would have shown a benefit beyond the placebo. Only a large study, or multiple studies considering the same drug — as was available for Prozac — would show a benefit, Fava said.
Sixty-five percent of the studies were sponsored by pharmaceutical companies, but Cipriani said he was able to use statistical manipulations to reduce any company bias.
“I think our data are quite robust. However, we cannot rule out the possibility of sponsorship bias,” said Cipriani, who has earned fees as an expert witness for a generic drug manufacturer that makes some antidepressants. Only one of the paper’s 19 authors reported receiving personal and grant funding from large pharmaceutical companies.
More research is needed on the causes of depression in children and teens and on the longterm use of antidepressants, Cipriani said.
“The message is, medication should not be an easy answer to the problem of major depression,” Cipriani said, “But at the same time, we have a tool which is effective, so if needed, let’s use it.”
I have a beautiful 15 year old daughter who wad told that she is depressed because of her moodiness and lack of interest. Granted everyday can’t be bubble gum and Rose’s. But to labeled bordem as depression is so wrong. I say this because if there is action that involves her to be in the limelight of it or it triggers euphoria then she it’s all smiles and ready to go. However, if it isn’t about her and she isnt the limelight or center she just wants lay in bed and sleep.
She doesn’t interact with her anyone unless it is in her phone. Do let’s stop calling every teenager depressed so we can fill them up on drugs and let’s look at the bigger picture….our cellular devices have rerouted the growing minds of our kids and our teenagers!!!!!
Put down the cell phone, go for walks. Have a social event. Interact face to face…..not face time to face time
To answer the question, I don’t know what happen but now I see it all the time.” Parents are irresponsible and place a disgusting amount of responsibility on young children. The oldest child of most families are raising their siblings. Children are dumped off on other family members or just left alone. Society has changed for the worst. The family unit is non-existent.
Why are the several critics of the use of especially prozac not mentioned given the possible connection between prozac and adolescent suicide? It is not a huge correlation but until absolutely proven to be incorrect i would prefer other meds to treat depression including methods that are not based on medication.
the early evidence of a possible connection between prozac and teen suicide should not be neglected. It may be slim but it is there. Alternative meds with little or no such negative reports should be better known and be allowed to be more of antidotes to medicating children with antidepressant meds.
My 17 year old son has Been dealing with some stuff nothing major really expect anxiety was lil worse considering everything that is changing (senior year, job, and getting licenses) well doctor very seriously says let’s try something to help. Let me tell when I say Prozac is the absolute worse thing that I could have gave my son it’s an understatement. We are still going through the side effects as it’s only been days since I took him off of it. Side effects like a pretty happy kid just having some anxiety turned into a freaking nightmare. He had such a bad adverse reaction to Prozac he went from 0 to million on suicidal thoughts crying uncontrollably sleeping absolute horrific panic n anxiety not to mention the physical part of flu like symptoms nausea vomiting headache sweating freezing shaking fever u name it he had it. So I understand everyone is different but my god almighty No one warned me about the black box label no one said crap about how he could have an adverse reaction. If I wouldn’t of listened to my mama gut and continue like they all said with this medication I do believe my son would of already of taken his life all bc he didn’t understand what was happening to him!! Moral of the story be very careful what u give ur kids if u do decide to give them medicine please please watch them every second and if u noticed any changes for the worse even if u don’t think it’s significant do something right then seek help immediately!!!!!
Comments are closed.