In the past few years, there has been a furious debate over the safety of antidepressants in children and teens. Both proponents and opponents of the drugs have complained about the lack of research. Now a new study suggests that the drugs do more good than harm.
Several years ago, some parents blamed antidepressants for the suicides of their depressed children. Studies showed the drugs might promote suicidal thoughts, so the FDA sent out a warning to doctors. That started a series of hearings and headlines. In 2004, the FDA called for so-called "black box" warning labels on antidepressants.
While this was going on, teenager Michael Haas of Needham, Mass., was struggling. He wasn't eating or sleeping.
"I sort of cut myself off from my friends and activities I used to do," Haas says. "I more or less dropped out of school."
His pediatrician and then a psychopharmacologist suggested antidepressants. His mother, Ronnie Haas, went along. She tried not to pay attention to the headlines about suicides and suicidal thoughts in teenagers taking antidepressants.
"I was more nervous about not going along with it," she says. "For us, it just felt like a higher risk not to take action."
Child psychiatrist David Brent sees patients and runs government-funded tests on antidepressants at the University of Pittsburgh. He was getting questions from parents who wanted to know if antidepressants were going to make their children worse. Brent's university asked him to stop doing research.
"It forced us to think carefully about the risks and benefits of the medications and what ought to be communicated to families and clinicians," Brent says.
So Brent and several of his colleagues identified 27 studies of antidepressants in 5,000 younger people with depression, obsessive-compulsive disorder, or extreme anxiety. They report their findings in the current issue of The Journal of the American Medical Association.
"The medications are effective," Brent says. "They help many more people than are affected by this slightly increased risk [of] suicidal ideation and behavior."
The drugs were more effective in teenagers than in younger children. Even some critics of antidepressant use were impressed.
"I think it will increase the comfort level," says psychiatrist Lawrence Greenhill of Columbia University, "when [patients] turn to the possibility of taking an antidepressant, knowing that the risks are slightly smaller and the benefits are better defined."
But will the new study end the discussions? Probably not, says study author David Brent. The safety of antidepressants in children is an emotional issue.
"You're talking about people who lost their kids to suicide," Brent says.
Michael Haas is 18 now, and he has been on antidepressants for more than a year. He is back in school, but he says the depression is not in the past tense for him. Today, he is still in psychotherapy, and he is still taking medication.
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