Apocalypse Suicide Page
Good Mood
Living with Depression
Mental Health Recovery
NIMH
SHOCKED! ECT

HealthyPlace.com Radio
Depression Support Groups

Books on Depression
Conference Transcripts
Depression Videos
Diaries - Journals
Disorders Definitions
Mental Health News
Online Depression Tests
Psychiatric Medications
Resources
Site Map

Email
ICQ
Instant Messenger

Visit and Post

Abuse
ADD/ADHD
Addictions
Anxiety-Panic
Bipolar
Eating Disorders
Personality Disorders
Self-Injury

send this page to a friend

Antidepressant Use for Kids
Gains Support

New Research Shows Zoloft Eases Debilitating Symptoms

(August 27, 2003) - Many parents face this quandary: When kids are seriously depressed, are they better off on antidepressants or not?

Amid recent concerns that the antidepressant drugs could increase the suicide risk for kids, parents may find some reassurance in an article in this week's Journal of the American Medical Association. New research reported there showed that the antidepressant Zoloft was modestly more effective than a placebo at easing major depression in children and adolescents, while showing no increase in suicide attempts.

The use of antidepressants in kids has been contentious. British health authorities in June said the popular antidepressant Paxil, made by GlaxoSmithKline PLC, shouldn't be used to treat children and teens with depression, because some data suggest the drug may trigger suicidal thoughts or self-harm in some young people. The U.S. Food and Drug Administration echoed those concerns and launched its own review.

Although the findings related only to Paxil, the health advisories reignited a debate about the safety of all antidepressants in Paxil's class, known as selective serotonin reuptake inhibitors, or SSRIs. Other name brands include Zoloft, Eli Lilly & Co.'s Prozac, and Celexa and Lexapro, both made by a unit of Forest Laboratories Inc.

Up to 3% of children and 8% of adolescents suffer from major depression. For years, doctors have prescribed SSRI medications to treat depression in kids, although only Prozac has FDA approval for that use. Now, a panel of experts convened by the British health authorities is reviewing the safety of all SSRI drugs and is expected to report on its findings early next year.

WEIGHING THE RESEARCH What is known about the effects of some leading antidepressants on kids*. DRUG AND MAKER COMMENT Zoloft Pfizer Two studies show Zoloft significantly improved depression in 69% of patients, versus 59% taking a placebo. Prozac Eli Lilly and generic, called fluxotine In one study, 41% of kids taking the drug showed a complete remission of depression, compared with 20% taking a placebo. In January the FDA approved Prozac for use in children 7 to 17. Paxil GlaxoSmithKline One study found 63% of kids taking the drug showed improvement versus 46% taking a placebo, but the drug was ineffective in two other studies. The FDA is evaluating reports of increased risk of suicidal thinking and attempts in kids who use it. Both the FDA and British authorities recommend children under 18 not take it. Celexa Forest Laboratories In an unpublished study, 36% of kids taking Celexa showed improvement, compared with 24% taking a placebo. *Studies vary in methodology and how they measure improvement.

The new research on Zoloft may buttress the views of psychiatrists who say the risks of taking the drugs are smaller than the risks of not taking them. David Shaffer, chief of Child and Adolescent Psychiatry at Columbia University in New York, believes that a drop in the suicide rate among U.S. adolescents likely stems from the advent just over a decade ago of SSRI medicines. Dr. Shaffer has no financial affiliations with any antidepressant maker.

As many as a quarter of adolescents in the U.S. have entertained thoughts of suicide at least once, estimates Joseph Biederman, psychiatry professor at Harvard Medical School and Massachusetts General Hospital. The JAMA study noted that half of adolescents with major depression attempt suicide at some point in their lives. British regulators "have taken a severe position," says Dr. Biederman, who gets research support and is a speaker for Lilly and Pfizer. "I would be very reassuring to parents who are considering the use of medication."

In the 10-week Zoloft trials, involving 376 kids from six to 17 years old, 69% of the patients taking Zoloft saw significant improvement, compared with 59% of those taking inactive pills. For a treatment to be considered successful, the patients had to see at least a 40% improvement in the symptoms of major depression. The research was sponsored by Zoloft maker Pfizer Inc.

Why the high placebo response? "Although it's an inactive pill, there are a lot of interventions that actually take place during the course of the study," says Karen Dineen Wagner, the principal author and director of child and adolescent psychiatry at the University of Texas Medical Branch in Galveston. The patients, for instance, have frequent meetings with psychiatrists and research staff, none of whom know which patient is on the drug and which is on the placebo. Kids may respond more than adults to the added attention.

advertisement

Zoloft was more successful than the placebo in treating irritability, low self-esteem, excessive weeping, listless speech and lethargic behavior. Two patients taking Zoloft and two taking placebos attempted suicide during the research, and there wasn't any statistically significant difference in suicidal thinking between the groups. At least twice as many Zoloft takers reported vomiting and other physical effects. Pfizer says it has received an FDA letter that likely will allow the company to add the pediatric-safety information from the trials to Zoloft's label, but it still has to work out the wording with the FDA.

While most kids go through rough patches, major depression is a debilitating illness. Kids with the ailment often can't get out of bed in the morning. They sometimes withdraw from friends and family, get unusually irritable and experience a change in sleeping patterns and appetite. They lose interest in activities that once were fun and can have feelings of low self-esteem and hopelessness. Grades in school often drop.

Doctors have long noted that the risk of suicide can increase in the early days of depression treatment. Some patients who previously were inert from depression gain energy and are briefly more prone to admit they have suicidal thinking or act on it.

Before starting any child or adolescent on antidepressants, John Walkup, an associate professor in the Division of Child and Adolescent Psychiatry at Johns Hopkins Children's Center in Baltimore, raises the issue of suicide with kids and their parents, noting that the medicines "activate and energize." "Sometimes they do it in a positive way that's part of the treatment for depression, and sometimes they do it in a negative way, where they agitate," says Dr. Walkup, who has received research grants and speaking fees from the makers of antidepressants.

Dr. Walkup still feels the benefits outweigh the risks. He tells patients and their parents he's going to watch carefully for signs of trouble. If a patient has suicidal thoughts, he says, "we manage it."

One mother in Oldwick, N.J., whose sons have been patients of Dr. Shaffer at Columbia, says she was concerned about the suicide issue but ultimately opted for antidepressants. When her oldest son began taking Prozac at age 15, she says, "the result was striking. For the first time he had normal relationships with other people." Later, she said, he had good results with Paxil.

To John March, chief of child psychiatry at Duke University, the wisest approach is to start with cognitive behavioral therapy, and then, if that doesn't work sufficiently on its own, to add a medication. Dr. March, who has received research grants from Lilly and research and consulting funds from Pfizer, adds: "These medicines are not a panacea, and will not, on average, carry kids to remission."

Source: WSJ

top ~ next ~ send page to a friend

HealthyPlace.com Homepage
Chat ~ Forums ~ Communities
HealthyPlace.com Films ~ HealthyPlace.com Radio ~ News
Site Map ~ Web Tour ~ Advertise ~ Email Us
send this page to a friend

We subscribe to the HONcode principles of the Health On the Net Foundation.

© 2000-2006 HealthyPlace.com, Inc. All rights reserved.
Terms of Use Privacy Policy Disclaimer Advertising Policy