Recently there have been news reports of increased
suicidal or other depressive behaviors in children and
teens taking some of the newer antidepressants,
particularly the SSRI class (like Prozac).  

http://my.webmd.com/content/Article/85/98557.htm?printing=true
"...In their review of some of the largest published
trials on the efficacy of newer antidepressants in
children and adolescents, psychiatric researchers say
that the reported benefits of these drugs to treat
depression in children have been exaggerated. They say
that children in these studies that received placebo
routinely achieved responses that were similar to
children treated with antidepressants.  Researcher Jon
N. Jureidini, MD, PhD, tells WebMD that even when the
effectiveness of an active antidepressant was reported
as significantly greater than the placebo, the
difference did not necessarily translate into a
clinical advantage. 

"Jureidini tells WebMD that one large trial involving
the antidepressant Zoloft was mathematically
determined to have an advantage over placebo. "But the
advantage amounted to just a 2- or 3-point improvement
on a 100-point variation scale. From a clinical point
of view this was most likely trivial..." 

"...In a March 22 press statement, FDA officials
reported that it was not yet clear whether
antidepressants contribute to the emergence of
suicidal thinking and behavior. But they urged
clinicians and those close to antidepressant users to
closely monitor behavioral changes, especially at the
beginning of drug treatment or when the doses are
increase or decreased...

"In the latest analysis, published in the April 10
issue of the British Medical Journal, Jureidini and
colleagues reviewed six previously published trials
that included 940 young patients. Roughly half were
treated with the antidepressants Paxil, Effexor,
Zoloft, or Prozac and the other half got a placebo.
The researchers say that biased reporting in the
mostly drug manufacturer-funded trials commonly led to
overstatements of the effectiveness of various
antidepressants...

"...Child psychiatrist David Fassler, MD, tells WebMD
that a major challenge is to better identify which
children and adolescents are most likely to respond to
antidepressant drugs.  "We are still learning about
depression in the young, and we may find that it is
not just one disorder but a number of them," he says.
"A drug treatment may be very effective for some kids
with depression, but not for others..." 


While I have not treated children since med school, a
similar effect in extremely depressed adults has been
know for years (a typical explanation: "they were
actually getting better in that they were listless
before, and the drug allowed them to become active,
yet hadn't had time to decrease their depression to
the point of 'seeing light at the end of the
tunnel'").
I have certainly seen antidepressants make a huge,
positive impact on adults, but drugs alone are not the
answer for all patients.  Frex, in those unable to
take antidepressants for various reasons, supportive
therapy, social engagement or even just the addition
of a pet has made significant and life-improving
changes.

Debbi

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