Benefits of antidepressants for children far outweigh the risks

Apr 22 2007

Researchers in the United States maintain that a review of research shows that the benefits of antidepressants for children and teens during the first few months of treatment far outweigh the risk of suicide.

The researchers at the Columbus Children's Research Institute, Ohio, reached this conclusion after reviewing 27 clinical trials and they say for every child or teen who experienced suicidal thoughts, many more were helped by the drugs.

The studies compared the effects of placebos with one of several medications, including Prozac, Paxil and Zoloft as well as others, during the first four months of treatment or less.

The team found no reported suicides, but 3 percent of those taking the drugs reported suicidal behavior compared with 2 percent of those taking a placebo; the Food and Drug Administration (FDA) researchers had found rates of 4 and 2 percent, respectively.

The results of the comprehensive survey come three years after the FDA ordered pharmaceutical companies to put black warning labels, which are the strongest possible warnings, on antidepressants, and the results supports evidence that antidepressants are effective in young people.

In 2004 the FDA ordered pharmaceutical companies to put warnings on antidepressants called selective serotonin reuptake inhibitors (SSRIs) that the drugs may increase the risk of suicidal behavior in children.

The action was in response to a hearing by two of its advisory committees that looked at the potential risks of drugs.

Experts have argued that the warning may well have discouraged doctors from prescribing antidepressants for children and teenagers, and many who would have benefited from such medications have being frightened away.

Epidemiologist and lead author Jeffrey Bridge and his colleagues looked at data on antidepressant use in 4,400 children and adolescents with major depressive disorder, obsessive-compulsive disorder and anxiety disorders.

They found that the risk of suicidal behavior was smaller than previously thought and the benefits appeared to be much stronger than the risks.

The FDA says there is no reason to change the warning labels and doctors are free to prescribe the drugs to young patients.

Antidepressants are used by millions of Americans and according to Dr. Bridge, antidepressants offer the best risk–benefit ratio for anxiety.

A recent Centers for Disease Control (CDC) report found that the adolescent suicide rate increased in 2004 for the first time in a decade, which some experts say is linked to reduced prescriptions for antidepressants.

The researchers cite a study published early this year which found that deaths from suicide in 10 to 19-year-olds rose 18.2 percent in 2004 from 2003 when no other causes of child death increased during that period.

The researchers say youngsters prescribed the drugs must be closely monitored and taken off them if they derive no benefit.

They emphasise that depression is the leading cause of suicide and the risk of no treatment can be deadly as suicidal thoughts and behavior are associated with depression itself.

The study is published in the Journal of the American Medical Association.