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April 9, 2004
Study Advises Against Drugs for Children in Depression
By GARDINER HARRIS
Pediatricians and family physicians should not prescribe antidepressants for depressed children and adolescents because the drugs barely work and their side effects are often significant, Australian researchers have concluded.
The researchers analyzed data from five published trials of three antidepressants, Prozac, Zoloft and Paxil, in depressed patients under age 18. They found that the drugs offered only a "very modest" benefit over placebos.
At the same time, the drugs carry significant risks, the researchers said in their report, published in today's issue of the British medical journal BMJ.
"If the drugs were highly advantageous over placebo, then you'd live with the risks," Jon Jureidini, a child psychiatrist in Adelaide and the study's lead author, said in an interview. "If the drugs were completely safe, then you might argue that there's nothing wrong with giving something that's only slightly better than a placebo."
However, Dr. Jureidini said, neither is true, so antidepressants should not be prescribed for children and adolescents except in extreme circumstances.
"We strongly want to say that non-child-psychiatrists should not be initiating the prescribing of" the antidepressants known as selective serotonin reuptake inhibitors or S.S.R.I.'s, a class that includes Eli Lilly's Prozac, Pfizer's Zoloft, and GlaxoSmithKline's Paxil, Dr. Jureidini said.
The study is the latest salvo in an increasingly bitter war over whether prescribing antidepressants to children and adolescents is appropriate.
Dr. Joseph Glenmullen, author of "Prozac Backlash" and a fierce critic of the pills, said the latest study further vindicated his view that antidepressants can be dangerous. "What this shows is that, on balance, there is no good reason to prescribe these pills," Dr. Glenmullen said.
However, Dr. Graham Emslie, a professor of psychiatry at the University of Texas Southwestern Medical Center, who was an author of some of the studies reviewed in the article, said the study was "illogical."
"I wish the effect size of these drugs was bigger, but at least there's some effect," Dr. Emslie said. "Some of these kids are severely depressed and we've got to do something."
Dr. Emslie, like many psychiatric researchers, is a consultant to pharmaceutical companies.
The Australian researchers suggested that psychiatrists offer children talk therapy in place of the drugs. But Dr. Emslie said that only one study had shown that talk therapy was beneficial.
"If people could offer better treatments than drugs, it'd be great," Dr. Emslie said.
British drug regulators have cautioned doctors against using any antidepressant but Prozac to treat depressed children and adolescents because the drugs have not proved effective against depression and may increase the risk of suicidal thoughts and behavior.
The Food and Drug Administration recently issued a warning that all patients taking antidepressants should be closely monitored by doctors, especially in the first weeks. But the agency emphasized that it had not concluded that the drugs caused suicidal thinking or behavior.
Dr. Laurence Greenhill, a professor of clinical psychiatry at Columbia University, said neither side in the debate had a monopoly on truth.
"I think that these medications are neither as much of a silver bullet as the advocates would have it nor as terrible as the critics would say," Dr. Greenhill said.
Copyright 2004 The New York Times Company