I
Ilena Rose
Guest
http://www.nytimes.com/2004/04/09/health/09DRUG.html?ex=1082088000&en=141b859ebb46dc10&ei=5062&partner=GOOGLE
Study Advises Against Drugs for Children in Depression
By GARDINER HARRIS
Published: April 9, 2004
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."
Ds. 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,"
Dt. 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.
Du. 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.
Study Advises Against Drugs for Children in Depression
By GARDINER HARRIS
Published: April 9, 2004
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."
Ds. 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,"
Dt. 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.
Du. 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.