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Drugs to Treat Children's Depression - Little effects but lots of side effects
The Committee on Safety of Medicines (CSM) in
Britain have eva-luated six psychotropic drugs to
treat Major Depressive Disorder (MDD) in
children: Fluoxetine, Sertraline, Citalopram,
Paroxetine, and Venlafaxine. The commercial
names of these include Prozac, Zoloft and
Paxil, popular drugs prescribed for depression
in adults, and now increasingly being prescribed
to children.
The children were between 6-18 years old.
With the exception of 182 children for Venlafaxine,
the number of children evaluated for each
drug type was large enough to draw some definitive
conclusions, ranging from 315 to 767 children.
Also, placebo was used in each and case to
minimize the psychological non-treatment
influence of the outcome.
The results were disappointing. Only Fluoxetine
produced "short-term efficacy"
with "modest" effect. None of the
other drugs created any intended benefit..
More disconcerting was that Fluo-xetine also
produced adverse side effects, most notably
"manic reaction", followed by hyperkinesias,
agitation, hypomania (lack of interests)
or mania (obsession), tremor and headache.
Suicide attempts were reported in 3 cases
of 228 cases (1.3%), which is more than double
the percentage in the placebo (no drug) group
(0.5%, 1/190).
At present, about 5% of these drugs are prescribed
for children, mostly by general practitioners
who have neither the time nor training to
do a thorough evaluation beforehand. Yet
only one drug managed to create temporary
benefits for young depressed patients, at
the expense of potentially harmful side effects.
In fact, systematic evaluations have so far
shown little link be-tween improvement in
depression and medication. To quote from
the New York Times, "Yet most studies
- including those recently reviewed by British
and American health regulators - have found
that S.S.R.I.'s (the drug class to which
Prozac, Zoloft and Paxil belong) are no more
effective in fighting teenage depression
than sugar pills."
As is often the case, drugs can't be expected
to effectively combat complex psychopathologies
or learning disorders. Unless benefits are
clearly demonstrated, drugs should not be
the first choice of treatment.