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Published: 9/25/2004

The irony of antidepressants

DOCTORS and federal health officials have a wonderful opportunity for a heart-to-heart chat with parents about the growing use of prescription drugs to treat psychological and behavioral problems in children and teenagers.

A U.S. Food and Drug Administration advisory panel opened the door by recommending that the FDA require a "black box" warning label on antidepressants prescribed for children. It would be a bold, highly visible, boxed warning that antidepressants raise the risk of suicide in kids.

That ironic risk became apparent in recent studies, and the FDA certainly should follow the advisory panel's advice and require the label. Estimates suggest that more than 1 million kids now take Prozac and other antidepressants, and the numbers apparently are growing.

Parents have good reason to put depressed kids on medication. Severe clinical depression is a major risk factor for suicide. And suicide is the third leading cause of death among teenagers, after accidents and homicide.

Yes, it is strange to imagine that the very drugs prescribed to prevent suicide may increase the risk of suicidal behavior in some children. Thankfully, the effect is rare. Only two to three of every 100 children on antidepressants have suicidal thoughts or attempt suicide.

Reassurance should be the first topic that medical people discuss with parents. The biggest risk for a child with severe clinical depression is to get no treatment at all. Parents should not hesitate to use antidepressants when their doctor diagnoses severe clinical depression and recommends medication.

Psychotherapy is a non-medical alternative that also works well. For many families, however, psychotherapy many not be a realistic option because of cost, lack of access to qualified therapists, or other problems.

At the same time, parents also need to hear words of caution about using pills as a quick fix for the brief mood swings, fleeting down-in-the-dumps feelings, and bizarre behavior of other sorts often seen in kids and teens.

Serious clinical depression certainly should be treated. However, parents should be aware of the unfortunate tendency for the pharmaceutical industry to "medicalize" problems. Medicalize means turning normal human behavior, feelings, or situations into a disease requiring medication. For all the good their products accomplish, drug companies in the final assessment exist to make a profit. And that means selling medicine.

Kids should become customers only when there is a genuine need, not when parents are too busy, or too timid, or too self-involved to try other solutions. It may be a diet for an overweight teen, a change in schools for a child performing below par, exercise for a couch potato, or human contact for kids living a solitary, friendless existence on the Internet.

One can envision a fireside chat, like those hosted by Dr. C. Everett Koop, the much-respected former U.S. surgeon general. But who's to do it in this administration? The FDA has only an acting commissioner, who is a veterinarian. Our wartime surgeon general is a trauma specialist. For all their capabilities, they may lack the human touch and ability to connect with the public.

That may leave this important task in the hands of doctors who provide care for children and teens, and advice for their parents.



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