Healthy Children: Antidepressant medications and children

Dr. P's Pediatric Journal Club

"Suicide risk during antidepressant treatment"

Simon G, et al. American Journal of Psychiatry, January, 2006.

-----------------------------------------------------------------

The study

The authors reviewed the computerized medical records (1992-2003) of 65,103 patients for:

- use of antidepressant medications (82,285 episodes of treatment)

- suicide attempts

- death by suicide

What the study found

- The risk of suicide was highest in the month before starting treatment and declined after starting medication.

- The newer antidepressant medications seem to have a lower risk of suicide than do the older ones.

- The risk of suicide attempts was 4X higher in children and adolescents, compared to adults.

What the study suggests

There is not a significant increase in suicide attempts following use of antidepressant medications.

Dr. P comments

In March 2004, the U.S. Food and Drug Administration (FDA) warned physicians and patients about a possible increased risk of suicide with the newer antidepressant drugs. This study suggests this concern was unwarranted and there is no such risk.

In the same issue, other researchers found that antidepressant medications worked extremely well in about 1/3 of patients. (This is consistent with Dr. P's Rule of Thirds: Most treatments work extremely well in 1/3 of patients, so-so in 1/3, and not at all in 1/3.)

So, although the good news is that the newer antidepressant medications seem to be pretty safe, it's also true that they are by no means a cure-all: they are likely to provide significant benefit to only 1/3 and mild benefit to another 1/3 of patients. Is the glass 1/2 empty or 1/2 full?

Medications alone are rarely the answer for depression - certainly I have found that to be the case in children and teenagers. They should always be used in conjunction with ongoing psychotherapy with a trusted, wise professional (which is equally, often more, important).

Dr. P's bottom line

Most parents are understandably reluctant to start their kids on psychiatric medications. While caution is indicated, I feel such a rigid rejection of their use in children and teenagers is a mistake and may deprive your child of a therapy that could help a lot. Used appropriately and wisely, with ongoing follow-up and psychotherapy, I have seen such medications make a huge positive difference lifting a child's mood and improving the quality of his/her life.

If you are faced with the question of starting your child on psych meds, don't reject it out of hand:

Educate yourself and become an informed consumer.
Ensure there will be follow-up care.
Be sure it is used in conjunction with ongoing psychotherapy.

If the medication doesn't work or if unwanted side effects are significant, it can and should be stopped. As a parent, you'll know what is best and can decide if the medications are a boon or a bust for your child.

Related Topics: Bipolar Disorder Treatments