In 1998, my daughter, then in the sixth grade, tried to commit suicide. Under assault by the so-called "popular" girls at school, Alicia could no longer face the ordeal of getting up in the morning and going to class. She swallowed most of a bottle of Tylenol and went to bed. A few hours later, she started vomiting violently. At the time, I had no idea that she had tried to commit suicide. I thought she just had food poisoning. But a few months later, it happened again, and the truth came out. I took her to a psychiatrist, who immediately started her on an antidepressant. Since then, she has had ups and downs, but no more suicide attempts. She's now doing well in high school and will soon leave home for college. The antidepressants, I was convinced, saved her life.
Now I realize that maybe she was just lucky. In the past six months, under pressure from critics, politicians and regulatory agencies here and in the U.K., several pharmaceutical companies have released internal data showing that the class of drugs most often used to treat depression in kids—Prozac, Zoloft, Paxil, Lexapro, Wellbutrin and a few others—may not work very well. Even in adults, they aren't magic bullets: Only about 60 percent of depressed patients respond to these drugs, which include the well-known selective serotonin reuptake inhibitors. By comparison, roughly 40 percent respond to a placebo. (Response, in these studies, is defined as a 50 percent improvement in symptoms—a far cry from a return to health.) In adolescents the picture is even more complex. Since minors generally don't participate in clinical trials, most of these drugs have not been closely studied for them. And there's some new science suggesting that because adolescent brains are still maturing, depression may develop quite differently in young people.
What's worse, old concerns that some of these drugs might cause suicidal impulses have been reawakened by reports of a potential link between antidepressant treatment and suicidal thoughts. The evidence is mixed. Because depression itself can lead adults and teens to suicide, it's hard to tease out cause and effect. One theory is that antidepressants lift the fatigue and passivity of the disorder before they change feelings of despair, resulting in a still-very-unhappy but now-energized patient. One recent analysis of previously unpublished data indicated that young people being treated with antidepressants may be at a higher risk for suicidal thoughts.
The link to suicide is far from being proved, but even the possibility that the drugs might be harmful is profoundly disturbing. A study in the British Medical Journal in April 2004 concluded that researchers have exaggerated the benefits of antidepressants in children and adolescents, and that as a consequence, nondrug treatments like talk therapy may have been overlooked.
My daughter has been through a lot of turmoil. Could it be that the antidepressant she's taking might one day drive her to another suicide attempt? Should I take her off the drugs that seem to have helped her so much? What am I—and other parents in my situation—supposed to do?
Antidepressants are among the most heavily prescribed drugs on the pharmacist's shelf. Among American children under 18, antidepressant use rose 49 percent in just four years, from 1998 to 2002, according to a study published in 2004. Even so, government drug regulators in this country have reacted cautiously to these concerns. British regulators went as far as to ban the use of antidepressants for children, with the exception of Prozac, the most thoroughly studied of the group. By contrast, the U.S. Food and Drug Administration last spring merely asked the makers of 10 antidepressants to add a warning label urging doctors to "carefully monitor patients receiving antidepressants for possible worsening of depression or suicidal [tendencies]." The FDA is continuing to study the issue, but has offered no further advice.
Parents who have worked hard to find the best psychiatric care for their children are now confused. According to a poll conducted in May 2004 by Columbia University, nearly a third of parents say they think antidepressants are harmful. The same number say they aren't. But even more—the remaining 38 percent—aren't sure what to think. Psychiatrists and researchers are worried too. "There are a lot of sick kids whose lives we've saved with medication," says Richard Sarles, a child psychiatrist at the University of Maryland and the president of the American Academy of Child and Adolescent Psychiatry. "If parents became reluctant to use these medications, a significant number of children and adolescents would be in trouble again."
One thing is for sure: Children or adults on antidepressants who decide to quit the drugs should taper off gradually under the supervision of a doctor. Going cold turkey may cause serious withdrawal symptoms. Yet teens being teens, these recommendations may not be so easy to apply in the real world. While I was wrestling with the problem of what to do with my daughter, she quit taking her medication—without any advice from me or her psychiatrist. "I don't need it any more," she told me. "I'm feeling fine." By the time she admitted it, it was too late to do anything except to tell her that she should not have made that decision on her own. Six months after she quit, she was sorry she had stopped. She began to feel a little shaky emotionally, and she visited her psychiatrist. He put her back on an antidepressant, and she's doing better. Maybe she has now learned not to make medication decisions on her own; maybe not.
Tags:
antidepressants,
depressed patients,
depression,
food poisoning,
illness,
magic bullets,
new science,
pharmaceutical companies,
placebo response,
popular girls,
regulatory agencies,
serotonin reuptake inhibitors,
sixth grade,
suicidal impulses,
suicide,
suicide attempts,
teen,
tylenol,
ups,
ups and downs
