WASHINGTON (AP) - Parents of children with depression must sort through an
emotionally charged controversy in deciding on treatment: Do popular adult
antidepressants sometimes increase the risk of suicide when they're given to
kids?
British authorities last month declared a list of common antidepressants
unsuitable for children, citing that possibility. Next week, U.S. health
authorities open public hearings on the issue, at which parents who blame
the drugs for children's deaths are expected to face families who credit the
same pills for saving lives.
It's a difficult question, as depression occurs in about 10 percent of
youth, and depression can lead to suicide. Some 1,883 10- to 19-year-olds
killed themselves in 2001, and specialists say there are 10 to 20 attempts
for every suicide.
Antidepressants called SSRIs, such as Paxil, Zoloft and Effexor, have been
long used by adults, and authorities say there's no evidence of a suicide
risk for them.
But medicines can work differently in children, and only carefully
controlled studies can prove if suicidal behavior is more common among
youths taking SSRIs. The same holds for determining whether if a risk is
proved, is the risk because the drug just did not alleviate the depression
or had had some other effect.
No suicides have occurred in studies encompassing 4,000 children. But
preliminary data suggest suicidal behavior and attempts, while infrequent,
might be two to three times greater among users of some SSRIs: roughly 3.2
percent among children getting the drugs compared with 1.5 percent among
those given dummy pills.
The possible risk was spotted after the U.S. Food and Drug Administration,
seeing pediatric SSRI use rising, ordered research to see whether they work
in children.
So far, the FDA has approved just one SSRI - Prozac - for use in depressed
patients under age 18, but the agency says none of the others are yet proven
to alleviate pediatric depression.
Lack of benefit in the face of possible risk led to Britain's warning that
SSRIs other than Prozac are unsuitable for children. Here, FDA still is
analyzing the research; it hopes to have recommendations by summer.
"Obviously there are many pediatric psychiatrists who believe in these
drugs, but definitive advice on what to do is still pending," says Dr.
Russell Katz, FDA's chief of neurological drugs. "Now, we can only say use
them with caution."
For 18-year-old Jame Tierney of Kernersville, N.C., that's not enough
warning. Next Monday, Jame will tell the FDA that fury and thoughts of
suicide consumed her while taking Effexor - an experience her family wants
the government to pay special heed to because Jame wasn't depressed when she
started the drug at age 14. It was prescribed for migraine headaches.
A year of the starting dose induced some jitteriness. But when the headaches
returned and the doctor doubled the dose, Jame's parents say their daughter
went from a sweet, popular honor student to a raging loner.
"I hated my family, my friends and most of all myself," Jame says,
describing screaming fits and hard-to-control impulses such as once lightly
cutting her wrist with a razor until the pain stopped her.
Effexor maker Wyeth Pharmaceuticals wrote doctors in August to warn that
while a cause-and-effect isn't certain, its studies show more
suicide-related thinking in children taking the drug than those given dummy
pills, including a 2 percent incidence of hostility.
The debate elicits strong emotions.
"The aim is to do no harm. Leaving it (depression) untreated is not 'doing
no harm,'" says Dr. Graham Emslie of the University of Texas Southwestern
Medical Center.
He co-chaired a task force of the American College of
Neuropsychopharmacology that last week declared evidence that links SSRIs to
suicide is too weak to justify not using them. The group points to evidence
that suicides have dropped as SSRI use increased around the world, and to
autopsy studies that show most suicides hadn't taken an anti-depressant, or
the right dose, just before their deaths.
On the other side, critics claim SSRIs sometimes cause agitation and urgent
anxiety, called akathisia, that could make certain people suicidal.
"I think these drugs have a place even in these age groups, but my ability
... to use these drugs safely is going to be enhanced if they come with the
right warnings," says Dr. David Healy, director of the North Wales
Department of Psychological Medicine, who helped trigger Britain's review.
Day-to-day, doctors and parents are caught in the middle.
"The kids are in distress at this moment, so we have to work with the
information currently available," says Dr. Joseph Gold, director of
pediatric psychiatry at McLean Hospital, affiliated with Harvard Medical
School.
He's reassured at the apparent low incidence of problems and notes that
older antidepressants have far more common side effects but prescribes the
lowest possible dose.
EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The
Associated Press in Washington.
