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analyses showed that anti-depressants, given to children and teens,
were associated with increased suicidal thoughts, actual self-harm,
and hostile behavior. How much of an increase? FDA recently estimated
that these drugs might double the risk of suicide in children. While the rate of
suicide at that age is low, this sounds very serious. Other analyses by FDA
reportedly indicated that the risk of suicide in children taking anti-depressants
was only 2% or so greater than in children given a placebo. However, FDA
also reported that children taking Effexor had almost 9 times the risk of
suicidal behavior or thinking (also reported in Washington Post). These are
much higher risks than most families would be willing to run, until science
tells us more about identifying the children most at risk taking anti-
depressants. We lack the accurate useable facts that we need. Any treatment
causing deaths or near deaths is a serious matter that will probably have far-
reaching effects on the treatment of depression. So, much more research is
needed.
The difficulty of predicting suicide is discussed in some detail in the earlier
prediction problem is an important part of the decision to use anti-
depressants or not. Also, the patient and his/her parents, if a child or teen,
should be involved in the tough decision-making about the use of drugs. It
isn’t just a question of what approach offers the most hope for improvement
but also what methods have helped and not helped before and how desperate
the situation is. If I am feeling terribly miserable, I’d be willing to take more
chances with a risky drug…just the same as when risky surgery is an option.
Please remember I am not a physician. I have no expertise concerning drugs.
My review is just a summary of the relevant available research which
suddenly seems very important. The data and my comments should in no way
be interpreted as opposing the use of anti-depressants. There probably are
many circumstances in which it is a very good judgment to give anti-
depressants to children and teens. This new information about anti-
depressants with children just makes it critical that case studies and
treatment plans are done at the highest level of professional competence.
I strongly recommend each depressed patient (and his/her parents, if the
patient is a minor), with the help of his/her physician (the prescription
writer), explore the pros and cons of taking anti-depressants. It is not a
simple decision. If the prescribing physician is not a psychiatrist or a
psychotherapist, then a therapist (Psychologist or Social Worker) should
permanently join the team. At this time (fall of 2004), only about 15% of
children and teens being treated for depression are prescribed anti-
depressants. If research continues to find suicide risks are associated with
anti-depressants, surely a number of changes are likely to be made in the
treatment of depression. What will change is hard to know until we get better
research. For instance, we need to know the rate of suicide in certain types of
patients in specific circumstances depending on whether they are taking anti-
depressants or not. Science needs to map the high risk points for depressed
patients on and off medication. Certain dangerous times have been known for
many years, but we need to know more. For instance, Wessely, Kerwin &
Kaye (2004) found that the most dangerous times for adults and children
taking anti-depressants were in the first nine days of treatment (a four-fold
