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Possible suicide risk in children
treated with SSRI’s
No one wants his or her child to be unhappy, let alone clinically
depressed. So when a diagnosis of childhood depression surfaces parents
may be tempted to go along with a doctor’s suggestion or even
ask the doctor for a prescription of antidepressants for the child.
But what is supposed to help may actually end up causing harm.
The Food and Drug Administration (FDA) has issued a warning of a possible
suicide risk in children and adolescents treated with a certain class
of antidepressants that includes Prozac and Paxil. The available data
from clinical trials suggest selective serotonin reuptake inhibitors
(SSRIs) may be associated with an increase in suicidal behaviors and
attempts shortly after the start of treatment. Although Prozac is the
only SSRI known to have a benefit in children and approved for such use
by the FDA, other drugs in this class may be prescribed “off-label” at
a physician’s discretion.
Already the British counterpart of the FDA recommends against using
SSRIs in children. And recently, a review in the British journal The
Lancet showed Prozac is the only SSRI not associated with negative outcomes
in children. The review involved an analysis of data from published and
unpublished studies. When comparing data from studies published in medical
journals, all the SSRIs offered a greater benefit than risk. But when
unpublished studies, which tend to have negative results, were also included
they showed that the risks outweighed the benefits for all the SSRIs
except Prozac.
The FDA has hired an outside group to re-evaluate the data provided
by SSRI manufacturers. Controversy surrounds the quality of the limited
number of clinical trials of these drugs in children and inconsistent
reporting of adverse events among the trials. The FDA plans to have results
of the reanalysis by the end of the summer and will hopefully come out
with concrete recommendations for treating depression in children and
adolescents.
If your child is diagnosed with depression, talk with his or her doctor
about the FDA warning and your concern with SSRIs. Until the FDA provides
clear advice, you may want to explore other treatment options, such as
psychotherapy.
July 2004 Update
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