Fewer Children Taking Antidepressants

The only SSRI approved by the FDA for use in pediatric patients is fluoxetine (Prozac). However, the analyses also showed a trend toward prescribing bupropion, a non-SSRI antidepressant, to young patients, the study authors said.

This "could stem in large part from physicians attributing the increased risk of suicidality primarily to SSRIs, even though bupropion is also labeled with a black box warning," the researchers noted.

"It is evident, however, that there is need for additional exploration into the relationship between FDA action, media reaction and physician behavior change to ensure that dissemination of drug safety information does not interfere with appropriate access to care," Nemeroff's group concluded.

Fassler said this finding is "of particular concern when viewed in the context of the recent report from the U.S. Centers for Disease Control and Prevention documenting the unexpected and disconcerting increase in the adolescent suicide rate between 2003 and 2004."

Based on the data currently available, he said, it would be premature to conclude there's a definitive causal link between the rate of suicides and the lower rate of prescriptions for SSRIs, Fassler said. "However, we do know that it's become increasingly difficult for many young people to access effective and appropriate treatment for depression," he said.

But another expert disagrees that use of all SSRIs has declined among children and teens.

"Information I have says that the use of Prozac has increased over time," said Dr. Randall S. Stafford, director of the Program on Prevention Outcomes and Practices at the Stanford University School of Medicine's Prevention Research Center.

Strafford stressed that treating depression in children and teens should include a combination of drugs and counseling. "Physicians were prescribing more drugs without following the advice that pediatric patients should also receive counseling and frequent follow-up," he said.

More information

The National Library of Medicine can tell you more about adolescent depression.

SOURCES: David Fassler, M.D., clinical professor of psychiatry, University of Vermont College of Medicine, Burlington; Randall S. Stafford, M.D., Ph.D., associate professor of medicine, director, Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, Calif.; April 2007,Archives of General Psychiatry