Antidepressants Help More Kids Than They Harm

The only SSRI approved by the FDA for use in pediatric patients is Prozac, but others are prescribed on an off-label basis.

In 2004, an FDA review of 24 placebo-controlled trials involving antidepressant medication in more than 4,400 children and adolescents found that the medications spurred a twofold (4 percent vs. 2 percent) increased risk for suicidal behavior or ideation (thoughts of suicide), although no completed suicides were reported.

The current paper was a large review of all of the published and unpublished randomized clinical trials involving the use of antidepressants by children and adolescents younger than 19. The youngsters were being treated for major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and anxiety disorders other than OCD. In all, 27 trials were reviewed and 5,310 patients were followed.

For every 100 children and adolescents treated with antidepressants, about one child would have thoughts of suicide or would attempt suicide beyond the risk associated with the underlying condition, the researchers found.

This was a number that was lower than the FDA's review, which found two instances of suicidal ideation or attempted suicide per 100 patients.

The study also found that the only antidepressant effective in treating depression in children under 12 was Prozac. Several medications were effective in older children.

The effects of the drugs were most pronounced for non-OCD anxiety disorders, followed by OCD and then MDD.

But the new findings are unlikely to be the last word on the subject.

"There are a few studies that are ongoing right now and that will certainly inform our findings," Bridge said.

"It doesn't seem like they have resolved the issue completely," added Ripperger-Suhler. "I'm hoping that someone will do a prospective study."

More information

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

SOURCES: Jeffrey A. Bridge, Ph.D., investigator, Columbus Children's Research Institute, and assistant professor, pediatrics, Ohio State University; Jane Ripperger-Suhler, M.D., assistant professor, psychiatry and behavioral science, Texas A&M Health Science Center College of Medicine and psychiatrist, Scott & White Mental Health Center, Temple, Texas; April 18, 2007,Journal of the American Medical Association