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Drugs to Treat Children's Depression - Little effects but lots of side effects

The Committee on Safety of Medicines (CSM) in Britain have eva-luated six psychotropic drugs to treat Major Depressive Disorder (MDD) in children: Fluoxetine, Sertraline, Citalopram, Paroxetine, and Venlafaxine. The commercial names of these include Prozac, Zoloft and Paxil, popular drugs prescribed for depression in adults, and now increasingly being prescribed to children.

The children were between 6-18 years old. With the exception of 182 children for Venlafaxine, the number of children evaluated for each drug type was large enough to draw some definitive conclusions, ranging from 315 to 767 children. Also, placebo was used in each and case to minimize the psychological non-treatment influence of the outcome.

The results were disappointing. Only Fluoxetine produced "short-term efficacy" with "modest" effect. None of the other drugs created any intended benefit..

More disconcerting was that Fluo-xetine also produced adverse side effects, most notably "manic reaction", followed by hyperkinesias, agitation, hypomania (lack of interests) or mania (obsession), tremor and headache. Suicide attempts were reported in 3 cases of 228 cases (1.3%), which is more than double the percentage in the placebo (no drug) group (0.5%, 1/190).

At present, about 5% of these drugs are prescribed for children, mostly by general practitioners who have neither the time nor training to do a thorough evaluation beforehand. Yet only one drug managed to create temporary benefits for young depressed patients, at the expense of potentially harmful side effects.

In fact, systematic evaluations have so far shown little link be-tween improvement in depression and medication. To quote from the New York Times, "Yet most studies - including those recently reviewed by British and American health regulators - have found that S.S.R.I.'s (the drug class to which Prozac, Zoloft and Paxil belong) are no more effective in fighting teenage depression than sugar pills."

As is often the case, drugs can't be expected to effectively combat complex psychopathologies or learning disorders. Unless benefits are clearly demonstrated, drugs should not be the first choice of treatment.