To Give Or Not To Give Antidepressants To Young People

Medical News Today has an interesting and thought-provoking article looking at the two sides to the antidepressant medication for children debate.  Two, highly respected doctors weigh in on the debate.

On the pro side:

We should not deny depressed children one of the few evidence-based available treatments, says Andrew Cotgrove, Clinical Director and Consultant in Adolescent Psychiatry at Pine Lodge Young People's Centre, Chester England.

Although cognitive behavioral therapy, interpersonal therapy and family therapy have some effect for young depressed patients, their effects are very small.

Cotgrove explains that disturbing procedural mistakes, exclusion of evidence in the conducting and reporting of some SSRI clinical trials, have justifiably alarmed doctors and members of the public. However, when one reviews the evidence carefully and objectively, the indications are that antidepressants have a role to play in treating young people with depression and OCD.

Young patients and their parents need to be told of the benefits and risks, given advice and support when choosing an evidence-based treatment. If we removed antidepressants as one of the options we would be taking away one of the few potentially effective interventions for these disabling conditions, Cotgrove concludes.

On the con side:

Prescribing SSRIs for young people is dangerous, not ethically sound, and poor value for money, writes Sami Timimi, Consultant Child and Adolescent Psychiatrist, Lincolnshire, England.

Timimi explains that as far as childhood depression is concerned, none of the SSRI studies has shown significant benefits over a placebo. Even so, national guidelines indicate the fuoxetine has more benefits than risks for young patients.

Timimi adds that a combination of fuzzy reporting and marketing spin have taken precedence over scientific accuracy, which have not helped the situation.

A reason for carrying out the studies in the first place was to validate well established prescribing patterns. It led to a trend which has been hard to undo, in spite of all the evidence.

What this article really demonstrates is how hard it is to make the right decisions on treatment for mental illnesses, especially in children.  No matter how informed the parent is, and how respected the doctor is that prescribes treatment, you can never be sure if you are doing the right thing. 

This illustrates the added stress that is put on families and patients of mental illnesses. 

Read the full article here:

To Give Or Not To Give Antidepressants To Young People

"Should young people be given antidepressants? Yes"
Andrew Cotgrove
BMJ 2007;335:750 (13 October), doi:10.1136/bmj.39316.399931.94
Click here to read first 150 words online
"Should young people be given antidepressants? No"
Sami Timimi
BMJ 2007;335:751 (13 October), doi:10.1136/bmj.39316.406470.94
Click here to read first 150 words online