Are Antidepressants Safe?

By Anne Chappell Belden
Over the last decade, the antidepressant prescription rate has tripled for children under age 18. In 2002 alone, doctors wrote 11 million antidepressant prescriptions for American youths with depression, anxiety or other disorders.

But concerns that these medications may have potentially deadly side effects are also growing. Last October, the U.S. Food and Drug Administration (FDA) issued a warning that antidepressant medications, including SSRIs (selective serotonin reuptake inhibitors), may increase suicidal thinking and behaviors in children and adolescents with depression and other psychiatric disorders.

The FDA then forced drug manufacturers to add a “black box” warning to the medications, describing the risk and emphasizing the need for close monitoring.

The action came after researchers analyzed 4,400 patients in 24 trials and concluded that children on antidepressants showed a greater risk of suicidal thoughts during the first few months of treatment as compared to a placebo group of depressed children.

Balancing the Risks

Noted Harvard psychiatrist Alvin Poussaint, M.D., worries that the FDA’s new labeling may make parents reluctant to seek treatment for their depressed children and psychiatrists reluctant to prescribe antidepressants to children for fear of lawsuits. He points out that none of the children in the study actually committed suicide.

“I think there may be a greater risk of committing suicide without these antidepressants than with a trial of antidepressants, but the children should be watched,” Poussaint says.

Other child psychiatrists agree, pointing to studies that show suicide rates dip in areas where antidepressant use among young people is widespread. They also cite the National Institute of Mental Health’s Treatment for Adolescents with Depression Study, a $17-million project that compared short- and long-term effectiveness of medication and psychotherapy for depression in kids ages 12 to 17. Researchers found that Prozac combined with cognitive-behavioral “talk” therapy produced the best success rate (71 percent improved) in treating depression. Second best was medication alone (61 percent improved), followed by talk therapy alone (44 percent) and the control group (35 percent).

With depression as the biggest known risk factor for suicide, “The risk for no treatment is much greater than the risk associated with the treatment, especially with careful monitoring,” says Graham Emslie, M.D., a well-known childhood depression researcher and chief of the division of child psychiatry at the University of Texas Southwestern and Children’s Medical Center in Dallas.

But opponents of the medications have their own mounting evidence against SSRIs. Over the past two decades, hundreds of adults have filed lawsuits against antidepressant manufacturers focusing on both violence and suicide. Anecdotal cases of teens committing suicide after starting antidepressants are increasing.

Psychotherapist Diana Kern, founder of the San Francisco Bay Psychotherapy Center, says parents should be concerned not only about the safety of antidepressants but also about the notion of labeling mental disorders as chemical imbalances.

“The context of our lives – unhappily married parents, major catastrophic illness of a sibling, high-stress schools – produce an emotional reaction,” she says. “To just say it is a biochemical imbalance and let’s prescribe a pill is to not grant the context of our lives as important.”

Former First Lady Rosalynn Carter, who has championed children’s mental health issues, calls for more research on the treatment of mental illness. “Physicians need to be extremely careful in prescribing these medications for children, and parents need to watch their children taking them closely."

But she also notes, “I have seen so many children helped with these medications that I would not like to see them completely withdrawn.”

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Anne Chappell Belden is a journalism instructor and award-winning freelance writer. She is the mother of two children.