ediatricians and family physicians should not
prescribe antidepressants for depressed children and adolescents
because the drugs barely work and their side effects are often
significant, Australian researchers have concluded.
The researchers analyzed data from five published trials of three
antidepressants, Prozac, Zoloft and Paxil, in depressed patients
under age 18. They found that the drugs offered only a "very modest"
benefit over placebos.
At the same time, the drugs carry significant risks, the
researchers said in their report, published in today's issue of the
British medical journal BMJ.
"If the drugs were highly advantageous over placebo, then you'd
live with the risks," Jon Jureidini, a child psychiatrist in
Adelaide and the study's lead author, said in an interview. "If the
drugs were completely safe, then you might argue that there's
nothing wrong with giving something that's only slightly better than
However, Dr. Jureidini said, neither is true, so antidepressants
should not be prescribed for children and adolescents except in
"We strongly want to say that non-child-psychiatrists should not
be initiating the prescribing of" the antidepressants known as
selective serotonin reuptake inhibitors or S.S.R.I.'s, a class that
includes Eli Lilly's Prozac, Pfizer's Zoloft, and GlaxoSmithKline's
Paxil, Dr. Jureidini said.
The study is the latest salvo in an increasingly bitter war over
whether prescribing antidepressants to children and adolescents is
Dr. Joseph Glenmullen, author of "Prozac Backlash" and a fierce
critic of the pills, said the latest study further vindicated his
view that antidepressants can be dangerous. "What this shows is
that, on balance, there is no good reason to prescribe these pills,"
Dr. Glenmullen said.
However, Dr. Graham Emslie, a professor of psychiatry at the
University of Texas Southwestern Medical Center, who was an author
of some of the studies reviewed in the article, said the study was
"I wish the effect size of these drugs was bigger, but at least
there's some effect," Dr. Emslie said. "Some of these kids are
severely depressed and we've got to do something."
Dr. Emslie, like many psychiatric researchers, is a consultant to
The Australian researchers suggested that psychiatrists offer
children talk therapy in place of the drugs. But Dr. Emslie said
that only one study had shown that talk therapy was beneficial.
"If people could offer better treatments than drugs, it'd be
great," Dr. Emslie said.
British drug regulators have cautioned doctors against using any
antidepressant but Prozac to treat depressed children and
adolescents because the drugs have not proved effective against
depression and may increase the risk of suicidal thoughts and
The Food and Drug Administration recently issued a warning that
all patients taking antidepressants should be closely monitored by
doctors, especially in the first weeks. But the agency emphasized
that it had not concluded that the drugs caused suicidal thinking or
Dr. Laurence Greenhill, a professor of clinical psychiatry at
Columbia University, said neither side in the debate had a monopoly
"I think that these medications are neither as much of a silver
bullet as the advocates would have it nor as terrible as the critics
would say," Dr. Greenhill said.