Sept. 6, 2004,
Prozac concerns intensify
Doctors evaluate if antidepressants in kids can lead to acts of
violenceBy LEIGH HOPPER
Copyright 2004 Houston
|Advice for parents of kids on antidepressants:|
Evaluate: Get a good evaluation by a mental
health professional with appropriate training and expertise.
? Be an advocate: Ask lots of questions
on behalf of your child.
? Be informed:
Get as much information as you can about the diagnosis and
? Monitor: Work
closely with the doctor to monitor your child's response.
? Watch out: Eliminate access to firearms
and potentially lethal medication.
warning: The drugs that are the focus of a new FDA
warning are Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro,
Wellbutrin, Effexor, Serzone and Remeron
The fatal shooting last month of a Galveston doctor by his
10-year-old son, who was taking Prozac, is fueling ongoing concerns
about the use of antidepressants by pediatric patients.
Most medical experts don't believe antidepressants prompt violent
acts. Rather, it's the brew of emotional difficulties prompting the
prescription in the first place ? plus access to a gun ? that can
boil over into a destructive act.
"Children who are depressed can have violent impulses either
self-directed or other-directed as symptoms of their difficulty,"
said Dr. Jon Sergeant, a psychiatrist for 25 years who heads child
psychiatry at Ben Taub General Hospital. "To the best of anyone's
knowledge, it doesn't look as though (antidepressants) in and of
themselves make children act in a suicidal or violent way."
The Aug. 27 death of Dr. Rick Lohstroh came at a time when the
U.S. Food and Drug Administration was already re-examining
antidepressant side effects in children. This month, the FDA will
hold a public meeting to discuss the issue and take suggestions for
labeling changes and possible regulatory actions.
"The general clinical consensus is that the potential benefit of
these medications far outweighs the risk," said Dr. David Fassler, a
child psychiatrist at the University of Vermont. "There's still
plenty we don't know."
Prozac, introduced in 1987 as the first of a new generation of
antidepressants, initially spawned worries about teenage suicide.
Scientific studies ultimately dispelled those concerns, and last
year, the FDA approved Prozac for use in children.
Recent studies have shown that Prozac, combined with
psychotherapy, produces the best chance of recovery for children
with depression ? better than either drugs or therapy alone.
However, uncertainty persists about side effects in pediatric
patients. No one knows the long-term effects of the drugs on a
child's brain. In June 2003, a study of Paxil, a drug similar to
Prozac, suggested an increased risk of suicidal thoughts in children
compared with those taking a placebo.
In March, the FDA issued a public health advisory asking
antidepressant makers to warn users of the need to closely monitor
for worsening depression or the emergency of suicidal behavior,
particularly at the beginning of therapy or when a dose is increased
Prozac and nine other antidepressants known as SSRIs ? or
selective serotonin reuptake inhibitors ? are the focus of the new
warning. The FDA said anxiety, agitation, panic attacks, insomnia,
irritability, hostility and impulsivity have been reported as side
effects by adult and pediatric patients.
The FDA hasn't concluded the drugs are to blame but said patients
with these symptoms might be at increased risk for depression or
Deborah Geisler, the 10-year-old boy's mother, said a
psychiatrist prescribed Prozac for her son in early August after he
was diagnosed with depression and anxiety. He started with a
10-milligram dose and gradually moved to higher doses.
A week before the shooting, Geisler said, the boy started taking
a once-a-week, time release dosage of 90 milligrams. He took his
second 90-milligram pill just hours before the shooting, she
Dr. Andrew Harper, an associate professor of child psychiatry at
the University of Texas Medical School at Houston, said such a dose
would be "reasonable" for an adult and probably appropriate for a
child, although the long-acting form hasn't been well-studied in
Harper said drug side effects of hostility or impulsiveness most
likely would result in verbal aggression or perhaps a thrown punch
rather than a multi-step plan to use a gun.
"I think it would be extremely rare," Harper said.
Information about whether the boy was in psychotherapy was not
available. Geisler and her ex-husband had gone through a contentious
divorce, finalized last year, and the shooting occurred when the
father arrived to pick up his sons.
"An acrimonious divorce puts a lot of pressure on a child," said
James Bray, a Baylor College of Medicine psychologist who focuses on
children, stepfamilies and the issue of divorce. "If a child has
emotional or behavioral problems prior to the divorce, that kind of
stress can accentuate ... those sorts of issues."
Experts highlight two safety recommendations for children
beginning treatment for depression or anxiety: Make sure there is no
access to firearms or to potentially lethal drugs.
Prozac, Harper said, can strengthen children's resources and
enable them to deal with troubling situations, but the drug won't
prevent them from reacting to family stress. The drug will neither
drive a child to use a gun nor stop a child who is planning to use a
gun, he said.