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. Forum: Join a Discussion on Mental Health and Treatment



Drugs (Pharmaceuticals)

Children and Youth

Medicine and Health

Is Prozac Better? Is It Even Different?


Published: September 21, 2004

Last week, a federal advisory panel urged regulators to warn parents that antidepressant drugs not only increase the risk of suicide in some children, but that most have a poor track record in curing their disease.

The recommendation came after a yearlong debate over whether the drugs are as safe and effective as advertised. It was based on evidence that a small minority of children show increased signs of suicidal behavior when taking the drugs.

Through it all, one of the drugs seemed somehow above the fray: Prozac.

Although the warning is recommended for Prozac as well as other drugs, Prozac is still the only one approved by the Food and Drug Administration for the treatment of depression in children and adolescents. A large government-financed trial recently found that it worked better than talk therapy in helping teenagers overcome depression. And when British health officials announced a sweeping ban of antidepressant use in children, which touched off the debate last year, they specifically exempted Prozac.

But is it really that different?

The short answer is no, experts say. Although chemically distinct from other drugs in the same class, Prozac works on precisely the same principle, they say, and there's no evidence that it is significantly safer or more effective than the others in treating childhood depression. Prozac has shown in several trials that it can relieve depression in youngsters and adolescents significantly better than dummy pills. Such convincing evidence is not available for the other drugs. But, research psychiatrists say, that does not mean the other drugs in the same family do not work in young people, only that they have not been properly tested.

"It makes no scientific sense that you would find any significant difference in the effects" of these drugs, said Dr. Steven Hyman, a Harvard psychiatrist and former director of the National Institute of Mental Health, who is not a consultant for antidepressant makers. "All target and bind to the same molecule in the brain."

Dr. John M. Plewes, a medical adviser at Eli Lilly, which makes Prozac, disagreed that the differences were minimal. "We've got very good data that the drug is safe and effective in children, and no other drug has this kind of data," he said.

The molecule these drugs bind to is the one the body uses to dampen the activity of a mood-altering brain chemical called serotonin, Dr. Hyman said. When this molecule is tied up by a drug, serotonin surges lasts longer and, over time, improve mood in some people who are depressed. Prozac was the first antidepressant drug on the market to work primarily on serotonin, and the others that came later - including Paxil, from GlaxoSmithKline; Zoloft, from Pfizer; and Celexa, from Forest Laboratories - are what some researchers consider copycat or me-too drugs.

Prozac does linger in the body longer than the others do, once people stop taking it, psychiatrists say. This makes withdrawal more gradual than from other antidepressants, and keeps levels of the drug steady if people miss doses. Teenagers in particular often forget or skip doses, child psychiatrists say, and many of these psychiatrists believe that the potential for suicide is highest in people being treated when their dosage is changing, up or down.

One recent analysis of records of patients who had taken antidepressants, including some 160,000 adults and children, found that the suicide risk was highest in the first three to four weeks of treatment. But no one has shown convincingly that there are significant differences among the drugs, or determined exactly what the withdrawal risks are.

"You really need to watch young patients on these drugs closely at all times," said Dr. John March, chief of the division of child and adolescent psychiatry at Duke University Medical School, the lead author of the recent study comparing Prozac to talk therapy. Dr. March has been a consultant to Pfizer and other drug makers but currently receives almost all his research financing from the government, he said.

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. F.D.A. Panel Urges Stronger Warning on Antidepressants (September 15, 2004) 
. F.D.A. Links Drugs to Being Suicidal (September 14, 2004) 
. Panel Urges Strong Warning on Antidepressants for Children (September 14, 2004) 
. Lawmaker Says F.D.A. Held Back Drug Data  (September 10, 2004)  $
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