For the Sake of Our Children

Treatment for depression in children is critical to reduce the likelihood of suicide.

Depression can be dark and dirty like uswept steps
Depression can be dark and dirty like uswept steps

There are few events more shocking and heartbreaking than the suicide of a child. Suicide is a leading cause of death in children and adolescents, and its most frequent cause is depression. Treatment for depression raises spirits, substitutes hope for hopelessness, and substantially reduces the likelihood of suicide.

Yet Great Britain has taken steps to ban some of the most effective antidepressants used by children and adolescents. Why would anyone, or any governmental agency, restrict treatments for depression in children and adolescents when these can, and will, reduce the risk of suicide? Incredibly, the British Medicines and Healthcare Products Regulatory Agency (Britain’s equivalent of the FDA) has done exactly this. The Agency has issued an advisory for health providers in Britain, recommending against the use of the SSRI antidepressants (with the exception of Prozac) and similar new-generation antidepressants in children and adolescents because of the risk of “suicidality.”

The evidence on which to base such a recommendation is nonexistent. In fact, no child or adolescent in any of the many clinical trials used to test these medications for the treatment of depression in children and adolescents committed suicide. Not one.

British regulators have confused completed suicide with “suicidality,” a term encompassing a wide range of activities and behaviors, many of which have nothing to do with suicide. “Suicidality” may be expressed by agitation, hostility, expressing suicidal thoughts, self-injurious behavior, and suicide attempts.

In paroxetine (Paxil) studies, such behaviors occurred in 3.7% of children and adolescents, compared with the 2.5% who were given a placebo. This difference is not statistically significant (that is, there is no scientifically meaningful difference); whether it is clinically significant is hotly contested. Nonetheless, the finding tells us nothing about completed suicide.

In fact there is no increased risk of suicide. Among other antidepressants, such as citalopram (Celexa) and sertraline (Zoloft), there is no difference between placebo and active drug using this definition of suicidal behavior. Both medications are effective in the treatment of depression in children and adolescents. In the United States, the Food and Drug Administration is conducting an inquiry using data from placebo-controlled clinical trials conducted on the treatment of children and adolescents for depression. Hearings will be conducted in the early part of 2004, and the results of their investigation will be made public.

Until this information is made public, what should we do? The answer is clear. Several of the new-generation antidepressants have been shown to be safe and effective in the treatment of depression in children and adolescents. They include Prozac, Zoloft, Paxil, and Celexa. The best way to reduce the risk of suicide among children and adolescents is to use these medications when appropriate, to relieve the suffering our children experience.

Second, make your voice heard. There are many anti-medication zealots in the United States whose life work is to get medications like Prozac banned. Tell your representatives in Congress, and write the FDA about how these medications have helped you and your children. Let them know that depression is not a political issue, but a medical illness that must be treated with great care.