A new study has found that using antidepressants to treat children and teenagers may be ineffective and even dangerous.
The researchers studied 14 antidepressants and found that only fluoxetine (Prozac) was actually more effective in treating depression than an inactive placebo given to children and teens. Venlafaxine (Effexor) was linked to an increased risk in suicidal thoughts and suicidal attempts compared to placebo and five other antidepressants.
Study author Dr. Andrea Cipriani, associate professor in the department of psychiatry at the University of Oxford, England, says, “In the clinical care of young people with major depressive disorder, clinical guidelines recommend psychotherapy – especially cognitive behavioral therapy or interpersonal therapy – as the first-line treatment.”
The researchers noted that depression is present in some 3% of children between the ages of 6 to 12, and 6% of adolescents between the ages of 13 to 18.
Cipriani and his team reviewed 34 studies that included over 5,200 children and teenagers. They found that only Prozac showed greater benefits compared to risks in terms of relieving symptoms and showing few side effects. The antidepressants Effexor, imipramine (Tofranil) and duloxetine (Cymbalta) showed the worst side effects, causing more patients to stop using them compared to those who took placebos.
“Prozac should be considered only for patients who do not have access to psychotherapy or have not responded to non-pharmacological interventions,” Cipriani cautioned. “Children and adolescents taking antidepressant drugs should be closely monitored regardless of the treatment chosen, particularly at the beginning of treatment.”
There is a limited number of studies regarding the use of antidepressants in children, so Cipriani says, “we should not underestimate these children because the potential risks.” Cipriani also notes that the at least 65% of the trials they reviewed in their study were financed by drug companies, so 90% had a risk of being biased in favor of the medication sponsoring the trial.
The US Food and Drug Administration issued a “black box warning” in 2004 about the use of antidepressants among teens and agency feared the use of these drugs would heighten suicidal thoughts and suicide attempts.
Despite the FDA warning, antidepressant use went up from 2005 to 2012. The proportion of children and teenagers taking antidepressants rose from around 1% to 2% in the United States, double the number.
Dr. Peter Kramer, clinical professor emeritus of psychiatry and human behavior at Brown University, says the study confirms what has been known: that these “medicines look less effective and riskier in children and adolescents than they do in adults.” He says, “Among them, Prozac has always stood out as relatively more effective.”
It is unclear how antidepressants work in children, Kramer added. “We just know so little about these medicines and what they do in children with developing brains.” So far, there has been little quality research into the matter.
Treatment for depression usually begins with psychotherapy, but for some, Prozac might be a better option, Kramer said. “There are a lot of desperate cases where the illness is so destructive that doing something that’s highly imperfect may seem like the right move.”
Dr. Jon Jureidini, author of an editorial accompanying the study, says, “This study gives us real concern about the usefulness of antidepressants.” However, he also warned that due to the nature of the trial studied, the benefits of antidepressants may have been overstated and the harmful effects downplayed by those conducting them. “Unfortunately, we cannot rely on the truthfulness of how the information has been processed. So we can’t even be confident about using Prozac in children and adolescents.”
Jureidini says young children should never be given antidepressants and should only be given sparingly to teens. “We should shift our practice away from prescribing and toward other treatments, because drugs are being oversold to us.” He adds that treatment for depression starts with understanding what is causing the child’s or teen’s depression and addressing these before medicating.
“We need to help young people get back into their lives, and their depression will get better,” Jureidi says. “They need help and support to re-engage with the world.”
The review was published online in The Lancet.