Dr. Scott Wooding's Parenting Thoughts

 There is little doubt that the incidence of depression among adolescents has been consistently rising over the past generation. At present most research studies indicate that about 5% of the adolescent population is at risk of major depressive disorder. Not only does the presence of depression in adolescents seriously limit their social life it can interfere with their academic performance and can often lead to suicide. No wonder, then, that in seeking to control depression in teenagers professionals have increasingly taken to prescribing the relatively new SSRI family of antidepressant drugs. Familiar brand names include Prozac, Zoloft, Wellbutrin, Celexa and Paxil. A recent Canadian study of teenagers in the province of Ontario indicates that about 2% of the adolescent population is presently taking these drugs to help control their depression.
    Recently, however, problems with these drugs have begun to surface. While all of these antidepressants have side effects of some type, few professionals realized that their use could possibly cause suicide in adolescents rather than preventing it. The first indicator of potential problems came from Britain late last year. On March 22, 2004 the US Food and Drug Administration concluded a review of the SSRI’s that resulted in a public health advisory being issued. Health Canada had issued a similar warning on Feb.2 of this year. This advisory asks drug manufacturers to include a warning on their product’s labels urging careful observation of those taking these drugs.
The interesting fact about the SSRI’s is that of the entire family of drugs, only Prozac is approved for use in children in the by the US  FDA and the Committee on the Safety of Medicines in Britain, while none are approved by Health Canada. On the other hand, none are specifically banned by any of these regulating authorities. As a result they are prescribed “off label” by doctors who feel that these products can help their patients. While there is very little research evidence as yet to substantiate claims either for or against the efficacy of these drugs with adolescents, doctors and mental health professionals have begun to recommend them in the hope that they can help control the very serious problem of adolescent depression.
    The evidence that these drugs can lead to suicide is not strong either. Several cases in the US have occurred, but not enough to lead to any clear conclusion. It could well be that in these cases, the adolescents were suffering from the depression caused by Bipolar Disorder (manic depression), rather than from major depressive disorder. Bipolar disorder does not respond to the SSRI’s, but the symptoms are often difficult to separate from clinical depression, especially among adolescents.
     The best advice that anyone can give at this point is that the use of antidepressants in adolescents should be carefully monitored for signs of severe depression or suicidal thoughts. It has always been the recommendation of most mental health professionals that if drugs are going to be used in the treatment of depression in teenagers, that it be combined with ongoing psychotherapy. This is particularly true now that doubts about the SSRI’s have surfaced. There does not seem to be any need to panic yet. Far more research needs to be done. Instead parents of depressed teens should read the FDA advisory  and ensure that its recommendations are being carried out.

For those interested these recommendations were that doctors should:

•  Monitor patients using these antidepressants for possible worsening of depression symptoms or suicidal thoughts or behavior, especially when drug therapy is begun or when doses are adjusted.

•  Carefully evaluate patients whose depression continues to worsen, or suicidality emerges quickly or severely, to consider what action should be taken next.

•  Be vigilant for symptoms including anxiety, agitation, restlessness, panic attacks, irritability, hostility, impulsiveness and mania.

• Taper patients off drugs gradually if they are discontinued.

•  Screen patients thoroughly for Bipolar Disorder. Antidepressants may induce mania in these patients.

•  Alert patients and their families and caregivers to be alert for problematic symptoms and to report them immediately to the doctor.

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