Children on anti-depressants

[catatonic]

The FDA plans a major meeting in February to discuss the use of anti-depressants in children. This is due to research showing:
1.) use of anti-depressants in children leads to increased suicidal ideation and increased self-harm behavior (ALL drugs in this category are implicated)
2.) anti-depressants in children are no more effective than placebo (only PROZAC has been shown to be effective in children)

Of particular concern is PAXIL. This drug (often prescribed for OCD and anxiety in children) has been BANNED from pediatric use in Britain because the research on it has raised such serious concerns. Here in the U.S. where drug companies and their money exert way too much political clout, it's still being merrily handed out to children.

If you'd like to read the FDA's cautionary statement on Paxil, it's here: www.fda.gov/bbs/topics/ANSWERS/2003/ANS01230.html

For more detailed information on research on pediatric use of anti-depressants and why it appears a dangerous practice, the FDA provides further details in its Public Health Advisory at:
www.fda.gov/cder/drug/advisory/mdd.htm

For the FDA's most recent update on this subject, continuing to urge physicians and caretakers to use caution in giving anti-depressants to children, see;
www.fda.gov/bbs/topics/ANSWERS/2003/ANS01256.html

[Jorgy]

I DO know that there is research that depressed adults and CHILDREN have suicidal ideations when NOT treated. Children HAVE comitted suicide due to undiagnosed and untreated depression. As to antidepressants not being effective in children, I may have not read ALL the studies but I live the life! My son is much better on Wellbutrin than off. As I work for doctors I do know that they could care less about drug company clout and money and do care about doing the best for thier patients. And no, they do NOT recieve "kickbacks" from drug companies for " merrily handing out" thier drugs. Seeing some of this mis information makes me ANGRY Sue

[AnneM]

My son takes St Johns Wort .... he started last December. All I can say is that his whole attitude and 'joie de vivre' (sp?) has improved ten-fold since he started this .... If a child has depression they NEED help ... to IGNORE it and not give the required help can in some instances be fatal at worst and downright miserable at best...

[mskris]

Jorgy: I totally agree!! However, I did look at the links, and they are legitimate FDA advisories.
I think the main issue is that so many medications are used for off-label indications - ie, a medication is approved by FDA for MDD (major depressive disorder), and a physician uses it in a child with ADHD or OCD - this is legal, but the fact is that the drug wasn't tested in that patient population with a control group. So adverse effect reports are difficult to interpret and to assess whether the event is actually related to the medication, the underlying disease, or some other factor.

Also, for many years, drugs were tested in only adults (primarily males, too). Physicians took educated guesses at dosing, etc. with meds in pediatric patients. More recently, FDA has asked for testing specifically in pediatric populations, and even more so in women. So more data are now available, but it's a long process...

In the meantime, it seems that FDA is just being cautious. CNS/psych disorders are notoriously difficult to diagnose/treat and there are few treatments available that have been proven efficacious. I see no problem with FDA suggesting caution. As I recall, there were a number of incidents of children receiving paxil who experienced suicidal ideation as an adverse effect - however, again, that's also a symptom of MDD to start with, so....it's up in the air.

Kris

[Jorgy]

Kris, I'm sorry it is not the research that gets me hot under the collar. I looked at it and it is legit. I have been also trying to find legit studies on long term effects of stims. What bugs me is the perception that the medical field in general loves to hand out meds. Believe me it doesn't . Unfortunantly we live in a sue happy world so doctors and nurses live by the saying "cover your butt". Everything possible is presented to the patient and he/she has the choice of treatment. It is unfortunate also that people think that "popping" a pill can take care of everything. Oh man! I'm on my soapbox again! I'll get off ;D. It will be very interesting to see the long term research but I also have to look at the here and now problem with my son.

[crillmom]

i keep thinking that those poor children who had suicidal thoughts had them because the treatment (anti-depressasnt) was not working not because of the treatment. In our own situation I can not even imagine the ramifications if we did not treat. I feel so fortunate that the treatment works so well for my son that he is able to live life as a "normal 9 year old" and able to live his life to the fullest. To me treating him with meds was the best decision ever for him.

[swmom]

We were on Paxil, not for depression, but to help my daughter gain weight and sleep better while on Adderall. We saw the FDA warnings, became concerned, asked the doctor WHY we were on a medication that had an FDA advisory on it! The doctor
wouldn't acknowledge the FDA warning but said to us
"If YOU'RE concerned about Paxil, you can take her off and here's how." I couldn't believe they didn't IMMEDIATELY find other meds for all their patients who were on Paxil. What's the deal? I had to wonder if there wasn't some financial incentive for them to keep their patients on this drug. In this particular instance, they clearly did not act in the patient's best interest.
We took her off as fast as we possibly could!!!!

[BBW4EVR1]

My turn-

First, be informed! Doctor's can only tell you what is available-you need to make the decision! Just because a doctor says something could help, does not make it so. Doctors are human beings--not God! Far too often if something doesn't work, we blame the doctors!

We complain that schools blame us parents because our kids have ADD/ADHD and how they behave. It makes us furious. We expect the teachers to be informed and it is not even their children! Yet, we are doing the same thing to doctors that the teachers do to us. We are blaming the doctors for all things evil in the world! Doctor's can and do make mistakes! Believe me, we know, our son is proof of that! But it was our choice not to listen to a particular doctor--because we didn't feel comfortable with what she was doing with our child. One bad doctor, does not however taint the whole crew. Please don't generalize and make statements that are generic. Like most teachers, most doctors are there to help and will go the extra mile for their students and patients. Don't look for someone to blame, move on, the goal is too help our kids, not play the blame game!

I might as well apologize now if I stepped on anyone's toes--that is not my intention. I sometimes use that same "soapbox" Jorgy does! OK- I am done!

[mskris]

SWMom: Just because there is an FDA advisory does not mean a particular medication isn't right for a particular person. FYI - I have taken paxil for 6 years and have had no adverse effects (except for the ramping up stage when I was sleepy and had dry mouth). There's no reason to panic, although if you prefer not to use that for your child, you should definitely speak up.

The FDA has declared any incentives to doctors to use particular drugs illegal. Sales reps can't even take a doc to dinner anymore or give holiday gifts, etc (this used to be common practice). So there isn't any incentive for a doc to prescribe a particular product over another.

However, there's no reason for a doc to withdraw a prescription med from all his/her patients just because of a warning or precaution. Most meds have warnings/precautions in their labeling. Unless the patient is experiencing problems or adverse effects, why make a change that might cause more problems?

Kris

[geewiznit]

My daughter has been on Paxil for years for OCD, with no adverse effects except for some activation, and I wouldn't dream of taking her off it. We know it's not causing her any problems, and it is important to her mental health. If, however, she were taking Paxil for depression, the recent press would make me have a discussion with her doc, but I still wouldn't ever rush to drop a med that was working. They're too hard to find!

[sassysmom]

The statement that "anti-depressants are no more effective than placebo" makes me crazy! I KNOW my daughter's depression was lifted because of the Zoloft she has been taking. She is monitored closely and attends counseling sessions, but the medication is what worked for us. When you're faced with a child who is having suicidal thoughts, telling them to stop just doesn't cut it.

[eaccae]

First - I want to point out the the articles catatonic attached mention that Paxil was of concern for MDD (not other disorders) in CHILDREN (not adults). I don't think catatonic was suggesting that those of us who have children that suffer from bipolar or depression shouldn't medicate our children - but wanted to share her knowledge on the information she came across.

I agree that we have to medicate our depressed children because the alternative is far worse. I grew up with a bipolar father who only went on lithium about 8 years ago. I can't even go into what that was like. I do think it is good that the FDA is doing studies on this. There really needs to be more research on depression with children - both on the diagnosis front (it can be very hard because often times the sympotms in children differ with those of an adult with the same problem) and the medical front. Lithium - which does a great job for helping manic depression (aka bipolar) does a great job with a majority of adults (I have SEVERAL family members with bipolar who are taking this with great success). But recent studies have shown that in children under 7 years old it can permanently affect the CNS. There maybe something with Paxil that reacts with severely depressed children. There may be nothing at all. But it is good that they are doing research. And I guess - reading these articles - if I had to medicate my child for depression I might look at another drug before Paxil to treat depression.

Remember - the articles regarding Paxil were about pediatric MDD - not anxiety or OCD. (I also do find it interesting that the only medication that is actually approved for pediatric MDD is prozac).

[sierra]

All I got to say on the matter is that Lexapro was a godsend to Li'l Sprout during a bad time. Lexapro isn't Paxil but it's a distant relative.

I'm dang glad his psychiatrist was able to prescribe it for him. I'm not sure how we'd have got him out of the rafters that year.

There's a lot wrong with drug companies and there's a lot wrong with the FDA. But some of these medications have made huge differences for both children and adults. They don't get a say in these weighty decisions. They just get affected maybe for good and maybe for ill.

I'm about to haul out the soapbox here. You might want to cover your ears.

I don't think bureaucrats should make medical decisions whether the bureaucrats work for insurance companies or government agencies or drug companies or are elected officials. Too much medicine gets practiced without the appropriate education in this country.

Done now. That vent should hold me for a few weeks.

[LitlBaa]

One of my favorite research tools is called "Nurses Drug Guide". I just got the 2004 version. It has everything you ever wanted to know about prescription meds (and a few things you didn't). While I trust doctors to a point, I will look up anything that's prescribed for any of us before I fill the prescription. My husband got it for me at either Borders or Barnes and Noble, I don't remember which.

[Jorgy]

Mary, That is a great resource. No nurse would be without it. You will find it in hospitals and clinics in the nursing areas. Sue