Antidepressants do help children and we should be slow to allow research to change clinical practice, argues Nicholas DeMartinis
The debate on the use of antidepressants in children has focused on tragic stories of suicide, findings of increased suicide risk and the ineffectiveness of antidepressants for childhood depression.
Indeed, the US Food and Drug Administration (FDA) is now requiring warning labels that antidepressants can increase suicidal behaviour in children - similar warnings are required in parts of Europe including the Republic.
This focus on negative outcomes, however, goes against the experience of the majority of physicians who have prescribed antidepressants to children. These good outcomes were recognised by the FDA, which did not prohibit the use of antidepressants in children.
Despite the findings from pharmaceutical industry studies, research conducted in clinical settings suggests that antidepressants are safe and effective for the treatment of depression in children.
A recent study of antidepressants and suicide in Britain, for example, examined the suicidal behaviour of newly diagnosed depressed children. None of the almost 7,000 children treated with antidepressants committed suicide.
Also, none of the more than 2,200 children treated with antidepressants in pharmaceutical industry studies examined by the FDA committed suicide.
Another recent study revealed that the rate of adolescent suicide has significantly decreased as the use of antidepressants by adolescents has increased in the US. Tens of thousands of depressed children have been safely treated with antidepressants in clinical settings.
The effectiveness of antidepressants for treatment of depression in children has also been demonstrated in clinics by thousands of physicians worldwide who have directly observed the course of treatment.
In addition, a large study funded by the US government recently found that both treatment with Prozac and treatment with Prozac plus therapy were effective for childhood clinical depression.
This US government study also found psychotherapy without medication was ineffective for childhood depression.
However, those of us treating patients know from our clinical experience that therapy is very beneficial.
It wouldn't make sense to stop offering therapy as a treatment to depressed children because some research studies failed to show it helps.
An important point missed in much of this debate is how much trust can be placed in the findings of research studies when they clearly go against clinical experience and even common sense.
When I was in medical school, the use of pain medications for infants undergoing minor procedures was being debated. Research showed that pain pathways in infants' nervous systems were underdeveloped and that the risks of using medications outweighed the minimal benefit.
It was believed that the squirming of infants undergoing potentially painful treatments was merely a reflex, not an indication of suffering.
Of course, years later we know that those research findings were wrong, and today pain medication for infants is routine. Similarly, children whose depression is left untreated because of overemphasis on risks of treatment will also be exposed to needless suffering.
Great care must be taken when using research findings to change clinical practice. Depressed youngsters starting antidepressants should be encouraged to share any feelings or thoughts of suicidal behaviour.
Their families and friends should be vigilant in monitoring them for any signs of suicidal tendencies early in treatment. With treatment and careful monitoring, the terrible burden of clinical depression and the risk of suicide can be eased. Relying too much on research findings that go against clinical experience carries its own risks.
• Nicholas DeMartinis is assistant professor in the Department of Psychiatry at the University of Connecticut Health Centre. - LA Times-Washington Post Service