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Key Issues about childhood depression and recent
findings
- Pediatric depression is a real
illness and treatment is effective. In the United States, depression is
responsible for over 500,000 suicide attempts by children and adolescents
each year. Untreated depression carries significant rates of impairment and
risk.
- Currently, fluoxetine (Prozac)
is the only antidepressant approved by the FDA for use in pediatric
depression (i.e. children and adolescents). The prescribing of all other
antidepressants in children and adolescents for any use is categorized as
"off-label" use.
- To date, only fluoxetine
(Prozac) has been shown to be clinically effective with depressed
adolescents in two carefully designed research studies.
- From the FDA's review of
antidepressant studies involving 4,400 children and adolescents, they
concluded that all the SSRI (including fluoxetine) and other newer
antidepressants could increase the risk of suicide-related thoughts and/or
self-harming behavior in some children and adolescents (78 of 4,400
patients). The FDA analysis identified the average medication-induced risk
to be 4% compared to 2% for a placebo. This means that statistically, 4
children adolescents out of 100 patients treated might show an increase in
suicide thoughts due to the antidepressant medication. The
medication-induced risk is greater when starting or adjusting the dose of
these antidepressant medications.
- In the 24 studies reviewed
involving children and adolescents taking SSRI antidepressant medications,
there were no deaths. Also, none of the patients with increased suicidal
thoughts or behavior went on to commit suicide. New research in the
treatment of adolescent depression (Treatment for Adolescents with
Depression Study - TADS) demonstrates that the combination of therapy
(cognitive behavioral therapy) and antidepressant medication (fluoxetine)
results in successful treatment (71% of depressed adolescent patients
responded positively to the combination treatment compared to 35% of
patients on placebo).
- In spite of the "black box
warning", the FDA has not taken a position that SSRI and other new
antidepressants are contraindicated in children and adolescents. Therefore,
these medications (9 listed above) can continue to be prescribed for
children and adolescents if rational prescribing principles are followed.
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