Healthy Skepticism Library item: 5263
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Wasowicz L.
Ped Med: The Anti-Depressant Dilemma
Red Orbit ( from UPI) 2006 Jun 21
http://www.redorbit.com/news/health/546096/ped_med_the_antidepressant_dilemma/index.html?source=r_health
Full text:
Ped Med: The Anti-Depressant Dilemma
By LIDIA WASOWICZ
With the older tricyclic anti-depressants generally deemed unsuitable for the young and depressed, treatment of this age group most often relies on the so-called selective serotonin reuptake inhibitors.
Of this class, Prozac is the only drug approved for such use.
Because they specifically target the brain levels of the feel-good neurochemical serotonin, SSRIs present fewer side effects than their predecessors — though not few enough to satisfy their critics.
Widely touted as safer than the tricyclics that came before them, SSRIs are less likely to prove lethal even in large quantities, doctors say.
The downside is that, with decreased worry of a fatal overdose, the risk of overuse rises while attention to monitoring declines, critics say.
A Food and Drug Administration warning, in fact, calls for minimizing the dosage to lessen the risk of an overdose and maximizing follow-up of young patients to lower the odds of unwanted consequences.
SSRIs are overprescribed because they were believed to be safe and the drug companies do such an incredibly effective marketing job, said Peter Goldenthal, a Wayne, Pa., pediatric and family psychologist.
I see a lot of really young children who someone else would encourage prescribing drugs for; when you take the sweet young children off the medication, it’s clear it’s not doing anything, he said.
I also see adolescents who, without medication, would be in deep trouble, he added. For a 17-year-old, who is close to being an adult and who really has bipolar disorder and not the diagnosis de jour, it can be lifesaving.
But only if the medicine is properly applied and the patient adequately supervised, doctors say.
With SSRIs, it’s easy to write a prescription and say, ‘Come back in three months,’ said Donna Palumbo, associate professor of neurology and pediatrics at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.
The temptation is all the greater for time-pressed primary-care providers who now see the majority of depressed patients, she said.
But specialists know that’s not how to treat depression, she said. Patients change moment to moment, whether they’re on medication or not.
This scenario sets the stage for a raised risk of suicide, cautioned Dr. Julio Licinio of the University of California, Los Angeles, whose study tracked an overall decline in suicide rates since the SSRIs came on the market scene.
When people start antidepressant therapy, the first symptom to be alleviated is low energy, but the feeling that life isn’t worth living is the last to go, he said.
Prior to taking SSRIs, depressed people may not have committed suicide due to their extreme lethargy, he said, explaining one commonly held theory. As they begin drug therapy, they experience more energy, but still feel that life isn’t worth living. That’s when a depressed person is most in danger of committing suicide.
Although the increased possibility of suicidal tendencies has attracted the most public attention, it applies to only a small minority of antidepressant users.
Greater numbers may be prone to suffering other ill effects from the drugs, which, despite their reputation of superior safety, do not come risk-free, researchers say.
A two-year review of the medical records of 82 children and adolescents treated with an SSRI at Massachusetts General Hospital for depressive or obsessive-compulsive disorders found 22 percent experienced psychiatric adverse effects, most commonly related to disturbances in mood, within three months of treatment.
The rate went up to 44 percent for those who restarted taking the drugs.
Overall, 74 percent of the young patients had an adverse reaction to an SSRI over the course of their therapy, the authors reported.
Other research indicates some 60 percent of minors can benefit from antidepressants without suffering serious complications, although there is debate over how much of the gain might be attributable to the placebo effect that could just as easily be obtained with a sugar pill or simply to time’s healing touch.
Most children get better anyway for other reasons, said Michael Conner, a Bend, Ore., clinical psychologist, researcher, director of the nonprofit Mentor Research Institute and author of Crisis Intervention with Adolescents; A Guide for Parents and Professionals, (AuthorHouse, 2006). The results are often ‘lumped together,’ which makes the benefits of antidepressants look better than they actually are.
Whatever the true source of relief, a finding that some 60 percent of children taking antidepressants improve with few or no side effects presumably suggests the other 40 or so percent gain no advantage from the drugs or do so at a cost.
Temporary and/or mild side effects may include insomnia, rashes, headaches, joint and muscle pain, stomach upset, nausea or diarrhea, doctors say.
A more serious potential complication presents itself when reduced blood clotting capacity opens the way for stomach or uterine bleeding — a risk that doubles when SSRIs are mixed with certain painkillers, such as aspirin, ibuprofen, naproxen or COX-2 inhibitors, research indicates.
Most children have mild side effects managed by modifying the dosage, some may get sleepy or nauseous, some children may get agitated, but in general the medications are well tolerated, said child and adolescent psychiatrist Dr. David Fassler, a trustee of the American Psychiatric Association.
In genetically predisposed children, the drugs may raise the risk of mania or its less severe version, hypomania, according to one study.
A 14-month Yale University investigation found 8 percent of patients admitted to the Massachusetts General Hospital psychiatric unit in 2001 may have been suffering from mania or psychosis brought on by their antidepressant treatment.
Applied nationally, that would translate to some 150,000 possibly SSRI-induced hospital admissions a year, researchers said.
News reporters, bloggers and defense lawyers have made much of the possibility SSRIs may at times trigger deranged mental states conducive to murder or other acts of violence.
A review in the Journal of the American Academy of Psychiatry Law pointed out it is difficult to dismiss the anecdotal reports out of hand, but convincing scientific evidence supporting — or negating — such a connection is scanty.
Use of the involuntary intoxication defense will likely continue to grow alongside development and marketing of novel psychotropic medications and advancement in understanding of their actions and effects, the authors predicted.
Most SSRI users do not experience severe side effects, Licinio stressed.
My concern is if you list every possible side effect, people will say, ‘I’ll have all of these? Then, I shouldn’t take it,’ he said.
Next: SSRIs and suicide risk.
(Editors’ Note: This series on depression is based on a review of hundreds of reports and a survey of more than 200 specialists.)
—
UPI Consumer Health welcomes comments on this column. E-mail: lwasowicz@upi.com
Source: United Press International
