Does your troubled teen need anti-depressants?
Adolescents can be notoriously moody. Anything from a lack of sleep to a fight with a best friend can cause teens to grow sullen and despondent.
But when moodiness turns to a deeper depression, worried parents wonder what to do, especially with all the alarming headlines about the dangers of antidepressant medications.
Several recent studies have questioned whether antidepressants are effective or even safe for children and adolescents. But Bart Main, MD, a psychiatrist at Cape Cod Healthcare’s Centers for Behavioral Health, said many of the studies are inaccurate and misleading.
The research may have actually contributed to more teen suicides, according to Dr. Main, since one study led public health officials to require label warnings that dissuaded some doctors from prescribing antidepressants to teen patients who needed them.
One meta-analysis study, published in The Lancet this month, suggested that most antidepressants were ineffective for those 18 and younger. Only fluoxetine (Prozac) was deemed to show more benefits than risks.
Another study, published earlier this year in The BMJ, concluded that children and adolescents taking antidepressants had double the risk of aggression and suicide than those who weren’t taking meds.
Those studies are inaccurate, misleading—or worse, said Dr. Main, who specializes in adolescent care. He said the study published in The Lancet was unfairly skewed by an incredibly high rate of 40 percent to 50 percent positive placebo response.
Placebo, from the Latin word placere (“to please”), refers to clinical trials in which patients are receiving simulations of medical treatments they believe to be the real thing. Patients given the placebo reported an unusually high rate of a lessening of symptoms of depression the study found.
“The evidence is weak in terms of statistical analysis when you have such a high placebo response rate,” Dr. Main said. “It’s hard for an antidepressant to beat that.”
The BMJ study about the suicide rate doubling for adolescents on antidepressants is not only flawed but dangerous, he said.
A similar study in 2003 led the U.S. Food and Drug Administration to require pharmaceutical companies to put a “black box warning” on all antidepressants, informing patients that taking these meds could cause an increase in suicidal thoughts or behavior in adolescents. A black box warning is the most serious warning that can be placed on prescription medications.
The results were almost immediate, Dr. Main said. Doctors didn’t want the liability of prescribing antidepressants that might lead to suicide, so they stopped prescribing them to young people.
“In that year, the prescribing rate for antidepressants in the teen age group dropped 25 percent,” Dr. Main said. “The death by suicide rate rose 18 percent. As far as I’m concerned the public health decision to put that warning on the label killed 18 percent more children.”
Even the wording “double the risk,” while technically true, is inflammatory, he said. The risk wasn’t about actual suicides, but increased suicidal thoughts. The risk of suicidal thoughts ranged from 2 percent in adolescents who were not taking antidepressants to 4 percent in those who were.