Antidepressants in children: researchers vs. psychiatrists

A small handful of researchers, and the FDA, are skeptical about prescribing selective serotonin reuptake inhibitors to children and teenagers. First, the point of view of the researchers.

Gingrich used mice that were genetically altered so that they lacked the ability to mop up serotonin. They were—in effect—born on Prozac. He wanted to see how depression was related to serotonin and norepinephrine, another neurotransmitter. “Our simple-minded idea was these mice would look like mice treated chronically with Prozac,” Gingrich says. They should have been free of anything like a mouse’s version of depression or anxiety.

Gingrich found quite the opposite. Because he could not chat with them about their feelings, he gave the mice stress tests. (An inability to handle stress is one hallmark of depression.) He put a small electric charge on the floor on one side of their cage. Normal mice will quickly learn to escape the tiny shock by running to the other side. These mice did not. “They have a tendency to freeze,” he says. “They stay on the same side where the foot shock is being administered, or they escape much more slowly.” The mice—­despite having lived their entire lives as if they were on Prozac—were afflicted with what looked suspiciously like an anxiety disorder.

Now, fair and balanced, the psychiatrists…

Even in the face of this evidence, however, many psychiatrists believe that antidepressants do far more good than harm in children and teens. Like Emslie in Texas, Harold Koplewicz, a professor of psychiatry at New York University and one of the city’s top child psychiatrists, has been using SSRIs aggressively in children and teenagers for more than a decade. “I am probably the first person to give these meds to kids clinically,” he says. As recently as a few years ago, most psychiatrists thought they should try talk therapy with kids before giving them medication. But that has changed, he declares.

He has seen what happens to teenagers who are not treated. “After they’ve had one episode of depression, they’re 60 percent more likely to have another. If they have two, they’re 90 percent more likely to have a third. And subsequent episodes are more difficult to treat…. Every good clinician will tell you the risk of not taking the medication is greater” than the possible risks of taking SSRIs.

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