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Adolescents And Antidepressants

Approximately two years ago, the Food and Drug Administration (FDA) asked manufacturers of all antidepressants to include warnings on their labels about the risk of suicidality, especially in teenagers. As a result, a great deal of controversy has swirled around the topic of using antidepressants to treat major depression in adolescents.

According to Charles Staunton, MD, former associate medical director for Butler Hospital's Child and Adolescent Services, the FDA’s intention was to advise mental health professionals, as well as parents, that teenage depression is a serious illness that requires comprehensive and continuous management. In retrospect, Dr. Staunton says, the warning may have been premature and not based on sound scientific evidence.

Since the warning was issued, there has been increasing attention on the issue of depression in teens as well as the use of antidepressants in the treatment of their depression. Until the past year or so, data on the subject of comprehensive scientific investigation of teenage depression has, according to Dr. Staunton, “been lacking.”

“The FDA’s initial warning was based on tragic stories provided by families whose youngsters had attempted or committed suicide while under psychiatric care,” says Dr. Staunton. “The FDA was correct in stressing that any treatment of adolescent depression should only be done after a careful and thorough evaluation under the supervision of a trained psychiatric professional. Recently several scientific studies have been completed that have proven to be of great assistance to both mental health professionals as well as patients and parents."

Dr. Staunton notes that one recent multi-site research project titled, The Treatment for Adolescents with Depression, or TADS1, looked at the effectiveness of two types of interventions in treating teenage depression. The study focused on cognitive behavioral therapy (CBT) and the use of Fluoxetine (Prozac) in management of adolescent depression.

There were three categories of interventions: medication alone, CBT alone, and the combination of CBT and psychopharmacology using Prozac. Dr. Staunton explains that there were 349 teenagers with depression in this study. The results convincingly showed that the combination of CBT and antidepressant medication was superior to using either of the interventions alone. Dr. Staunton says only 1.6 percent (7 out of 349 depressed teenagers) attempted suicide, and there were no successfully completed suicides.

Dr. Staunton also reports that another recent study, Antidepressants and Youth Suicide in New York City, 1999-2002, also shed significant light on the issue of antidepressants and teenage suicide.

In this study, autopsy results for 41 individuals younger than 18 years of age in New York City who committed suicide between 1999 and 2002 were studied. Of these 41 adolescents, 36 were given a toxicological analysis. The analysis showed that only one person who committed suicide had evidence of antidepressants at the time of death. The researchers concluded that “the detection of antidepressants at autopsy was quite rare in youth suicides in New York City from 1999 – 2002.”

According to Dr. Staunton, the results of the New York research are extremely similar to those of the TADS study. He believes that the problem of teenage depressiveness is probably more widespread and serious than previously recognized. Fortunately, he says, there seems to be increasing scientific data indicating that the illness of depression in adolescents is serious but that the risk for suicidality is likely not compounded by the use of antidepressants in the treatment of serious depression.

“The two studies that I’ve mentioned are good examples that indicate why carefully conducted scientific study of adolescent depression and the use of medications in treatment needs to continue,” Dr. Stauton explains.

Dr. Staunton is hopeful that future studies will yield even more useful and conclusive results on the topic. As for now, the two studies he mentioned seem to support the belief held by some clinical professionals that teens who are not treated for major depression run a far greater risk of attempting suicide than those who are treated with psychotherapy and antidepressants.

1. Fluoxetine, Cognitive Behavioral Therapy, and Their Combination for Adolescents With Depression, Treatment for Adolescents With Depression Study (TADS) Randomized Controlled Trial, JAMA, 2004;292:807-820.

2. Antidepressants and Youth Suicide in New York City, 1999-2002, JAMA, August 18, 2004—Vol 292, No. 7 (reprinted).

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