Archive for Friday, March 4, 2005

Antidepressants carry risks

March 4, 2005


I am writing in response to the Jan. 11 article, "Double take: Medication just one part of treating depressed teenagers," by Wes Crenshaw and Jenny Kane. I learned of the article from members of your community who were outraged by Dr. Crenshaw's statement that antidepressants are not dangerous for teenagers. I share their dismay at such an irresponsible comment in light of the FDA's historic 2004 warnings that antidepressants "increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents."

The FDA has said unequivocally that antidepressant-induced suicidality "is beyond the suicidality as a result of the disease." In October 2004, the FDA upgraded the warning for children and adolescents to the strongest warning possible: a permanent black box warning in the official prescribing guidelines for the drugs. Does Dr. Crenshaw really think that suicidal thoughts and behavior are not dangerous in children and adolescents?

Dr. Crenshaw states that the FDA warning applies to "most antidepressants," suggesting that some antidepressants are not associated with this risk. In fact, the FDA warning applies to all 32 antidepressants on the market in this country. Dr. Crenshaw says that at his clinic, "we never prescribe these medicines to anyone without a follow-up in two to four weeks -- and at least monthly thereafter." But the FDA recommends much closer monitoring of children and adolescents given the dangers involved: "at least weekly face-to-face ... during the first four weeks of treatment, then biweekly visits for the next four weeks, and as clinically indicated beyond twelve weeks." Is Dr. Crenshaw aware that the monitoring his clinic apparently provides falls below the standard recommended by the FDA?

Dr. Crenshaw fails to mention that repeated studies have found that most antidepressants are not effective in children. The only antidepressant approved by the FDA for depressed children is Prozac. The antidepressant most widely prescribed to depressed children is Zoloft. But, Zoloft is not approved by the FDA for depressed children and two studies have found Zoloft is no better than placebo (dummy) pills for depressed children. Indeed, a recent study found that as many as 89 percent of prescriptions for antidepressants for children and adolescents are for conditions not approved by the FDA. When considering antidepressants for children and adolescents, the risk-benefit ratio simply does not support Dr. Crenshaw's statements.

For decades, pharmaceutical companies and drug advocates have denied antidepressant-induced suicidality. The new FDA warnings are vital to keeping our children safe. Comments like Dr. Crenshaw's set back the progress we have made and need to be confronted.

Dr. Joseph Glenmullen is a clinical instructor in psychiatry at Harvard Medical School and author of "The Antidepressant Solution."

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