WASHINGTON – In 2001,there were 4,243 suicides among 10-24 year-olds.
A group of brain science experts said Wednesday it would like the federal government to help reduce that number and provide doctors with more options for treating children with depression.
The American College of Neuropsychopharmacology released a report that concludes common antidepressant drugs do not lead to suicide. But the group said the findings are preliminary because it does not have all of the available data.
“More definitive studies need to be done,” said J. John Mann,ACNP task force co-chair,at a news conference.
The task force urged the Food and Drug Administration and pharmaceutical companies to release all available data so more in-depth studies can be conducted. The FDA will discuss the issue at an advisory committee hearing Feb. 2. It does not release data on unapproved drugs,said Susan Cruzan,an FDA public affairs specialist.
According to the report,suicide is the third leading cause of death among 15-24-year-olds.
The ACNP task force report says depression occurs in 10 percent of youths annually and most cases of depression are untreated and undiagnosed. Mann said most suicides occur when depression goes untreated.
The antidepressants in question are selective serotonin reuptake inhibitors,or SSRIs. Included in this group are drugs such as Prozac and Paxil. Prozac is the only SSRI approved for children under 18,Cruzan said.
But Prozac is not the only SSRI commonly prescribed for children,said Jennifer Hartstein,director of the group psychotherapy program at Montefiore Medical Center in New York.
“I don't think anything works alone. Most things work in combination,” Hartstein said. “I do feel that others should be approved,especially since without the approval they will be used anyway.”
The use of medications for conditions that have not been officially approved by the FDA is referred to as “off label use,” and is quite common,said Arthur Schlosberg,associate professor in the doctoral clinical psychology program at Argosy University's Atlanta campus.
It's a gray area,he said,and could lead to legal problems for doctors.
“In an extreme example,say we're going to use Vaseline to treat cancer. Let's say the Vaseline is medication. There's not literature to support it,” Schlosberg said. “Someone could say that's malpractice because there's nothing to support it.”
One main problem in pediatrics is that few clinical studies look at adverse reactions,Schlosberg said.
“If people don't understand (off label use),it can be quite alarming,” Schlosberg said. “When dealing with children,you can really appreciate some of the problems because who wants to have children participate in a lot of these research studies?”
Graham Emslie,task force co-chair,said SSRIs are effective as a group in treating depression. He said there is a need for alternative treatments because people respond differently to certain medications.
“There's no question that children have been disadvantaged in terms of the research effort in trying to evaluate treatments of all sorts,” Mann said. “And we're just seeing kind of a catch-up effort going on and it needs to continue and be expanded.”
In trying to offer the best treatment of depression in youth,Mann said looking at the similarities,differences and side effects of drugs is important. He said testing SSRIs on adolescents is better than not trying them at all.
“One is faced with a lot of potential criticisms for experimenting on kids,” Mann said. “But if we don't test these potentially valuable treatments on children,we don't know if they're going to work.”
Judith Lederman,co-author of “The Ups & Downs of Raising a Bipolar Child: A Parent's Survival Guide,” can attest to that. Her bipolar son was misdiagnosed with attention deficit hyperactivity disorder at age 8.
“He was put on Luvox (an SSRI) and Ritalin,a horrible combination for bipolar children, we found out later,” Lederman said.
Lederman's son experienced side effects,including thoughts of suicide and rage. She said he threw 10 pound weights at family members,tried to pull a menorah down in an attempt to set the house on fire,pulled the steering wheel in the car while she was driving and other dangerous things.
“The problem is that not all parents bring their child to a child psychiatrist to get medications. Many go to pediatricians,and they might not know what to diagnose,” Lederman said. “It is hard to find child psychiatrists,so you end up going to adult psychiatrists or a pediatrician.”
In writing her book,she said she spoke to hundreds of parents of children with mental illnesses who had similar experiences.
“It's heartbreaking to hear children talk about suicide,” she said. “To hear them say they want to be anywhere but here.”
Now 13,Lederman's son is relatively stable. He takes three medications,none of them SSRIs.
“Anyone who thinks that there's a happy pill for children with mental illnesses is misinformed,” Lederman said.