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FDA Public Health Advisory - requires black box warnings on SSRIs for teens and children

Dr. Michael Hogan - Director, Ohio Department of Mental Health

Dr. Ellen Rome - Cleveland Clinic

Center for Disease Control - more than 40-percent Americans using prescription drugs

Psychology Today - "Teen Depression - Boys"

Psychology Today - "The Pill Paradox"

Psychology Today - homepage - "Antidepressants: Medicine for Depression" - "Should Children Take Antidepressants?"

Julie Grant
Teenagers: The Millennial Generation and Prescription Drugs
More High Schoolers Today are on Anti-Depressant Medicines

Thursday, December 9, 2004

Alcohol use among teenagers is down, marijuana use is down, and so is cigarette smoking. But today's high-schoolers still may be the most drugged generation yet. Many of them went through elementary school taking Ritalin or other drugs to combat A-D-D. Now in high school, more and more are taking prescription medicines.

WKSU's Julie Grant reports:

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A new government report shows a sharp increase in the rate of drug prescriptions for children and teenagers in recent years. But the director of the Ohio Department of Mental Health says most kids still aren't getting the help they need for depression and other psychological disorders:

HOGAN: "...because the number of children with these problems is huge."

Dr. Michael Hogan was chairman of President Bush's Commission on Mental Health in 2002. He says one in five kids has some mental health disorder, such as anxiety. One in ten has serious enough psychological problems that it affects their schoolwork and home life:

HOGAN: "And about one in 20 children, about five percent of children, develop a problem that is so serious that it really puts them at great risk of suicide attempts or other serious problems. It's sort of the mental health equivalent of pneumonia."

Hogan says more Americans report feelings of depression today than forty or fifty years ago. He believes the new class of anti-depressant drugs can reduce the risk of suicide. Dr. John Duby is president of American Association of Pediatrics in Ohio:

DUBY: "If one looks back over the last 10 or 15 years at the rate of suicide in our country, it's dropped dramatically and one of the main reasons is because of the newer generation of anti-depressant medications that have become available during that time. We talk about Prozac and what it can or cannot do to people, but the truth is that since it was introduced in the early 1990s, and then its additional members of that same family of medications that we call the SSRIs have become available, we have done a much better job in identifying depression and anxiety in young people as well as adults."

20-year-old Ben is currently is currently a student at the University of Akron. When he was around 14, his parents divorced and he spiraled into depression:

BEN: "I remember just crying out of nowhere. I could be reading a book or checking my email or doing relatively normal things and all of a sudden just bursting into tears, which was a little odd for me to deal with."

But Ben says he wasn't alone. Depression provided an identity for lots of kids he knew:

BEN: "And I actually remember an awful lot of kids took great pride in how absolutely depressed they were. And it was really kind of sick. I remember a number of random little parties that I went to, where it was the guys in one corner complaining about girls, and the girls in one corner, listening to relatively depressing music, and complaining about their fathers. And this was what we thought we were supposed to be doing."

Ben thought his depression was worse then most kids and had his mom take him to a therapist. Then they decided to put him on Zoloft:

BEN: "That was my idea - an unfortunate one, 'cause, I mean, they're called mood-levelers for a reason. I mean, it doesn't make you happy, it's not Soma - it just makes you not care. And while that can be good for a short amount of time to give you a sort of more long-view sort of perspective, 'cause it does help for a minute to allow you to take yourself out of the tiny little moment that you happen to be living in constantly, and sort of assess what's going on around you. But, at least for me, the longer I was on it, and the more I ended up taking because my dosage kept getting upped, the less I was available for anyone around me."

Ben says the Zoloft was like a protective fog around him. He didn't feel depressed; he also didn't care about his friends or his homework anymore:

ROME: "Well, that's the wrong medicine for that particular kid."

Dr. Ellen Rome is head of adolescent medicine at The Cleveland Clinic:

ROME: "...just like with asthma medicines or a diabetes management plan, it can take awhile to get the right dose and the right amount and the right medicine. Different people react to different medicines in their own ways. For instance, I'll have one kid who may have to try three different SSRIs 'til they get the right one."

Rome says kids today have more pressures at school, are more likely to experience divorce, and have less family time. These things can contribute to depression. But she says kids are also getting more help then in the past:

ROME: "My practice, and I've been practicing in Cleveland for the past decade, I do not see things getting worse. I see parents and teachers recognizing it better. And that's a wonderful thing."

Many more kids are on anti-depressants now then a decade ago. One study shows that these drugs along with talk therapy helped 70 percent of teenagers diagnosed with moderate to severe depression. But some people worry that too many kids are rushed to drugs instead of learning to deal with problems. One Northeast Ohio mother was worried about her 16-year-old son after a breakup with his long term girlfriend:

MOTHER: "My child went through a whole range of emotions on it. When it first happened he felt not exactly suicidal, but he said things like, 'I feel like dying.'"

Her big, broad-shouldered son would cry unexpectedly and wasn't eating much. His grades dropped. She took him to talk to a therapist. After three visits, the counselor wanted to put him on anti-depressant medication to moderate his feelings:

MOTHER: "I was really surprised by that because first of all it seemed to me that it would be kind of normal to be depressed about a year long relationship that ended. And, the other was how quickly the counselor was willing to turn us toward medication rather than giving any psycho-analysis and just generally talking through the opportunity to see if that would work."

This mom decided against the drugs:

MOTHER: "What if this whole new range of chemicals comes in and affects their brain chemistry and their body chemistry so that the person that you end up with at 18, 19, or 20 is not the person that you would have ended up with?"

Her concerns about long term effects are shared by Dr. Ronald Dahl. He's Professor of Pediatrics and Psychiatry at the University of Pittsburgh:

DAHL: "I'm very skeptical about using pharmacologic interventions for complex things like emotions in kids with developing brains because for everything we understand there are several things we don't understand. There's lots of stories in medicine where we've improved things a little bit over the short run and it takes years to figure out what we're doing in the long run."

Dr. Rome at The Cleveland Clinic is confident that use of SSRI anti-depressants long term does not harm a child's brain:

ROME: "In fact, if it helps with school success, boy, the positive self esteem that can come with academic success or sports success or whatever activity success, can be so integral to helping get them to a healthy adulthood that I think there is more pluses then minuses."

But the Food and Drug Administration is concerned that SSRIs can sometimes cause suicidal thoughts and actions in children and teenagers. It recently ruled that anti-depressants should come with a black box warning on the label saying the drugs could cause suicidal tendencies. Dr. Hogan of the Ohio Department of Mental Health hopes the black box reduces unnecessary uses of the drugs:

HOGAN: "I am really concerned, though, that there are children who have depression who would have otherwise been helped who are not going to be prescribed this medication, and when you've got a condition like clinical depression which can increase the risk of suicide very significantly, kids are going to die because they don't have access to the medication as to opposed to them having it."

Hogan says the government's black box warning is a quick fix, when what's really needed is long term research on the effects of SSRIs on teenagers.