Medication & Melancholy
Unraveling the jumble of data on depression, drugs, and kids
Her journal entries practically sparkled with the hopes of any happy 12-year-old. And while Candace Downing's school worries may have been excessive for a perennial honor student, her luminous enthusiasm endeared her to everyone. Still, as sixth grade wore on, her normal need to achieve morphed into generalized anxiety disorder. Her psychiatrist said not to worry: The condition could be alleviated by a low dose of Zoloft and regular therapy visits.
Ten and a half months later, on Jan. 10, 2004, her mother, Mathy Milling Downing, found Candace hanging from the valance over her bed in their Laytonsville, Md., home. "There was never a note," Downing says, her words choked by tears. "An hour before, she was on her father's lap watching Animal Planet. This is what these drugs do to children."
Contrast the Downings' tragic story with that of Sherri Walton. Each of her three daughters has obsessive-compulsive disorder, and her oldest girl, Jordan, also struggles with depression. When she was 13, she sobbed to her mother, "I am a horrible person. I just want to kill myself." Walton realized that Jordan was not simply experiencing the puberty blues but was in the midst of a serious depression. A psychiatrist prescribed antidepressants, and after a month Jordan began to feel better.
During the past year, parents have been engulfed in information about the effectiveness and safety of using antidepressant drugs with children. Some reports say the drugs--called selective serotonin reuptake inhibitors, or SSRI s--are the best medicine for debilitating melancholy, while others say the drugs paradoxically increase the risk of suicide in young people. This scientific debate is what brought both Walton and Downing to hearings at the Food and Drug Administration. While Downing sat crying in the audience three weeks following Candace's death, Walton came to tell a positive story. She explained how this "beautiful 14-year-old was functioning and happy with life because of these meds." For Walton's family and others, the same drugs that others decry have created a normal life.
These are just two faces of the suicide and antidepressant debate: one, tear-stained and scarred by grief; the other, full of hope and relief. And in between these agonizing extremes are concerned doctors like John March, professor and chief of child and adolescent psychiatry at Duke University, who says: "It is very difficult in the cacophony of voices to discern the story that the data is telling us."
Fine lines. or some, the suppressed data from the pharmaceutical companies that suggested increased rates of suicide in people taking SSRI antidepressants made an irrefutable case for never prescribing these drugs to children. For others, subsequent research pointed to a direct correlation between increased prescriptions for SSRI s and decreased rates of suicide. But there are finer points of debate, like the differences between suicidal thoughts, suicide attempts, and actual suicide. How to calculate the benefits with the risks of antidepressants? Have antidepressant prescriptions overlooked both the fragility and the variety of children's brains?
It has not quite been a year since the FDA told manufacturers of antidepressants to place a black-box warning on the drugs, saying that antidepressants can cause suicidal actions in children and adolescents. Recently, the FDA modified its warning, saying the drugs "increased the risk of suicidal thinking and behavior in short-term studies of adolescents and children" with depression. Medco Health Solutions, a company that manages pharmaceutical benefits for employers and healthcare organizations, looked at the trends of how many patients under the age of 18 took the SSRI s from 2003 through 2004. It noted that from November to December 2004, after months of controversy, the number of children and adolescents taking antidepressants had decreased by 16 percent, compared with the same period the year before.
advertisement
