Medication & Melancholy
Unraveling the jumble of data on depression, drugs, and kids
Another problem with the research has to do with the lumping together of age groups. A 6-year-old ballerina cannot possibly be evaluated in the same way as a 17-year-old football player. The brain pathways of prepubertal children are profoundly different from those of older teenagers, as are the ways they metabolize drugs. That leads many psychiatrists to be very reluctant to prescribe drugs for younger children. The placebo effect is also far stronger in children than in adults. "When a child gets into a clinical trial where there is a tremendous amount of attention and nurturing, they get better," says Charles Nemeroff, chair of the department of psychiatry and behavioral sciences at Emory University.
The questions swirling around the use of antidepressants are also deeply connected to the stigma of mental illness. "People don't think that depression is a real illness," says John Mann, professor of psychiatry and radiology at Columbia University Medical Center and the chief of the department of neuroscience at N.Y. State Psychiatric Institute. "If this whole question arose over cancer in children and adolescents, we wouldn't be having the same kind of black-box warnings. We have three out of three studies showing that these drugs work."
Of course, this is all academic for those who are convinced of the drugs' perils. But for others, life without these medicines is perilous. That's what makes these decisions so troubling, says Duke's March: "There is no conspiracy, no villain here; everyone is coming at this from different points of view, and the system isn't working." The stakes are high: "If we are going to prevent adult mental illness," March continues, "we need to figure out a public-health strategy for our children."
FOR MORE HELP
The Web offers a number of resources to help parents, physicians, and children untangle some of the often confusing safety information about antidepressant drugs. The first of the websites listed below, hosted by the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association, concludes that there is no documented connection between childhood and adolescent suicide and the use of antidepressant medication.