Antidepressants a Risky Rx for Kids

Giving antidepressants to children is controversial, but a new study suggests most of them are ineffective — except for one.

Children on Effexor (venlafaxine) experienced a higher risk of suicidal thoughts and attempts.

Prozac (also sold under the name Sarafem; the generic name is Fluoxetine) was more effective than 13 other antidepressants and a placebo in children and teens with major depressive disorder.

Dr. Andrea Cipriani, an associate professor at the University of Oxford in the U.K., published an analysis in The Lancet, covering 5,620 participants in 34 trials — the most comprehensive report available on the topic.

The research doesn’t mean Prozac is the only antidepressant that works, Cipriani told LifeZette.

Even if Fluoxetine should be the drug of choice, clinicians shouldn’t discard all other antidepressants. He stressed that physicians and mental health experts have to adapt to each patient using not only the best evidence, but also taking into account the values and preferences of the patients and their families.

“In some specific cases other drugs may work as well,” he said.

Children on other antidepressants that appear to be working shouldn’t change to Fluoxetine as a result of this study. If another drug hasn’t worked, or if a patient is trying medication for the first time, Cipriani said that is when it should be the medication of choice.

Otherwise, psychotherapy is the recommended first line of defense. “It is important to avoid a one-size-fits-all approach,” he added.

Major depressive disorder affects about 3 percent of children aged 6 to 12, and 6 percent of those from 13 to 18 years old.

He also found that children on Effexor (venlafaxine) experienced a higher risk of suicidal thoughts and attempts in comparison to five other drugs and a placebo. Pamelor (Nortriptyline) was “significantly less effective” than seven other antidepressants and a placebo pill. Tofranil (Imipramine), Effexor (venlafaxine) and Cymbalta (duloxetine) were lowest rated for tolerability.

Major depressive disorder affects about 3 percent of children aged 6 to 12, and 6 percent of those from 13 to 18 years old. In 2014, about 2.8 million children between the ages of 12 and 17 had a depressive episode.

It presents differently in kids than in adults; adolescents show irritability, aggressive behavior and problems at school. Cipriani said episodes are more dramatic because it impairs their social functioning and can cause more suicidal ideation and attempts.

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Dr. M. David Rudd, a psychology professor and president at University of Memphis, told LifeZette that parents need to monitor their children for side effects. If a child does not tolerate medication well, there are other psychotherapeutic treatment options.

“Perhaps most importantly, starting with what is known to be most effective, in this case Fluoxetine, boosts morale, compliance and recovery trajectory,” he said.