Los Angeles Times | Saturday, May 1, 1999
The Food and Drug Administration has yet to approve the use of Prozac-type antidepressants for patients under age 18, but that hasn't stopped physicians from prescribing the drugs at their own discretion, as they are legally entitled to do. According to the drug research firm IMS Health, the number of patients under 18 receiving prescriptions for the three most common antidepressants -- serotonin-based drugs called SSRIs--more than doubled between 1994 and 1997.
These relatively new drugs are unquestionably helping some children function better at school and home, but there are also growing signs that doctors have come to prescribe them too readily.
The latest sign is a study to be released today at an international pediatrics convention in San Francisco. It suggests that a majority of family physicians and pediatricians are treating children with SSRIs for even mild conditions, despite a lack of scientific evidence of the drugs' safety and efficacy. Of the 597 family physicians and pediatricians surveyed by pediatrician Jerry L. Rushton and his research team at the University of North Carolina, 72% acknowledged prescribing SSRIs to patients under 18 and 57% said they had prescribed the antidepressants for conditions not traditionally associated with depression, like bed-wetting and conduct disorder.
Most doctors agree that in adults, the SSRIs are safer than many other common prescription drugs. Nevertheless, the long-term effects of SSRIs on children's sensitive, developing brains are only now being studied, no clear age and dosage guidelines exist and the general practitioners who are prescribing them often miss side effects like agitation and nervousness that psychiatrists are trained to spot. Most of the pediatricians and family practitioners who told Rushton they had prescribed antidepressants to children admitted feeling uncomfortable with the practice.
Most of the medical questions highlighted by the study are relatively easy to address with proper federal oversight. The Food and Drug Administration should require drug companies to test their drugs for children using the so-called "gold standard" of scientific research: double-blind, placebo-controlled studies wherein unbiased researchers compare one drug against a sugar pill or placebo, instead of against another drug.
The FDA should also require drug companies to make their studies public, so parents themselves can consider the companies'often-inflated claims of effectiveness.
The cultural problems highlighted by the study cannot be resolved so easily. Studies suggest that some time-crunched parents and HMO doctors might find it easier to medicate children than to talk to them long enough to explore potential sources of their troubles. It's probably no coincidence that from 1989 to 1996, when the percentage of children with attention-deficit disorder receiving psychotherapy dropped from 40% to 25%, the percentage of such children receiving the stimulant Ritalin jumped to 75% from 55%.
Today's cornucopia of new drugs can work wonders. But adults--from pediatricians to parents -- should remember that children's problems are often rooted not only in their brains but in their lives.
Prescribed for Children
Prescriptions writen for the three most common serotonin-based antidepressants -- Prozac, Zoloft and Paxil -- for ages 6-18:
Source: IMS Health\ Copyright 1999 Los Angeles Times. All Rights Reserved