Clinical Depression In Children. Should Children Get Mood-Altering Pills?
Q.There are no systematic long-term studies assessing the safety of using Prozac to treat children. In 2001, the average clinical trial with Ritalin lasted only three and a half weeks and very few studies to date have looked at the effects of the drug for longer than two years. Writing in the British Medical Journal in October 2000, experts concluded that the evidence on the benefits of stimulants to ADHD sufferers in the longer term was limited: "Little is known, for example, about outcomes such as educational achievement, employment, or social functioning."
A.Clinicians were particularly worried about the use of Prozac, one of a family of anti-depressants known as selective serotonin reuptake inhibitors (SSRIs). Last December, the UK Committee on the Safety of Medicines (CSM) advised doctors against prescribing almost all SSRIs to treat depression in children because they increased suicidal thoughts and self harm without conferring significant benefits. Prozac was the only drug for which the benefits were found to outweigh the risks, though young patients on other SSRIs were warned not to stop taking them without consulting their doctors. Even for Prozac the positive outcome rested on a relatively small number of studies. "The evidence base for SSRIs is inconclusive and inadequate, but clinicians believe they work as well for children as adults," said a consultant psychiatrist who commented in our survey. "In fact, they don't work that well for adults." In some cases, while published data suggested that the drugs were effective in treating depression, adding unpublished negative drug trial results to the analysis showed that overall the drug did children more harm than good. Indeed, GlaxoSmithKline is currently being sued by the state of New York for allegedly suppressing studies that showed that its SSRI Paxil - marketed in the UK as Seroxat - increased suicidal tendencies in children. Responding to our straw poll, more than 90 per cent of clinicians agreed that pharmaceutical companies should make all clinical trial data publicly available. Consultant child and adolescent psychiatrist Dr Morris Zwi is involved with the Cochrane Collaboration, an international non-profit organisation dedicated to providing unbiased reviews of clinical trials for doctors. He thinks that researchers should be able to see the full results of all trials, positive or negative. "This is a basic public health issue that needs to be addressed in which there is conflict between the public interest and the pharmaceutical industry," he said. The situation may be exacerbated by psychiatrists conducting clinical trials for the pharmaceutical industry. A recent study published in the Canadian Medical Association Journal found that trials funded by drug companies tended to report more favourable results. But Zwi points out that government money for drug trials is limited. "There is a real difficulty in getting funding for trials from anywhere but the pharmaceutical industry," he said. The new Government initiative recognises the urgent need for more clinical trials to assess the safety of using drugs on children.
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