Anti Depressants: An Overview

We must limit the number of young children who are administered antidepressants, as we do not have sufficient, if any, data regarding the effects of these drugs on the developing brain. Greater involvement from parents, teachers, ministers, and friends, as well as counseling and psychotherapy must all be used extensively before turning to the "quick fix" of antidepressants.

In the last ten years, the psychiatric field has been flooded with a new group of antidepressants known as Selective Serotonin Reuptake Inhibitors, or SSRIs. Michele Laraia defines an SSRI as "a group of compounds that block the reuptake of serotonin by the pre synaptic neuron" (6). By adjusting the level of serotonin, the mood-altering chemical which our body naturally creates, that reaches the brain, we can control the stability of a person's mood.

Tania Unsworth writes that "almost 600,000 children and adolescents in the US were prescribed SSRI antidepressants in 1996" (1). A more alarming statistic, reported by Joseph Coyle, is that "there has been a 10-fold increase in the prescription of SSRIs in the US for children under 5 years old between 1993 and 1997" (1). Parents, teachers, and psychiatrists across the country seem a little too anxious to jump on the antidepressant bandwagon. Apparently, many people are willing to turn first to the quick fix of drugs rather than the more time consuming approach of counseling and psychotherapy, although these have proven to be much more effective in the long run (McDougle 1).

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The most common reason for the prescription of an antidepressant is depression. Until about ten years ago, depression was thought to be nonexistent in children. Depression is now found, using the same criteria used for adults, to be unquestionably diagnosable in children (Fishbein 1). Joyce Price notes that "the American Academy of Child and Adolescent Psychiatry puts the number of significantly depressed children and adolescents at 3.4 million" (1). The consequences of depression for children include social dysfunction, academic underachievement, impaired self-image, and suicidal and anti-social behavior (Laraia 1).

Depression is also commonly linked to other problems such as conduct disorder, attention deficit disorder, and anxiety disorder. In a survey done by Judith Asch-Goodkin, she reports that "of over 600 physicians surveyed, more than half (57%) had prescribed an SSRI for a diagnosis other than depression" (1). In some cases, of course, medication is really necessary in order to correct a persisting disorder or complex which, if left untreated, would continue to grow. However, in young children, drug use should be reserved for a final remedy, and even then used with great moderation.

The problem with most prescriptions given to children is that these drugs are used simply as a quick fix. Claudia Kalb writes that "experts say frustrated parents, agitated day-care workers and 10-minute pediatric visits all contribute to quick fixes for emotional and behavioral problems" (1). Parents seem too eager to find an "excuse" for their child's behavior. The easiest excuse for a parent to digest is the suggestion that their child has a natural chemical imbalance, correctable by medication. This helps to put the parents mind at ease, assuring them that it is not their fault. In most cases the parents are so relived to find out that their child's condition is not their fault that they do not bother to look into other ways of helping their child; instead they put their trust in their doctor and do whatever he first suggests.

Of course, the scariest thing about giving an antidepressant to a child is that less than 20 percent of the drugs used in children have been tested on children (Price 2). As a matter of fact, none of the drugs which fall in the category of an SSRI have been tested on children. However, since the FDA has approved them for use in adults, doctors can legally prescribe them to children (Crowley 1). The courts have always left drug treatment to the physician's "best judgment" (Fisher 1). In fact, Rhoda Fisher states that "prescribing physicians do not need any scientific proof that a particular drug is effective for the patient they have in mind to treat" (1).

In addition, general practitioners and pediatricians do not, for the most part, have the psychiatric knowledge necessary for the prescribing of antidepressants. Determining which medication to use and when to use it can be a confusing task for these doctors (McDougle 1). Without the proper education, prescribing an antidepressant can be a shot in the dark. Rebecca Voelker found in a study of over 600 family physicians and pediatricians that "72% had prescribed an SSRI for a patient younger than 18 years. Yet only 8% of the physicians said they had received adequate training in the management of childhood depression, and just 16% said they felt comfortable treating children for depression" (182). Surely some method of regulating which physicians can prescribe antidepressants can be established.

Furthermore, the vast majority of evidence, so far, suggests that antidepressants do not help childhood depression (Price 1). The body of a child grows far too rapidly for the drug level to remain constant in their body. Fisher goes on to put it more bluntly in saying that "in view of their negative side effects and clearly demonstrated lack of therapeutic effectiveness, it is inappropriate to treat the younger segment of the population with antidepressant medications" (2). Almost 80 percent of children who are put on medications were referred to doctors for school problems, yet antidepressants have been proven to be ineffective in treating school problems or nebulous behavior problems (Asch-Goodkin 1). Once again, another case where frustration in a child's behavior is put above the child himself. A quick and easy answer to everything does not always exsist. With no empirical evidence to support drug treatment in young children, many could argue that it is not only dangerous but unethical as well.

Even in cases where medication is absolutely necessary, psychotherapy should always be a big part of the treatment. The goal of the medication should be to help the child learn to deal with their condition, hopefully drug-free at some point. Too many times the medication is used as the sole treatment. Christopher J. McDougle points out that " the American Academy of Child and Adolescent Psychiatry, the AACAP, recommends psychotherapy as the initial treatment for mild to moderate depression" (1). He goes on to say that "the AACAP notes that SSRIs are never sufficient as the sole treatment" (2). It has been proven time and time again that most children are just reaching out and need an adult to show actual one-on-one attention to them. This is why psychotherapy is so very important. Children need that human contact.

Of course, the primary concern in treating children with antidepressants is that we have absolutely no data on how these drugs affect the long-term brain development (Kalb 2). We are shoveling pills into the mouths of little children whose bodies and minds are at the most sensitive stages of their development, and we do not even know how these drugs will affect that. The pharmaceutical companies remain as the major funding sources for the study of various drugs and their effects on the body (Allen 6). The problem is that the law only requires them to test the drugs on adults. After that, it is up to the physicians who prescribe them. Allen explains their lack of ambition in pursuing such tests by claiming that "there is little incentive for the industry to conduct premarketing or post-marketing controlled treatment trials in children, since they are very expensive and raise liability concerns" (6). What is the key word here? Money. The pharmaceutical companies are not willing to shell out the extra money no matter what the costs.

In his studies, McDougle found that "children and adolescents are more likely to have behavioral side effects; younger children being the most vulnerable" (5). Common side effects that are popular with younger patients are gastrointestinal distress, nausea, and anorexia (McDougle 3). Others common side effects are headaches, tremors, jitteriness, and nervousness (McDougle 3). Also, for some children hypomania, mania, and psychosis have all occurred (McDougle 4). On the other side of the mania disorders are the many different sleep disorders caused by these drugs. McDougle"s studies go on to show that "SSRIs, like virtually all antidepressants, alter sleep architecture, decreasing total sleep time, sleep efficiency, and the total duration of rapid-eye movement sleep" (3). The result of this is children who suffer daytime sedation, insomnia, and vivid, frightening dreams. In one of McDougle"s study groups, 42 percent had wild, vivid dreams that resulted in the subjects injuring themselves enough to require hospitalization (5).

Another concern, reported by Rhoda Fisher, is the scattered cases of children dying "suddenly and unexpectedly" (2). This may be linked to Serotonin Syndrome, a condition which can be derived from just one seronergic agent (McDougle 5). Children suffering from Serotonin Syndrome will experience fever, muscular rigidity, and a drastic mental status change. Also, they may be affected by hyper pyrexia (temperature above 105 degrees farenheight)mandating aggressive cooling, muscular paralysis, and intubation (McDougle 3).

The time has come when we must demand that the pharmaceutical companies, physicians, and psychiatrists be better regulated. The changes made would be minimal but their outcome would be incomparable to anything else. Certainly, we must protect the health and the rights of young people who may not be able to do so for themselves. Medication is just a part, and a small part at that, of the therapeutic process.

All options outside of medication should be thoroughly exercised before moving on to the next phase. Parents, teachers, and ministers must first do their part before recommending a child for professional care. After that, strict regulations must be put on doctors and psychiatrists to ensure that only those knowledgeable enough to prescribe antidepressants to children can do so. Furthermore, the pharmaceutical companies must be forced to test their products on any age group that might have access to these drugs. It is critical to the future of our society that we stop drugging are youth and look for more natural approaches.

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