Depressing News About Antidepressants

What Parents Need to Know

By Peter W. Crownfield

Antidepressants are the most commonly prescribed drug on the market. That's a lot of (apparently) depressed people - and a lot of people taking medication with potentially deadly side effects. Even more disturbing, according to a 2004 study in the journal Psychiatric Services, children age 5 and younger represent the fastest growing group of antidepressant users in the United States!

Should children that young be taking antidepressant medication? Should children of any age be taking antidepressants, for that matter? Let's hear what some of the experts have to say.

Another 2004 study, this one published in the British Medical Journal, found that the entire class of antidepressant medications -more than 30 different drugs - is not as effective as advertised and can be unsafe, particularly when given to children. In the study, researchers analyzed six published clinical trials on antidepressant use in children. Here's what they discovered:

First, drug trials routinely "exaggerated the benefits" of the drugs they were investigating, while downplaying the negative side effects. Not surprisingly (albeit shocking), pharmaceutical companies paid for four of the six studies and paid or otherwise compensated the authors of at least three of the larger studies. Second, when comparing children given antidepressants with those given only a placebo (e.g., a sugar pill the children thought was medication), some children taking only the placebo pill improved nearly as much as children taking the actual antidepressant medication. Finally, the researchers concluded that the risk of a child suffering a serious adverse event while taking antidepressant medication "raises serious concerns about their potential for harm," adding, "The magnitude of benefit is unlikely to be sufficient to justify risking those harms, so confidently recommending these drugs as a treatment option, let alone as first-line treatment, would be inappropriate."

Clear Warnings

The Food and Drug Administration (FDA), which approves and regulates all drugs, seems to understand the potential dangers of antidepressant medication, particularly when administered to children. In late 2004, the FDA issued a public health advisory directing pharmaceutical companies to include a "black box" warning on the label of all antidepressant drugs. The statement included on the box warned of the following: "Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of [drug name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need."

Earlier this year, the FDA proposed that drug companies update the warning on all antidepressant product labels to include warnings about increased risk of suicidal thinking and behavior in young adults (ages 18-24) during the first few months of treatment.

If all this isn't enough, an article in the December 2003 issue of the Harvard Mental Health Letter, a publication of Harvard Medical School, emphasized the potential dangers of prescribing antidepressant medication to children: "The rule is caution in prescribing antidepressants for children. They should be neither a first choice nor a last resort."

So, given the profound dangers - dangers researchers and other experts suggest outweigh the benefits in the majority of circumstances - why are so many doctors putting children on drugs? And perhaps more importantly, why are so many parents allowing doctors to do so? Here are a few possible (probable) reasons:

1. Drug companies spent almost $30 billion on pharmaceutical promotion in 2005, more than $25 billion of which was spent to influence medical doctors, hospitals, etc. - the people who prescribe/dispense medication.  More than $4 billion was spent on direct-to-consumer advertising.
2. Some medical doctors are at least becoming more aware of the existence of alternative medicine. However, the overwhelming majority still choose drugs first. That's what conventional medicine is all about - treating the symptoms with drugs, rather than dealing with the cause of the problem. That means if you visit the doctor's office with any type of complaint or symptom, you're likely to be prescribed a drug to mask the problem.
3. Several studies suggest many doctors prescribe medications based on patient expectation. In essence, if they think you expect a prescription, they'll gladly provide one. And of course, one of the reasons you may expect a prescription is because you've seen it advertised on TV or in your favorite magazine.
4. As all parents know, your children mean everything to you. Your worst fear is that they'll get sick or hurt in any way. If they do, you want them to get better - fast. That's exactly what medications promise: fast, easy solutions.

A Potential Drugless Option

St. John's wort (Hypericum perforatum) is a plant with yellow flowers, native to Europe, West Asia and North Africa. It is now grown in North America, South America and Australia as well. The plant is ground up and prepared as a liquid, capsule or tablet.

Currently, St. John's wort is not recommended for very young children and pregnant or nursing mothers - not because research says it's unsafe, but because not enough research has been done to evaluate its safety when used by these groups. However, one large study has found St. John's wort to be a safe and effective way of treating mild to moderate symptoms of depression in children under age 12. (Source: University of Maryland Medical Center.) And since St. John's wort is considered a worthy alternative to antidepressant medications in other subject populations, it deserves mention.

In a review article published in the December 2005 issue of the American Family Physician, researchers evaluated 40 clinical studies involving St. John's wort. In 26 of 27 studies, "St. John's wort was either more effective than placebo or as effective as older pharmaceutical antidepressants in the treatment of mild to moderate depression." In the same article, the researchers reviewed 13 additional clinical trials, 10 of which suggested St. John's wort was superior to placebo or as effective as standard antidepressants (Prozac, Zoloft, etc.) in the treatment of mild to moderate depression.

When I recently visited my primary care physician (who is quick to prescribe medications for a variety of ailments and complaints), we talked extensively about herbal and botanical products and their effectiveness in treating certain conditions. He affirmed the benefits of saw palmetto for prostate health and - guess what - St. John's wort for mild to moderate depression.

St. John's wort does have potential side effects, although fewer than a variety of standard antidepressants. Research also has shown potential interactions with a number of drugs - including antidepressants, ironically. That's why it's important to talk to your doctor before you or your child starts taking any herbal product, supplement or medication.

Get the Facts

In the March 2007 issue of To Your Health, we reported on the "Dangers of Drug Reactions & Interactions," and included questions to ask your doctor before you or your children take any medication. They're important enough to bear repeating:

• Are there any natural alternatives proven to be as effective as the medication being prescribed? In this case, ask about the research supporting the use of St. John's wort for treating mild to moderate depression.
• Are there any lifestyle changes (e.g., diet, exercise) I can make in order to avoid taking a particular medication?
• How long has this prescription medication been on the market? In what manner and for how many months did the drug undergo testing and trials?
• Where can I find a full list of the drug's potential side effects?
• Will a new prescription cause an adverse reaction with any herbs, vitamins, OTC medications, or prescription drugs I am already taking? What is the risk of such a reaction?
• Will I need to change my current diet or cut out any particular foods while taking this medication?

Your children are far too important to jeopardize their health in any way. While depression is a serious condition, the obvious question that begs to be asked is: With notable exception, can a child age 5 or younger be depressed enough to require medication? A debatable issue, to be sure, but regardless, antidepressants just don't seem to be worth the risk in the majority of cases. Remember the FDA's black box warning. Remember the researchers' conclusions: The risk of a child suffering a serious adverse event while taking antidepressant medication "raises serious concerns about their potential for harm." And remember that conventional medicine often isn't the best answer.

Peter W. Crownfield is the executive editor of To Your Health. Direct all comments and questions to .


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