Anti-depressant use in adolescents increases suicidal thoughts

As seen in this report on Science Daily, and as commented on here

The use of anti-depressants in adolescents has kicked up a psychotropic dust-storm of controversy.

In what many consider a vindication of their minority viewpoint, a team from the Stanford University School of Medicine in California has dug up evidence of potential misuse of the medicines in young patients in the years preceding the 2004 federal warning of a doubled risk -- from 2 percent to 4 percent -- of suicidal thinking and behaviors in some medicated adolescents.

Surprised at how little data existed about depression treatments in this age group, the Stanford sleuths began their own investigation.

The probe uncovered a troubling trend of physicians taking liberties with their own clinical guidelines, often bypassing psychotherapy as a component of first-line treatment. Instead, the study shows, in the years 1995 to 2002 they increasingly relied solely on the drugs that were supposed to support, not supplant, counseling.

The Stanford team, led by Dr. Randall Stafford, also found although federal regulators have deemed only one anti-depressant, Prozac, to be sufficiently studied for safety and effectiveness in minors to warrant their seal of approval for such use, doctors were prescribing a variety of other, unsanctioned mood-altering medications.

It should be pointed out some 30 percent to 40 percent of children fail to fully respond to Prozac, so other options may be needed.

Also, the "off-label" doling out of drugs is routine in the underage population so, in that respect at least, anti-depressants are not that different from many other medicines prescribed to minors without benefit of federal authorization.

However, the guidelines of the American Academy of Child and Adolescent Psychiatry call for trying talk treatments first in depressed children and, in the most severe cases, combining pharmaceuticals with psychotherapy. Part of the reason for this recommendation is to increase the odds the physician will monitor the medicines' effects and ensure patients' compliance.

But what the Stanford team found was that while office visits by depressed teens more than doubled over the seven years studied -- soaring from 1.4 million in 1995 to 3.2 million in 2002 -- the use of psychotherapy in that period sank from 83 percent of the visits to 68 percent. At the same time, reliance on drugs increased from 47 percent to 52 percent of the cases.

That may not seem like such a big change -- until you consider the dramatic increases in the diagnosis of depression in children and realize the actual number of youngsters on anti-depressants more than doubled during the period studied, the scientists said.