Skip to main content

Advertisement

SpringerLink
Log in

Treating Depressed Children With Antidepressants: More Harm than Benefit?

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

An Erratum to this article was published on 18 July 2008

Abstract

Since the FDA held hearings in February 2004 on the safety of antidepressants in children, there has been a great deal of controversy regarding the use of antidepressants in children, culminating in the well publicized black box warnings about increased risk of suicidal behavior in children and young adults (up to age 25) caused by these medications. Using questions that a parent might ask, the current article attempts to summarize the efficacy and safety data on the use of antidepressants in children so that psychologists, with or without prescription privileges, may be able to inform parents of young patients about the science behind this treatment. This article is based on a presentation at the 2007 American Psychological Association conference by the author in acceptance of the 2006 APAHC Bud Orgel Award for Distinguished Achievement in Research. Much of the information described in this article is drawn from the recent APA Report of the Working Group on Psychoactive Medications for Children and Adolescents. (Brown et al. 2006; available at www.apa.org/pi/cyf/childmeds.pdf) culminating in a book by the same authors (Brown et al., Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions 2007).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ambrosini, P. J., Bianchi, M. D., Rabinovich, H., & Elia, J. (1993). Antidepressant treatment in children and adolescents: I. Affective Disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1–6.

    Article  PubMed  CAS  Google Scholar 

  • American Psychiatric Association. (2005). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

  • Antonuccio, D. O. (in press). Tailoring treatment to parental values: A comment on TADS. Archives of General Psychiatry.

  • Antonuccio, D. O. (2007). Antidepressants in children: More harm than benefit? Paper presented at the annual meeting of the American Psychological Association, San Francisco.

  • Antonuccio, D. O., Danton, W. G., DeNelsky, G. Y., Greenberg, R. P., & Gordon, J. S. (1999). Raising questions about antidepressants. Psychotherapy and Psychosomatics, 68, 3–14.

    Article  PubMed  CAS  Google Scholar 

  • Bridge, J. A., Iyengar, S., Salary, C. B., Barbe, R. P., Birmaher, B., Pincus, H. A., et al. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. Journal of the American Medical Association, 297, 1683–1696.

    Article  PubMed  CAS  Google Scholar 

  • Brown, R., Antonuccio, D. O., DuPaul, G., Fristad, M., King, C., Pelham, W., et al. (2006). Psychopharmacological, psychosocial, and combined interventions for childhood disorders: Evidence base, contextual, factors, and future directions. Report of the Working Group on Psychoactive Medications for Children and Adolescents, American Psychological Association.

  • Brown, R., Antonuccio, D. O., DuPaul, G., Fristad, M., King, C., Pelham, W., et al. (2007). Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions. Washington, DC: American Psychological Association.

    Google Scholar 

  • Burns, D. D. (1999). Feeling good: The new mood therapy. New York: HarperCollins.

    Google Scholar 

  • Clarke, G., Lewinsohn, P., & Hops, H. (1990). Adolescent coping with depression course. Eugene, Oregon: Castalia Publishing Company.

    Google Scholar 

  • Coupland, N. J., Bell, C. J., & Potokar, J. P. (1996). Serotonin reuptake inhibitor withdrawal. Journal of Clinical Psychopharmacology, 16, 356–362.

    Article  PubMed  CAS  Google Scholar 

  • Csoka, A. B., & Shipko, S. (2006) Persistant sexual side effects after SSRI discontinuation. Psychotherapy and Psychosomatics, 75, 187–188.

    Article  PubMed  Google Scholar 

  • Dalfen, A. K., & Stewart, D. E. (2001). Who develops stable or fatal adverse drug reactions to selective serotonin reuptake inhibitors? Canadian Journal of Psychiatry, 46, 258–262.

    CAS  Google Scholar 

  • Donovan, S., Madeley, R., Clayton, A., Beeharry, M., Jones, S., Kirk, C., et al. (2000). Deliberate self-harm and antidepressant drugs: Investigation of a possible link. British Journal of Psychiatry, 177, 551–556.

    Article  PubMed  CAS  Google Scholar 

  • Duvjone, V. F., Barnard, M. U., & Rapoff, M. A. (1995). Pharmacological and cognitive-behavioral approaches in the treatment of childhood depression: A review and critique. Clinical Psychology Review, 15, 589–611.

    Article  Google Scholar 

  • Emslie, G. J., Heiligenstein, J. H., Wagner, K. D., Hoog, S. L., Ernest, D. E., Brown, E., et al. (2002). Fluoxetine for acute treatment of depression in children and adolescents: A placebo-controlled, randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1205–1215.

    Article  PubMed  Google Scholar 

  • Emslie, G. J., Rush, J., Weinberg, W. A., Kowatch, R. A., Hughes, C. W., Carmody, T., et al. (1997). A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Archives of General Psychiatry, 54, 1031–1037.

    PubMed  CAS  Google Scholar 

  • Fava, G. A. (2002). Long-term treatment with antidepressant drugs: The spectacular achievements of propaganda. Psychotherapy and Psychosomatics, 71, 127–132.

    Article  PubMed  Google Scholar 

  • Fisher, R. L., & Fisher, S. (1996). Antidepressants for children: Is scientific support necessary? The Journal of Nervous and Mental Disease, 184, 99–102.

    Article  PubMed  CAS  Google Scholar 

  • Garland, E. J. (2004). Facing the evidence: Antidepressant treatment in children and adolescents. Canadian Medical Association Journal, 170, 489–491.

    Article  PubMed  Google Scholar 

  • Gibbons, R. D., Hur, K., Bhaumik, D. K., & Mann, J. J. (2006). The relationship between antidepressant prescription rates and rate of early adolescent suicide. American Journal of Psychiatry, 163, 1898–1904.

    Article  PubMed  Google Scholar 

  • Goode, E. (2004) Stronger warnings urged on antidepressants for teenagers, February 3, 2004, New York Times.

  • Hammad, T. A., Laughren, T., & Racoosin (2006). Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry, 63, 332–339.

    Article  PubMed  CAS  Google Scholar 

  • Hazell, P., O’Connell, D., Heathcote, D., Robertson, J., & Henry, D. (1995). Efficacy of tricyclic drugs in treating child and adolescent depression: A meta-analysis. British Medical Journal, 310, 897–901.

    PubMed  CAS  Google Scholar 

  • Healy, D. (2003). Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Psychotherapy and Psychosomatics, 72, 71–79.

    Article  PubMed  Google Scholar 

  • Healy, D. (2006). The latest mania: Selling bipolar disorder. PLoS Medicine, 3, e185. Accessed at www.plosmedicine.org.

  • Jureidini, J. N., Doecke, C. J., Mansfield, P. R., Haby, M. M., Menkes, D. B., & Tonkin, A. L. (2004), Efficacy and safety of antidepressants for children and adolescents. British Medical Journal, 328, 879–883.

    Article  PubMed  CAS  Google Scholar 

  • Keller, M., Ryan, N., Strober, M., Klein, R., Kutcher, S., Birmaher, B., et al. (2001). Efficacy of paroxetine in the treatment of adolescent major depression: A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 762–772.

    Article  PubMed  CAS  Google Scholar 

  • Kendall, T., Pilling, S., & Whittington, C. J. (2005). Are the SSRIs and atypical antidepressants safe and effective for children and adolescents? Current Opinions in Psychiatry, 18, 21–25.

    Google Scholar 

  • Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine, 5, 260–268.

    Article  Google Scholar 

  • Kuehn, B. M. (2007). Cognitive behavioral therapy shows promise for children with mental illness. Journal of the American Medical Association, 297, 453–455.

    Article  PubMed  Google Scholar 

  • Lacasse, J. R., & Leo, J. (2005). Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Medicine 2, e392 doi:10.1371/journal.pmed.0020392.

    Article  PubMed  CAS  Google Scholar 

  • Lancet (2004). Depressing Research, 363, 1335.

    Google Scholar 

  • Laughren, T. P. (2004). Background comments for February 2, 2004 Meeting of Psychopharmacological Drugs Advisory Committee (PDAC) and Pediatric Subcommittee of the Anti-infective Drugs Advisory Committee (Peds AC). Memo from Dept. of Health and Human Services Public Health Service Food and Drug Administration Center for Drug Evaluation and Research. Retrieved June 21, 2005 from http://www.fda.gov/ohrms/dockets/ac/04/briefing/4006B1_03_Background_Memo_01-05-04.htm.

  • Lineberry, T. W., Bostwick, J. M., Beebe, T. J., & Decker, P. A. (2007). Impact of the FDA black box warning on physician antidepessant prescribing and practice patterns: Opening Pandora’s suicide box. Mayo Clinic Proceedings, 82, 516–522. Retrieved at http://www.mayoclinicproceedings.com/inside.asp?AID=4346&UID=.

  • Michael, K. D., & Crowley, S. L. (2002). How effective are treatments for children and adolescent depression? A meta-analytic review. Clinical Psychology Review, 22, 247–269.

    Article  PubMed  Google Scholar 

  • Moreno, C., Laje, G., Blanco, C., Jiang, H., Schmidt, A. B., & Olfson, M. (2007). National Trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry, 64, 1032–1039.

    Article  PubMed  Google Scholar 

  • National Center for Health Statistics (2004). Health, United States, 2004. Hyattsville, Maryland.

  • Preda, A., MacLean, R. W., Mazure, C. M., & Bowers, M. B. (2001). Antidepressant-associated mania and psychosis resulting in psychiatric admissions. Journal of Clinical Psychiatry, 62, 30–33.

    PubMed  CAS  Google Scholar 

  • Rigoni, G. (2004, February 2). Drug utilization for selected antidepressants among children and adolescents in the U.S. In Psychopharmacologic Drugs Advisory Committee and Pediatric Subcommittee of the Anti-infective Drugs Advisory Committee. Retrieved on April 22, 2005 from http://www.fda.gov/ohrms/dockets/ac/04/slides040061.htm.

  • Rosenbaum, J. F., Fava, M., Hood, S. L., Ashcroft, R. C., & Krebs, W. B. (1998). Selective serotonin reuptake inhibitor discontinuation syndrome: A randomized clinical trial. Biological Psychiatry, 44, 77–87.

    Article  PubMed  CAS  Google Scholar 

  • Seligman, M. E. P., Reivich, M. A., Jaycox, L., & Gillham, J. (1995). The optimistic child. Boston, MA: Houghton Mifflin.

    Google Scholar 

  • Simeon, J., Dinicola, V., Ferguson, B., & Copping, W. (1990). Adolescent depression: A placebo-controlled fluoxetine treatment study and follow-up. Progress in Neuro-psychopharmacology and Biological Psychiatry, 14, 791–795.

    Article  PubMed  CAS  Google Scholar 

  • Sommers-Flanagan, J., & Sommers-Flanagan, R. (1996). Efficacy of antidepressant medication with depressed youth: What psychologists should know. Professional Psychology: Research and Practice, 27, 145–153.

    Article  Google Scholar 

  • Treatment for Adolescent Depression Study (TADS) Team. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression. Treatment for Adolescents of Depression Study (TADS) randomized controlled trial. Journal of the American Medical Association, 292, 807–820.

    Article  Google Scholar 

  • Treatment for Adolescents with Depression Study (TADS) Team. (2007). Treatment for adolescents with depression study: Long term effectiveness and safety outcomes. Archives of General Psychiatry, 64, 1132–1144.

    Article  Google Scholar 

  • Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, 252–260.

    Article  PubMed  CAS  Google Scholar 

  • U.S. Department of Health and Human Services. (2004). NTP-CERHR expert panel report on the reproductive and developmental toxicity of fluoxetine. Center for the evaluation of risks to human reproduction. National Toxicology Program. NTP-CERHR-Fluoxetine.

  • Wagner, K., Ambrosini, P., Rynn, M., Wohlberg, C., Yang, R., Greenbaum, M., et al. (2003). Efficacy of sertraline in the treatment of children and adolescents with major depressive disorder. Journal of the American Medical Association, 290, 1033–1041.

    Article  PubMed  CAS  Google Scholar 

  • Wagner, K. D., Robb, A. S., Findling, R. L., Jin, J., Gutierrez, M. M., & Heydon, W. E. (2004). A randomized, placebo-controlled trial of citalopram for the treatment of major depression in children and adolescents. American Journal of Psychiatry, 161, 1079–1083.

    Article  PubMed  Google Scholar 

  • Weintrob, N., Cohen, D., Klipper-Aurbach, Y., Zadik, Z., & Dickerman, Z. (2002). Decreased growth during therapy with selective serotonin reuptake inhibitors. Archives of Pediatric and Adolescent Medicine, 156, 696–791.

    Google Scholar 

  • Whittington, C. J., Kendall, T., Fonagy, P., Cottrell, D., Cotgrove, A., & Boddington, E. (2004). Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data. The Lancet, 363, 1341–1345.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine, Reno, Nevada, USA

    David Antonuccio

Authors
  1. David Antonuccio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Antonuccio.

Additional information

This article is based on a presentation (Antonuccio, 2007) at the 2007 American Psychological Association conference by the author in acceptance of the 2006 APAHC Bud Orgel Award for Distinguished Achievement in Research. The opinions expressed are those of the author and do not necessarily represent those of APA or the coauthors of the APA Report of the Working Group on Psychoactive Medications for Children and Adolescents.

An erratum to this article can be found at http://dx.doi.org/10.1007/s10880-008-9121-z

Rights and permissions

Reprints and permissions

About this article

Cite this article

Antonuccio, D. Treating Depressed Children With Antidepressants: More Harm than Benefit?. J Clin Psychol Med Settings 15, 92–97 (2008). https://doi.org/10.1007/s10880-008-9108-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-008-9108-9

Keywords

Search

Navigation