A new study has revealed that various antidepressants are ineffective with children and teenagers suffering from depression, and in some cases they might actually exacerbate symptoms.
The Study
The new study involved a comprehensive review of various published and unpublished clinical trials, which compared the effects of 14 different antidepressant active chemicals in young people suffering from major depressive disorders. The study’s ultimate findings were based on 34 trials which incorporated 5,260 participants.
The study assessed the drugs on efficacy (how effective the drug is at achieving its stated aim), tolerability (the number of participants that discontinued usage due to adverse events), acceptability (the number of people stopping taking the antidepressant for any reason) and any side effects such as thoughts or actions related to suicide.
The results were eye opening and shed new light on how best to deal with depression in children and teenagers. Only one of the 14 antidepressants showed a success rate better than a placebo. Fluoxetine, (marketed under the Prozac and Sarafem brand names) was the one shown to be better at relieving symptoms.
At the other end of the scale, venlafaxine, (Effexor) actually increased the likelihood of the user having suicidal tendencies. Venlaflxine, along with imipramine and duloxetine had the lowest scores for tolerability. Nortriptyline (branded as Pamelor) was also concluded to be “significantly less effective” than a placebo pill.
Depression in children and adolescents
Depression is on the rise for the youth of America. It is estimated that roughly three percent of 6 – 12 year olds and a more worrying six percent of teenagers have suffered from major depressive disorder, and about eleven percent have had at least one depressive episode in their lives.
The lead author of the study, Dr. Andrea Cipriani of the University of Oxford explains that depressive disorder in young people is different to that that is found with adults. “Not only is it still under-diagnosed and under-treated but also it tends to present in a different way,” Dr. Cipriani said when talking to the Lancet.
“Depressive symptoms in children and adolescents are rather undifferentiated. You notice more irritability, aggressive behavior and problems at school. And consequences of depressive episodes in children and adolescents are dramatic because they include impairments in their social functioning but also an increased risk of suicidal ideation and attempts,” he added.
Alternatives to antidepressants
It has long been understood that antidepressants and young brains can be a dangerous combination. Dr. Cipriani stated, “…because with children and adolescents we are talking about a developing brain, so we are always very cautious when prescribing medications because we don’t know the potential implications in the long term for a developing brain”
Worryingly, another study published in the Lancet earlier this year showed that between 2005 and 2012, antidepressant usage levels in young people increased from 1.3 percent to 1.6 percent. A concerning trend, but one which shows no sign of abating.
Other methods to tackle depressive disorder, that do not involve drugs and chemicals include cognitive behavioral or interpersonal therapy.
Fair test?
There is a wonderful book by Ben Goldacre called Bad Science. He explains, far more articulately than this author, the problems with big pharmaceutical companies and the validity of the studies we hear about every day.
Of the studies analysed in this report, 65 percent were funded by the pharmaceutical company, who will obviously have one desired outcome they are working towards.
We can therefore assume that the results are probably even worse than those published. Intentional and subconscious bias mean that the use of selective data, randomized trials that aren’t actually random and many others tricks can heavily skew the results.
Dr. Jon Jureidini at the University of Adelaide in Australia, adds to the study in an accompanying editorial that “The effect of misreporting is that antidepressants, possibly including fluoxetine, are likely to be more dangerous and less effective treatments than has been previously recognized, so there is little reason to think that any antidepressant is better than nothing for young people.”
Conclusion
This study is certainly of scientific merit. It is important to understand what we are giving to the youth, and the consequences of these drugs. And, I am always happy to stick the boot into big pharmaceutical companies whenever the opportunity arises.
However, important as it is to look at cures, as with all things, surely prevention is better. We need to understand why greater numbers of young people are reporting these depressive symptoms.
Is it just because they are more comfortable admitting they are having a tough time, or is there something else, in the food we eat, in the way we interact with each other, with the increased use of social media that is driving this increase? This is the area that perhaps requires greater attention and money should be directed to stop the problem at root.
