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Authors of a new comprehensive analysis of antidepressants for children and teenagers say the benefits of treatment trump the small risk of increasing some patients' chances of having suicidal thoughts and behaviors.
The risk they found is lower than the one the Food and Drug Administration identified in 2004, the year the agency warned the public about the drugs' risks in children. After the warning, U.S. youth suicides increased and some mental health experts said reluctance to try antidepressants might be to blame.
The new analysis includes data from seven studies that were not part of the previous FDA analysis, including two large pediatric depression trials that were unavailable three years ago.
Researchers analyzed data on 5,310 children and teenagers from 27 studies. They found that for every 100 kids treated with antidepressants, about one additional child experienced worsening suicidal feelings above what would have happened without drug treatment. In contrast, the FDA analysis found an added risk affecting about two in 100 patients.
There were no suicides in any of the studies. The antidepressants included Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Serzone and Remeron.
"The medications are safe and effective and should be considered as an important part of treatment," said study co-author Dr. David Brent of the University of Pittsburgh School of Medicine. "The benefits seem favorable compared to the small risk of suicidal thoughts and behavior."
Antidepressants worked best when used to treat anxiety, the analysis found. They worked moderately well treating obsessive-compulsive disorders. They worked less well, but were still effective in treating depression.
Adolescents responded better than children to treatment for depression and anxiety, the researchers found. They also found that only Prozac worked better than dummy pills in depressed children younger than 12.
In the studies involving depression, 61 percent of patients improved while on antidepressants. But 50 percent of depressed patients taking dummy pills also improved.
Among young patients with obsessive-compulsive disorders, 52 percent improved on antidepressants, compared to 32 percent who improved on dummy pills.
And in the studies of anxiety disorders, 69 percent improved on antidepressants and 39 percent improved on dummy pills.
Effectiveness of the drugs was measured in the studies using widely accepted rating scales. The analysis appears in Wednesday's Journal of the American Medical Association.
Dr. John March, chief of child and adolescent psychiatry at Duke University Medical Center, welcomed the study as "the most comprehensive analysis of the data yet put together." He said the suicidal behavior risk, although lower than found by the FDA, demands that doctors and families watch for warning signs.
"You can't treat kids with these drugs without taking this information into account," said March, who was not involved in the study, but does similar research. "You can't say, 'Take these and call me in six weeks.' You have to monitor carefully the benefits and adverse events."
The study didn't measure the effects of talk therapy, March pointed out. He said cognitive behavioral therapy used with antidepressants can lower suicide risk and speed up recovery for depressed youth.
The study was supported by grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation.
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