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The stakes are high for families and for pharmaceutical companies in the wake of a warning that children and teenagers taking antidepressants may be at greater risk of suicide.
Every week a million prescriptions are written for antidepressants such as Prozac, Paxil and Zoloft. This class of drugs, called specific serotonin reuptake inhibitors, or SSRIs, is the fastest-growing segment of the pharmaceutical industry, raking in $12 billion a year.
The Food and Drug Administration has begun a series of public hearings to determine if antidepressants are safe for the more than 1 million Americans under 18 who take them. The hearings come after British health authorities last year announced long-suppressed research suggests certain antidepressants might increase the risk of suicidal behavior in youngsters.
The FDA's full analysis of the data on children and antidepressants, which includes 20 studies in all, is not likely to be completed until summer, said Dr. Tim Johnson, ABCNEWS' medical editor. Among the evidence the FDA will consider is a report from the American College of Neuropsychopharmacology, which examined a total of 15 clinical trials of SSRIs - totaling more than 2,000 kids and teens - including those reviewed in Britain last year. That report concluded there is no reliable evidence linking antidepressants to increased suicide in teenagers.
In the meantime, parents of children on antidepressants should consult their doctors if they are planning to take their children off the drugs, Johnson said.
"We know one thing for certain: That people of all ages should not stop taking the drug suddenly," he said. "That is very dangerous and can cause a rebound effect of anxiety and depression. It can be so powerful that it can lead to suicide or self-harm. So if a parent is to stop their child's treatment with antidepressants they must only do it under the guidance of a physician."
Prozac Not Part of Ban
Britain has banned the use of all antidepressants except Prozac for use by children. There have been several rigorous studies conducted with children treated with Prozac, and all the evidence points to it doing more good than harm, Johnson said.
"The evidence is there to prove that Prozac is effective in treating depression in children," Johnson said. "But it may not be safe."
Since depressed children are already at a seriously increased risk of suicide, it is hard to know if the drug or the disease is causing suicidal behavior. Also, when people who are depressed start taking antidepressants and begin to feel better they often gather enough mental and physical strength to commit suicide, Johnson said.
"It seems counterintuitive, but often the severally depressed don't have the strength and ability to even consider suicide, let alone carry it out," Johnson said. "So this is another factor that complicates getting to the bottom of this."
There is some evidence that adolescents - the main group of people under 18 who are prescribed the drugs - may metabolize these antidepressants at a faster rate than adults.
"That means the drugs could disappear from their bloodstream at a faster rate, leaving them with less of the drug in their system," Johnson said. "So it's possible the teens are not getting enough of the drugs and that they may need higher doses."
Although many studies have been conducted on Prozac on children, with positive results, there have been fewer studies on other antidepressants, such as Paxil.
"There haven't been as many trials, and the results have been mixed," Johnson said. "That's why the FDA is going to gather all the clinical data available, and look at it as a whole, and then make a recommendation."
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