During the 14 years since a Harvard doctor first suggested a link between Prozac and suicide, the popularity of antidepressants has exploded. Thirty million Americans (including 10 million kids) take the drugs. Until now the FDA has been relatively silent on their possible dangers, although regulatory agencies in other countries have required warnings for years. But after trials indicated that depressed kids on the drugs were more likely to become suicidal–and that the drugs might not help kids at all–the FDA started hearings.
Antidepressants will remain popular, says Andrea McDonough of NOP World Health, a research firm that has polled docs on the issue. In NOP’s latest study, 72 percent of psychiatrists (and 78 percent of child psychiatrists) strongly agreed that the benefits of antidepressants outweigh the risks, even after learning that the FDA was questioning the drugs’ safety. The agency is still reviewing the studies on kids, and there aren’t any studies that definitively link antidepressants and suicides in adults. Adults on the drugs have committed suicide–but no one can say whether the pills or depression itself was responsible.
Almost all doctors agree on one thing: patients taking psychoactive drugs need an advocate, someone to track their ups and downs. Family members can help, but ideally it should be the doctor’s job. Unfortunately, most primary-care providers don’t have time for such monitoring. (In the first week of therapy, you might need to see your doctor several times.) In the past few years, primary-care providers have become more open to prescribing antidepressants instead of leaving it to psychiatrists. “Rather than being skeptical, they’ve been almost more enthusiastic than the drug companies,” notes David Healy, author of the forthcoming book “Let Them Eat Prozac.” In light of last week’s announcement, many primary-care docs may refer patients to specialists from now on, rather than prescribing the drugs themselves.
If your kids are the ones in treatment, it’s especially important to keep a close eye on them–advice that goes for all medications, not just antidepressants. And no matter how much you trust your pediatrician, you should reconsider letting him or her prescribe the drugs. “I wouldn’t even think of letting a primary-care provider be the sole doctor administering a kid’s mental-health care,” says Michael Faenza, president of the National Mental Health Association. His advice: get a pediatric psychiatrist involved from the outset. You should also make sure your child is taking the right drug: only Prozac is approved for kids. If your child is on another, off- label drug, watch him extra carefully–and ask your doctor why he’s not on Prozac.
The controversy is far from over. Researchers are expected to brief the FDA again this summer; the agency will then decide whether the drugs are too dangerous for children. Until then, parents–and adult patients–will have to decide for themselves whether the small but horrifying possibility of a downturn is something they want to risk. Most important, they should stay calm. As McDonough notes, “If they do panic, there are plenty of nice drugs for that too.”
