Pediatricians endorse Prozac-like anti-depressants for children
Canada.com News
November 5, 2013
Note: The position statement by the Canadian Pediatric Society on which this Canada.com article is based, can be seen HERE
A
copy of the CPS statement is attached
The group representing the nation?s pediatricians says the potential benefits of Prozac-like antidepressants ? drugs that have only ever been officially approved for use in adults in Canada ? outweigh the potential harms when used in children.
Known as SSRIs, or selective serotonin reuptake inhibitors, the drugs are being widely prescribed to children as young as five for depression and anxiety disorders, such as separation anxiety and social phobia, despite concerns that the pills help only the most severe cases and provide little or no benefit over placebos, or sugar pills, for milder symptoms.
In a new position statement, the Canadian Paediatric Society says untreated depression ?is more likely to result in harm than appropriate SSRI use.?
According to the group, 40 to 70 per cent of adolescents with depression treated with an SSRI respond to the drugs. But almost equal numbers ? 30 to 60 per cent ? get better on placebos.
For children under 12, only one SSRI ? fluoxetine, the chemical name for Prozac ? has demonstrated benefit over placebo, according to the position statement.
?Mental illness in children and adolescents is a significant problem,? said principal author Dr. Daphne Korczak, head of the inpatient and day treatment program in the department of psychiatry at Toronto?s Hospital for Sick Children.
But there is a dearth of child psychiatrists across the country and long waits for care. The bulk of prescribing of antidepressants to children is being done by pediatricians and family doctors who often have little formal training in their use.
Korczak said that, for children and adolescents with moderate or severe depression or anxiety, ?these medications (SSRIs) can be helpful.
?These are people who are really seriously suffering ? people who are not functioning at school with their peers, who are thinking about suicide or questioning the value of their lives at a young age,? she said.
?For these patients, medications can be life-improving.?
However, for children with milder depression or anxiety, the benefits may not outweigh the risks, she said.
The goal of the newly published position statement is to caution pediatricians about when to use SSRIs, how to use them and how to monitor children closely for potential side-effects, including suicidal thinking and behaviour.
?We don?t want to see anybody get hurt, or sick or worse,? Korczak said. ?We want to see people get better and helped.?
?These kids are very distressed and suffering, the families are suffering, and they?re often coming to pediatricians for help.? She stressed that SSRIs should just be one tool in the ?treatment armamentarium.?
But Irving Kirsch, associate director of the Program in Placebo Studies at Harvard Medical School, says data from published as well as unpublished trials suggest the benefits of SSRIs for children and teens have been exaggerated and their risks downplayed.
Of 16 randomized, placebo controlled trials testing SSRIs in children, ?only three showed even a statistically significant benefit over placebo,? said Kirsch, a professor of psychiatry at Plymouth University in the U.K. Even then, ?the benefit was very small,? he said.
Common, short-term side-effects include gastrointestinal symptoms (nausea, vomiting and diarrhea), sleep changes such as insomnia or vivid dreams, restlessness, headaches and appetite changes.
In 2004, drug companies were ordered to add warnings of an increased risk of suicidal thinking. In 2012, GlaxoSmithKline was fined $3 billion by the U.S. Department of Justice partly for unlawfully promoting its SSRI, Paxil, or paroxetine, for use in children and teens. The Canadian pediatrics group says three randomized controlled trials found no benefit from paroxetine in the treatment of adolescent depression.
?I don?t think that something magical happens at age 18, where it?s OK to use SSRIs where it wasn?t earlier,? said Dr. David Juurlink, a specialist in internal medicine and head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto. ?My overriding concern is that, in adults and in children, these drugs are often prescribed for conditions other than severe depression,? he said.
?There are some serious side-effects with these drugs and I don?t think anyone can really argue convincingly that they don?t increase the risk of violent behaviour, and of suicide in particular,? Juurlink said. ?That means that physicians should be careful in how they prescribe them. It means that we should be only using these drugs in people where we really think the benefits outweigh the risks ? squarely in the group of people with severe depression.?
?The intensity of depression really should be quite profound before we consider setting somebody on an antidepressant, especially a child or an adolescent,? added Dr. David Gardner, a pharmacist and professor of psychiatry at Dalhousie University in Halifax.
For every 50 youth treated with an SSRI, one will experience a worsening of suicidal thoughts or new thoughts of self-harm, he said. The suicide attempt risk attributable to an SSRI is about one in more than 500, he added.
For every 10 young people with moderate to severe depression treated with an SSRI, one will experience a ?substantial benefit? from the medication, Gardner said.
For childhood anxiety disorders, it?s about one in three, he said.
?These drug have a place in therapy,? Gardner said. ?But we need to be judicious in who we use them for.?
Canada.com News
November 5, 2013
Note: The position statement by the Canadian Pediatric Society on which this Canada.com article is based, can be seen HERE
A
copy of the CPS statement is attached The group representing the nation?s pediatricians says the potential benefits of Prozac-like antidepressants ? drugs that have only ever been officially approved for use in adults in Canada ? outweigh the potential harms when used in children.
Known as SSRIs, or selective serotonin reuptake inhibitors, the drugs are being widely prescribed to children as young as five for depression and anxiety disorders, such as separation anxiety and social phobia, despite concerns that the pills help only the most severe cases and provide little or no benefit over placebos, or sugar pills, for milder symptoms.
In a new position statement, the Canadian Paediatric Society says untreated depression ?is more likely to result in harm than appropriate SSRI use.?
According to the group, 40 to 70 per cent of adolescents with depression treated with an SSRI respond to the drugs. But almost equal numbers ? 30 to 60 per cent ? get better on placebos.
For children under 12, only one SSRI ? fluoxetine, the chemical name for Prozac ? has demonstrated benefit over placebo, according to the position statement.
?Mental illness in children and adolescents is a significant problem,? said principal author Dr. Daphne Korczak, head of the inpatient and day treatment program in the department of psychiatry at Toronto?s Hospital for Sick Children.
But there is a dearth of child psychiatrists across the country and long waits for care. The bulk of prescribing of antidepressants to children is being done by pediatricians and family doctors who often have little formal training in their use.
Korczak said that, for children and adolescents with moderate or severe depression or anxiety, ?these medications (SSRIs) can be helpful.
?These are people who are really seriously suffering ? people who are not functioning at school with their peers, who are thinking about suicide or questioning the value of their lives at a young age,? she said.
?For these patients, medications can be life-improving.?
However, for children with milder depression or anxiety, the benefits may not outweigh the risks, she said.
The goal of the newly published position statement is to caution pediatricians about when to use SSRIs, how to use them and how to monitor children closely for potential side-effects, including suicidal thinking and behaviour.
?We don?t want to see anybody get hurt, or sick or worse,? Korczak said. ?We want to see people get better and helped.?
?These kids are very distressed and suffering, the families are suffering, and they?re often coming to pediatricians for help.? She stressed that SSRIs should just be one tool in the ?treatment armamentarium.?
But Irving Kirsch, associate director of the Program in Placebo Studies at Harvard Medical School, says data from published as well as unpublished trials suggest the benefits of SSRIs for children and teens have been exaggerated and their risks downplayed.
Of 16 randomized, placebo controlled trials testing SSRIs in children, ?only three showed even a statistically significant benefit over placebo,? said Kirsch, a professor of psychiatry at Plymouth University in the U.K. Even then, ?the benefit was very small,? he said.
Common, short-term side-effects include gastrointestinal symptoms (nausea, vomiting and diarrhea), sleep changes such as insomnia or vivid dreams, restlessness, headaches and appetite changes.
In 2004, drug companies were ordered to add warnings of an increased risk of suicidal thinking. In 2012, GlaxoSmithKline was fined $3 billion by the U.S. Department of Justice partly for unlawfully promoting its SSRI, Paxil, or paroxetine, for use in children and teens. The Canadian pediatrics group says three randomized controlled trials found no benefit from paroxetine in the treatment of adolescent depression.
?I don?t think that something magical happens at age 18, where it?s OK to use SSRIs where it wasn?t earlier,? said Dr. David Juurlink, a specialist in internal medicine and head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto. ?My overriding concern is that, in adults and in children, these drugs are often prescribed for conditions other than severe depression,? he said.
?There are some serious side-effects with these drugs and I don?t think anyone can really argue convincingly that they don?t increase the risk of violent behaviour, and of suicide in particular,? Juurlink said. ?That means that physicians should be careful in how they prescribe them. It means that we should be only using these drugs in people where we really think the benefits outweigh the risks ? squarely in the group of people with severe depression.?
?The intensity of depression really should be quite profound before we consider setting somebody on an antidepressant, especially a child or an adolescent,? added Dr. David Gardner, a pharmacist and professor of psychiatry at Dalhousie University in Halifax.
For every 50 youth treated with an SSRI, one will experience a worsening of suicidal thoughts or new thoughts of self-harm, he said. The suicide attempt risk attributable to an SSRI is about one in more than 500, he added.
For every 10 young people with moderate to severe depression treated with an SSRI, one will experience a ?substantial benefit? from the medication, Gardner said.
For childhood anxiety disorders, it?s about one in three, he said.
?These drug have a place in therapy,? Gardner said. ?But we need to be judicious in who we use them for.?
