“Modern antidepressant drugs which have made billions for the pharmaceutical industry will be banned from use in children today because of evidence, suppressed for years, that they can cause young patients to become suicidal.
The Medicines and Healthcare Products Regulatory Agency (MHRA) told doctors last night not to prescribe all but one of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs).
The exception is Prozac, which is licensed for use in depressed children in the US. But the MHRA will warn that, at best, it helps only one child in 10.” —Guardian.UK
I have written extensively about the thoughtful psychiatrist’s balancing act in the face of the rapacity of Big Pharma on the one hand and the somewhat histrionic overreaction on the other of those with sometimes good and sometimes bent intentions to protect psychopharmacological patients, sometimes from the care they need. This decision was prompted by public outcry and throws the baby out with the bathwater. Based on my own practice standards, I have said all along that the best antidote to adverse outcomes of drug treatment is prudent responsible doctoring, not regulation, but, I don’t know, I suppose I should not speak for the profession as a whole. It may serve society’s interests better to prevent harmful bad practice than rely on good. It is indicative of the sorry state of modern medical practice to be at the mercy of both market forces and hysteria and not steer through the currents with any authority or respect.
Two of the SSRI class of drugs have already been banned – or, technically, contra-indicated in children – by the agency.
The first, in June, was Seroxat, which goes by the generic name paroxetine (Paxil); the second, in September, was Efexor (venlafaxine) (Effexor); joining them now will be Lustral (sertraline) (Zoloft), Cipramil (citalopram) (Celexa), Cipralex (escitalopram) (Lexapro) and Faverin (fluvoxamine) (Luvox).
[I have added in italics the corresponding trade names of these drugs in the US. — FmH]
If this British pronouncement works anything like analogous decrees in the US, it is worth pointing out that it does not have the force so much of law as of recommendation (“technically, contraindicated”, rather than “banned”), and will serve to give prescribers but more importantly patients or parents, pause. It is just another eddy being introduced into the marketplace. When alarm in the US last year resulted in a recommendation that one SSRI, Zoloft (sertraline) not be prescribed for children, I am not sure it changed prescribing practices much. I would be interested in the data.
It may influence GPs more than psychiatrists. As you know, I feel that the proper source of consumer concern over adverse effects of psychiatric medications is the fact that they are mismanaged by poorly prepared general practitioners who have been the major targets of Pharma’s marketing efforts over the twenty years since the SSRIs were introduced. That shift in targeting strategy has been, I am convinced, the biggest cause of the change in the landscape of modern psychiatry during my practice, and I have fought bitterly against it. The single most helpful thing to do to insure maximal benefit from psychopharmacological treatment is to take your loved one, or yourself, to a reputable psychiatric specialist rather than allow your medication to be prescribed by your general practitioner.
Now, turning to the other claim, that antidepressants may not be very effective in children, that should rightly prompt profound consumer skepticism when a doctor reaches for a prescription pad, especially to treat a child. There is an epidemic of both overdiagnosis and overprescription for conditions in which medication may not be effective. However, I am dubious about the 1:10 claim. I am not a child psychiatrist but I know that my colleagues in that end of the field have far greater success rates than 10%, when diagnosis is properly performed and prescribing is targeted and prudent. A truly depressed child is at considerable risk of morbidity and mortality, and prudent antidepressant use has an invaluable role in ameliorating her/his suffering and preventing a dire outcome. It just has to be managed by someone properly trained, adequately experienced, well-intentioned, and not in the pockets of the drug companies.
