“A top government scientist who concluded last year that most antidepressants are too dangerous for children because of a suicide risk wrote in a memo this week that a new study confirms his findings.” (New York TimesThe ) The senior FDA epidemiologist drew his conclusion from a study of 22 studies, but his findings were reportedly suppressed by his bosses at the FDA. A newer study using different data analyzed by a different methodology parallels his conclusions. Should antidepressant prescribing to children be banned? Certainly, the credible evidence that they are more likely to commit suicide when administered antidepressants is worrisome. Children have less ability than adults to understand and contain the bodily agitation, the feeling “like you’re crawling out of your skin” (in the words of numerous patients), that some antidepressants can cause, so they are far more likely to get into trouble with these medications. And I feel that, like most psychotropics, they are far overprescribed by the pharmacological evangelists most of my profession have become, uncritically. However, I would be concerned if the rare truly, desperately, lethally depressed child were deprived of the possibility of a properly used powerful therapeutic agent. In other branches of medicine, doctors use very dangerous medications when the potential benefit outweighs the risk, and they are capable of using them carefully. Police the profession, not its armamentarium! And get the damn pharmaceutical industry and its single-minded devotion to its profit, which mediates for prescribing to more and more patients more and more uncritically, out of the central role it has in healthcare!
Actually, the FDA does not have the power to ban thei drugs’ use. As the equivalent agency in the UK has done, they can recommend restrictions in a medication’s use, but any licensed physician is able to prescribe a legal drug for any indication, including so-called ‘off-label’ uses, they deem necessary. Making antidepressant use off-label for children would have several consequences. First, one would hope doctors would become far more cautious, since an adverse outcome arising from an off-label use presents far more liability to the physician. Second, risk management in off-label prescribing requires far more stringent informed consent to the patient (or the patient’s parents or guardians). A thorough explanation of regulatory concerns about these drugs’ use would make many a parent too skittish to consent. Finally, prescription coverage by third-party payors for off-label uses may be denied or may require prior approval, effectively placing the drugs out of financial reach of many patients.
