The Luvox Debate

News last week that a drug widely prescribed for depressed adults had been tested on children with severe anxiety disorders set off a spirited debate. Drug researchers were delighted by the positive results. Critics were aghast that mind-altering chemicals were being given to kids. Parents weren't sure what to think.

It's a tricky issue. Let's start by defining a few terms. Every child has his share of worries--those first-day-of-school jitters, shyness around strangers, fear of dogs or Ferris wheels. But severe social anxieties, which afflict 5% to 10% of children, are something else. These kids have anxieties that far exceed normal bounds. Fear overtakes them; they can't sleep alone, can't separate from their parents, can't bear to go to school, can't make or keep friends.

Anxiety disorders are serious psychiatric conditions that often run in families and are linked to higher-than-normal rates of depression, alcohol dependence, substance abuse and suicide. Children who suffer from them are sometimes offered cognitive behavioral therapy, which attempts to explain and replace their crippling fears with rational thoughts and action. But most of these kids go untreated. Or they are given antidepressants "off label"--in ways for which they were not specifically approved.

That's why the National Institute of Mental Health set out to study the drug fluvoxamine, part of the class of selective serotonin-reuptake inhibitors that includes Prozac, Zoloft and Paxil. For eight weeks, researchers tracked 128 children, ages 6 to 17, who had been diagnosed with serious anxiety disorders. When they were offered behavioral therapy alone, only five children showed any improvement. When they were given Luvox, a brand of fluvoxamine, 76% showed swift and substantial improvement.

Dr. Mark Riddle of Johns Hopkins University, one of the authors of the report that appeared last week in the New England Journal of Medicine, describes the progress of some of the kids in the Luvox study as "miraculous."

But Riddle shares the concerns of critics who fear that drugs like Luvox could be misused in an effort to socially engineer children who are merely shy or reserved. He warns that serious anxiety disorders must not be confused with the garden-variety anxieties of growing up. "We're not talking about a Woody Allen type of worrier here," he says. "These kids were paralyzed. There were kids who had not been able to go to school." He acknowledges that there is much left to learn about antidepressant drugs. Researchers aren't sure if Luvox will work long term or how long it is safe for a child to be on it. The drug made some kids more active than usual, and side effects like gastrointestinal problems forced five of them out of the study.

Parents who wonder whether their child has an anxiety disorder that warrants treatment should look for such signs as debilitating shyness, unwillingness to leave home or irrational fears that don't go away. Dr. Richard Harding, president of the American Psychiatric Association, counsels that a well-trained physician should be involved in any diagnosis. "Families should try psychotherapy first," he suggests. "This drug is for children who are disabled by their symptoms."

Related Links:
Treatment of Children with Mental Disorders
From the National Insitute of Mental Health

Anxiety Disorders Association of America

NIMH-sponsored study of fluvoxamine

You can e-mail Amy at timefamily@aol.com