Teen Suicide Pills?

The question of how to treat depression in children and teenagers one of the toughest a parent can face is back in the news. After an emotional two-day public hearing, a panel of experts last week advised the Food and Drug Administration to require strong warning labels on antidepressant medications. The source of their concern: a number of scientific studies and anecdotal reports that have surfaced over the past year showing that severely depressed youngsters who take the drugs may be at increased risk of suicidal thoughts and behavior. If the proposed warning labels prompt closer monitoring of children who are being treated for depression and dampen the cavalier way some health-care providers have been handing out these drugs, so much the better. But it would be tragic if the recommended changes amount to an informal ban.

Here's why: when it comes to depression, the greatest risk may be doing nothing. Recent studies show that suicide rates among adolescents have fallen by about a third over the past decade in those countries that prescribe serotonin reuptake inhibitors, the class of antidepressant drugs that includes Prozac. And just last month the first large-scale, federally funded study of major depression among adolescents found that the best treatment for depression involved a combination of Prozac and cognitive-behavior therapy that aims to improve coping skills. In fact, says the study's leader, Dr. John March of Duke University, combination treatment was the only effective approach in those with strong suicidal tendencies.

That doesn't mean that the risk of suicide from antidepressant drugs is nonexistent. For example, there is reason to believe that children with bipolar disorder, in which periods of depression alternate with manic states, may be particularly susceptible to suicidal acts if they are given antidepressants alone. And doctors have long known that patients in the early stages of recovery from depression by whatever means are, paradoxically, more likely to commit suicide.

What should you do if your child is taking one of these drugs? First, don't let the latest news disrupt the regimen; halting medication abruptly can be dangerous. Instead, pay attention to any increase in agitation or impulsivity, particularly when treatment is started or if the dosage is increased. Finally, talk frankly with your doctor if you have any doubts about your child's treatment.