Children & Teens
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Depression in children is a controversial area recently with the British government coming out against every medication except fluoxetine (Prozac) for children.  Paroxetine (Paxil) has been particularly controversial with reports of increases in suicide attempts.  Tricyclic anti-depressants have not been very beneficial in a number of studies.  Venlafaxine's manufacturer discourages its use in children.  

Although the above may sound discouraging, there are many interventions that can help childhood depression.  However, prescription medicine should be used with caution and non-medication alternatives including vitamins and minerals should be used extensively.  Many of my studies are scattered on other pages and I haven't gathered them here yet.

Depression in Pre-Schoolers Similar to Adults: A study of 156 children ages 3-5 found 54 diagnosed with depression. Two types of depression were found: 57% similar to the more severe adult melancholic depression with anhedonia (a lack of interest in things), slowed down, and restless with a family history of depression; the other a more "reactive" depression that arises in response to traumatic or stressful events could brighten at times and have fun. Joan L. Luby et al, Washington University. American Journal of Psychiatry, November 2004.

Children & Teens Frequently Given Medication: Using national health surveys for 1996-9, the average annual rate of outpatient treatment for depression for patients ages 6-18 who made one or more visits was 0.93 per 100 individuals per year. For Afro-Americans is was 0.23 and for uninsured it was 0.43. Psychotherapy was used for 79% and antidepressant medication for 57%. The average number of visits for depression was 7.8 per year. Those getting anti-depressants were more likely to have parents who graduated from high school and to have insurance. Authors say antidepressant are used far more often than would be expected based on published treatment recommendations. Columbia Univ. Outpatient treatment of child and adolescent depression in the United States. Olfson M, Gameroff MJ, Marcus SC, Waslick BD. Arch Gen Psychiatry. 2003 Dec;60(12):1236-42

Hippocampal Volume Reduced: In a small study of 17 depressed children 13-18 years of age compared to 17 healthy controls found a 17% reduction in the brain hippocampal volume in children suffering from Major Depression. Frank MacMaster and Vivek Kusumakar, Dalhousie University and the National Research Council of Canada, BMC Medicine 1/30/04

Fluoxetine Better than CBT, But Combination Did Best for Teens: In a DB PC study of 439 depressed teens ages 12-17 comparing twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) CBT alone, (3) CBT with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d), the placebo and fluoxetine alone were administered double-blind; CBT alone and CBT with fluoxetine were administered unblinded. Compared with placebo, the combination of fluoxetine with CBT was statistically significant (P =.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =.02) and CBT alone (P =.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =.01). Rates of response for fluoxetine with CBT were 71.0%; fluoxetine alone, 60.6%; CBT alone, 43.2%; and placebo, 34.8%. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J; Treatment for Adolescents With Depression Study (TADS) Team. Duke University. JAMA. 2004 Aug 18;292(7):807-20

Child Suicide Risk Said Highest with Luvox, Effexor, Paxil: Tarek Hammad, an FDA senior medical reviewer, said 2-3% of children are likely to incur increased suicidal thoughts from taking any antidepressant. Looking at all the drug company studies, the relative risks of suicidal behavior or thoughts were highest among youths taking Luvox, Effexor and Paxil and lower among youths taking Celexa, Zoloft and Prozac. 9/13/04 Wash AP. Ed: Fluoxetine, generic Prozac, has the best record and by far the lowest cost.

Don't Give Anti-Depressants to Depressed Children, But Teens are Helped Says Some SSRI Data: In a meta-analysis of data from four DB PC studies of sertraline for pediatric major depressive disorder or obsessivecompulsive disorder, the number of youth needed to treat in order to benefit one ranged from 2 to 10, which are fairly reasonable figures. Benefit was greater for OCD than for MDD, and for adolescents as compared with children in MDD. No age effect was apparent for OCD. Suicidality was reported in 8 patients (5 assigned to sertraline and 3 assigned to placebo). All but 1 (a placebo-treated patient in the Pfizer OCD trial) were enrolled in the sertraline MDD trial. The number needed to harm, i.e. to cause one case of suicidality in Major Depression was 64. However, treatment emergent suicidality was much more common in children (NNH 28.7) than in adolescents (NNH 706.3). Because no patient developed suicidality in sertraline-treated OCD patients, the NNH for sertraline in OCD approaches infinity. Treatment Benefit and the Risk of Suicidality in Multicenter, Randomized, Controlled Trials of Sertraline in Children and Adolescents. March JS, et al. Duke University. J Child Adolescent Psychopharm 2006;16(1-2):91-102.

Anti-Depressants May Increase Risk of Mania: Researchers reviewed all consecutive admissions with a diagnosis of bipolar disorder to a university-affiliated children's hospital, and collected information regarding previous exposure to antidepressants and stimulants. The mean age of diagnosis of bipolar disorder in our cohort was 12. Children who received prior antidepressant and/or stimulant treatments had an earlier bipolar diagnosis (age 10.7) than children never exposed to these medications (12.7; p = .099). Stimulants appeared to be tolerated for a longer duration than antidepressants (55 months vs. 6.7 months, p = .0001). Children exposed to antidepressants appear to be diagnosed with bipolar disorder earlier than those never exposed to these medications. Antidepressant exposure in bipolar children. Cicero D, El-Mallakh RS, et al. University of Louisville School, Kentucky. Psychiatry. 2003 Winter;66(4):317-22.