Editor—Ramchandani discusses the treatment of major depressive disorder in children and adolescents.1 The conclusion of the Committee on Safety of Medicines is based on two premises: lack of effectiveness and increased risk of suicide.
None of the evidence stacks up. Even the paper of the Food and Drug Administration points out that the effectiveness of sertraline and fluoxetine is likely to be the same.2
Furthermore, it says that in all the organised trials, no completed suicide was reported. It also points out that in major depressive disease, suicide is a likely event anyway. (In any case, the correct management of depressed children entails suicide watch.) If the risk increases it is likely to only be at the beginning of treatment, when the disinhibiting effects of selective serotonin reuptake inhibitors are not yet balanced by improving mood patterns.
What I find most unsatisfactory is the failure to publish the data on which the conclusions are based. The Food and Drug Administration concludes that the trials to show effectiveness were possibly flawed and inconclusive. This is an example of jumping on the bandwagon of media scare stories, and its likeliest effect is to increase morbidity and suicide risk in children and adolescents.
Competing interests: None declared.
References
- 1.Ramchandani P. Treatment of major depressive disorder in children and adolescents. BMJ 2004;328: 3-4. (3 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Food and Drug Administration. FDA issues public health advisory entitled: Reports of suicidality in paediatric patients being treated with antidepressant medications for major depressive disorder (MDD). Rockville, MD: FDA, 27 October 2003. www.fda.gov/bbs/topics/ANSWERS/2003/ANS01256.html (accessed 1 Feb 2004).