A Word from DBSA's Scientific Advisory Board Chair
All 65 of our SAB members and their colleagues are constantly in search of new ways to recognize, treat and prevent mood disorders. Not all of our work will produce groundbreaking new treatments. Sometimes it will give us new knowledge about brain chemistry or allow us to rule out a treatment that doesn’t work. As we move toward new and meaningful discoveries, we must also make sure that people are educated about mood disorders. We must do everything in our power to reduce stigma. Greater acceptance of mood disorders can lead to increased research funding, and appropriate insurance coverage. It can also motivate more patients and families to seek help sooner.
The effect of antidepressant medications on young people has been in the news often in recent weeks. We know that mood disorders can lead to suicide. This is especially tragic when it happens to a child, but this tragedy can no more be traced to one cause than it can be solved with one answer.
One thing is certain: children with mood disorders need treatments that will help them to lead stable, healthy lives. Their parents and health care providers need as many options as possible. They need the information necessary to make informed, educated choices.
Many people became concerned late in 2003, when the British Regulatory Agency recommended against the use of selective serotonin reuptake inhibitor (SSRI) antidepressants in patients under the age of 18. In response to this ruling, the American College of Neuropsychopharmacology (ACNP) formed a task force to examine this issue. In a review of all available data from published clinical trials conducted in young people, the ACNP task force failed to find any statistically significant increase in suicide attempts, self-harm or suicidal thinking related to SSRI treatment. They also pointed out that in the relatively few years since prescribing of these medications has become widespread, there has been an unprecedented decline averaging 33% in rates of youth suicide in 15 countries.
However, in a public meeting held on February 2, the Food and Drug Administration (FDA) noted that only a few of the trials of SSRI’s in youth showed clear superiority to placebo. Many trials showed no difference. The FDA also examined a large database of unpublished trials, which suggested that there may be an increased rate of suicidality in young people taking these SSRIs. This led the FDA’s Psychopharmacologic Drugs Advisory Panel to recommend stronger warnings about the use of SSRI’s in youth. In the meantime, they are analyzing the unpublished data more closely.
The decision to take SSRIs, or any other type of treatment, is one that must be made individually by each patient and his or her family and health care providers. It is important that every individual have as many safe, effective choices as possible. It is also essential that patients, family members and health care providers have sufficient information to be able to weigh the potential benefits against any possible risks.
Even today’s reduced incidence of suicide and self-harm in young people is clear evidence of critical unmet needs. Our children need more specialized health care providers. Primary care providers, as well as educational, juvenile justice and foster care systems should have knowledge of mood disorders and treatments. Everyone concerned with the welfare of our children must make special efforts to meet these needs.
Children deserve wellness as much, if not more than adults do. The fact that this wellness is often even more difficult to reach than it is for adults means that it is even more important that we remain steadfast and dedicated to maximizing every child’s chance to achieve it.
Ellen Frank, DBSA's Scientific Advisory Board Chair
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