USPSYCH: Antidepressants Benefit Teens Despite Black Box Warnings

NEW ORLEANS, Nov. 22 -- Parents of children and adolescents with depression should be reassured that the benefits of antidepressants outweigh the risks, despite black box warnings about the potential of suicide in adolescents, a pediatric psychiatrist said here.

"There is no reason to be afraid of treatment," said John T. Walkup, M.D., of the Johns Hopkins Medical Institutions in Baltimore, at the U.S Psychiatric & Mental Health Congress here. "I sing that loud and clear."

Dr. Walkup offered some background information on teens and suicide risk, and he discussed data from recent studies that support the benefits of treating depressed children with antidepressants.

Nearly 17% of teens have considered suicide at some point, according to the 2003 Youth Risk Behavior Survey, Dr. Walkup said. The CDC survey of more than 15,000 U.S. high school students also found that 16.5% had made a plan for suicide, 8.5% had made a suicide attempt, and nearly 3% had made a suicide attempt that required medical attention, Dr. Walkup said.

"Those are huge numbers," he said. "Suicide attempts are more common than strep throat. This is a big problem."

However, the survey also found that completed suicides amounted to only seven per 100,000 teens per year. "So there is a huge difference between suicidal ideation and completed suicides," Dr. Walkup said. "It's more than one-thousand-fold less. As clinicians, we should be especially concerned about completed suicides."

In the analysis upon which the FDA black box warning is based, there were no completed suicides, Dr. Walkup said. The analysis found that 2% of depressed teens treated with placebo reported some type of suicidal ideation, compared with 4% of depressed teens on antidepressants, Dr. Walkup said.

Doctors seeking to persuade parents of the benefits of treating their depressed teen with antidepressants should cite the Treatment of Adolescents With Depression Study (TADS), Dr. Walkup said. The NIH-supported study included 439 teens, ages 12 to 17. The 12-week study compared the effect of medication (fluoxetine), cognitive behavioral therapy, a combination of the two, and placebo.

Combination therapy proved the most effective, with a 71% response rate. Fluoxetine was next with a response rate of 61%. The rate for cognitive behavioral therapy was only 43%, and the placebo rate was 35%.

TADS found no increased suicide risk with any form of treatment, Dr. Walkup said.

Two studies of completed suicides in teens also looked at toxicology results to determine whether the teens were significantly more likely to have antidepressants in their blood. "If there was a link, you would expect to find it in the toxicology," Dr. Walkup said. But the studies found no such link, he added.