With drug science and administration improving constantly, children and adolescents have become exposed and increasingly administered antidepressants. As a doctor and a parent, we allow children to take these antidepressants because it is what we believe to be best for our kids and what will benefit their health and stability. Except it is now being reevaluated across the world just how beneficial these antidepressants are for adolescents and youth.

According to this source, a study was conducted in 2000 regarding use of antidepressant treatment in individuals between 0 and 19. Data was recovered from files from the state-Children’s Health Insurance Program (s-CHIP) in the United States to measure a total of 125,383 youth, the pharmacy files under the inter action database that holds information of 72,570 youth in the Netherlands, German health insurance company Gmuender ErsatzKasse which covers approximately 480,680 citizens and the Odense University Pharmacoepidemiologic Database (OPED) contributing information on 111,452 Danish individuals under 20. For an adolescent to be considered administered, he or she must have been dispensed one or more prescriptions classified as an antidepressant. The results showed that the United States has the highest percentage of 1.63% of youth prescribed antidepressants. 0.54% of Dutch under 20 were prescribed an antidepressant, 0.11% of German youth, and the Danish had a mere 0.18%.

So what does this information tell us? The observational study had a very large sample size and the results are somewhat staggering, but there is no definite conclusion that can be drawn. The United States may be more careless in how they prescribe youth with intense drugs, or the United States may have better doctors and resources available while other countries cannot provide the drugs needed for a struggling adolescent. What ever you may believe the conclusion to be, it is evident that with a significantly higher percentage of our youth exposed to antidepressants, more research and studies should be conducted on the risks and benefits.

In 2004, the FDA acknowledged and included a warning that the antidepressant increased the risk of suicidal thinking and behavior in those with major depressive and other psychiatric disorders. More recently, the FDA suggested antidepressants to update the warnings about an increase in risk of suicidal thinking and behavior in adults 18-24 during the first two months of starting the trial. Should this arise more concern and skepticism in antidepressant use in adolescents?

Another study performs a meta-analysis of a combination of six different trials found that while antidepressant use decreased overall depression, there are significant other effects. Of 93 individuals using a paroxetine treatment, 11 “had serious adverse events” compared to only 2 of the placebo group of 87. Furthermore, seven of the treatment group were admitted to a hospital, however the reasons were not stated in the article. 17 of 189 individuals treated with sertraline withdrew from the trial due to adverse events. Only 5 of 184 withdrew from the placebo group. It is also mentioned that the trials analyzed might not have studied the full influence of adverse effects. An example described how children and adolescents with OCD tend to “exhibit a variety of treatment emergent effects of fluoxetine including an ‘activation syndrome’ affecting up to half of young patients; self injurious ideation or behavior was seen in 6/42 patients.” A majority of the analyzed trials were, interestingly enough, funded by pharmaceutical companies. This raises concern that the conclusions and analysis may be bias when claiming that all treatments proved to be extremely safe and effective.

I think the previous meta-analysis shows the importance of checking other scientific work and promoting integrity behind scientific work because it will obviously affect a large number of people in society. Also, I think that there needs to be more trials conducted in which effects besides just suicidal thoughts and behavior are tested in adolescents and youth taking antidepressants. We don’t know how much small side effects in a person’s youth could affect his actions and health over a longer period of time. But even as we do uncover more truth behind adolescent use of antidepressants, it is important to weigh out the benefits and risks. It may be the case that the effects in youth is actually miniscule compared to the potential outcome if the individual is not prescribed antidepressants, with the worst case scenario being suicide. As previously stated, however, we will not know for sure until more extensive and in depth studies are conducted.