Next Up: Prozac

By Jeffrey Kluger

When you're 10 years old, you shouldn't have much to be depressed about--or so an adult might think. But just as more and more children are taking Ritalin to calm their hyperactivity storms, a growing number of kids are turning to Prozac and other antidepressants to treat their blues.

Childhood depression is a disturbingly common phenomenon. About 3.4 million Americans under 18 are said to be "seriously" depressed. That's a lot of gloom in a group so young--and a lot of potential consumers for Prozac and its neurochemical cousins Zoloft and Paxil. In North America, up to 800,000 antidepressant prescriptions were written last year for children, some only five years old. A number of those kids were also taking stimulants like Ritalin, since depression can be a by-product of wrestling with ADHD.

For many psychiatrists, this kind of freewheeling pharmacology makes sense. Childhood depression is not just a pint-size version of adult depression; teen suicide is a real danger, and when depression hits, doctors may hit back with whatever is available in the therapeutic arsenal.

There can be problems with this approach, however. For one thing, the Food and Drug Administration has approved antidepressants for only adult use. It's perfectly legal for doctors to make them available to children, but such "off-label" prescribing can be tricky. When a drug is tested and a dosage is set for an adult body, the same medication given to a person half the size can have unexpected effects. Antidepressants can lead to agitation and nervousness in anyone; in children, they may trigger full-blown manic episodes.

Some doctors are worried that emotional development will suffer too. It's one thing to fool around with serotonin levels in a brain that's already hardened and set, but quite another thing to manipulate a young, still elastic brain. And if children learn to medicate depression away, when do they develop the coping skills to weather psychic squalls on their own?

At the moment, such concerns aren't slowing the sales of Prozac to the prepubescent--and for a child spiraling into depression, they probably shouldn't. Meanwhile, Prozac's manufacturer, Eli Lilly, is conducting clinical studies in the under-18 age group, and may have just the product for this booming new market: liquid Prozac flavored a tasty peppermint.

--By Jeffrey Kluger