Kids And Depression

By MICHAEL D. LEMONICK

Suffering from severe depression yourself is bad enough. The smallest effort seems huge; feeling happy, or even content, is impossible to imagine. Things can get so bad that suicide may seem the only rational course. But it's almost worse when your child is depressed. Watching someone you love go through such misery is agonizing. You would do anything to help.

But figuring out what to do has grown more confusing. One of the best tools for fighting depression is the so-called SSRI class of drugs, including Prozac, Paxil and Zoloft. But evidence has been mounting that these relatively safe medications might trigger suicidal thoughts in some kids. While there's no proof that the drugs have actually caused any suicides, British authorities pretty much banned everything but Prozac last December for children under 18. And in March, the FDA warned that anyone taking antidepressants, including Prozac, should be monitored for emotional agitation.

Then, two weeks ago, results from the first major government-sponsored study of SSRIs and children came in. It showed that Prozac is more effective for kids than a popular form of traditional talk therapy called cognitive behavior therapy--and that when combined, Prozac and therapy together are most effective of all.

So Prozac, at least, has clear benefits. But it probably has risks as well. "It's really understandable that people are confused," says Carol Glod, director of developmental studies at McLean Hospital in Belmont, Mass. "We just haven't studied antidepressant drugs in kids enough to make many definitive statements." Part of the problem is that the brain chemistry of kids is different from adults'. Prozac works for both groups, but Paxil seems to work only for grownups. Kids, moreover, are amazingly responsive to placebos. While 70% of kids get better on Zoloft, for example, 60% improve on sugar pills.

There's obviously no point risking side effects from a drug that doesn't work. But for the ones that do, the danger of suicidal tendencies can be minimized with careful monitoring by parents and practitioners. It's clear that at least some antidepressants, taken in conjunction with conventional therapy, can be a reasonably safe way out of the despair of childhood depression.