What kind of a parent would allow his or her child (or even a loved one in distress) to take medicine that has suicide as a side effect? What kind of a doctor would prescribe them?

I'd like to think it's parents/doctors who recognize that *not* prescribing the drugs also has risks of suicide, and have carefully made a risk/benefit calculation. Surely, that isn't case though.

The SSRIs are much better than the older tricyclics in terms of side effects, which is why they are termed 'miracle' drugs. Truth is, the tricyclics are actually a bit more effective, but are deadly in overdose, whereas the SSRIs are easily tolerated in overdose. It's like any new technology: there are risks and rewards that accrue with the use of that technology.

Bruce:

Fine for physical diseases, but aren't you assuming that there is a distinct disease called depression that afflicts children and that it should be seen as a medical issue requiring medication?

I do not think kids should be prescribed these drugs, because their growth provides so much hormonal variability there would be no way to really analyze the safety and effectiveness of drugs.

But adults do suffer from depression as a medical condition. Not as many as are diagnosed these days, but I am married to one who cannot sleep, eat or function without an anti-depressant. He has tried numerous times to go off of them (as do most adult depressives -- at least the ones who really need the drugs and who strongly desire to consider themselves 'normal'). We finally came to the sad conclusion that he, like a person with chronic heart condition, must stay ont he drugs for the rest of his life. Beleive me, it was not an easy decision, nor was it based on fashion.

I have a friend who said of Prozac, 'it kept my mother from jumping out the window, so it's a miracle drug for my family'-- her mother was manic depressive and had tried to go off medication many times.

As with any illness for which there is a pill, depression is over-diagnosed. But to claim it is a condition that doesn't exist is just wrong.

First of all, it must be said that there are people who need these medications.

However, your dismissal is just a bit off-target: wouldn't it be better to say that the reason anti-depressants are so popular (or venerated) is because it is far easier to think of them as cures rather than palliatives?

Are there many doctors who actually try to get their patients to go beyond the medication and look at their habits, their characters, and their souls? Probably not. Taking a pill may help in the crunch, but people need to learn about themselves - they need to learn how to communicate. In short, they need friends. Drugs can't do that for them.

Peter - yes, I do assume there exists childhood depression, and I have seen it. The treatment for it is tricky, as doctors must necessarily extrapolate from adult studies & practice. The best bet is to 'conduct further studies' (isn't that always the recommendation?) using actual children and scaled-down doses, but those are rare right now.

Believe me, with my family and a family law practice, I'd be the last one to say depression doesn't exist, although I am very skeptical about claims it exists (as a disease)in children or that children benefit from medical treatments in any profound way. But surely when you have a drug whose declared side effect is suicidal idealization, you are playing with fire. Children simply don't tend to talk about their deepest feelings and resent those who try to make them. They don't like to admit there is anything wrong in the head and it isn't hard to understand why--they are not mature enough to handle the emotionally grim side of life. It scares tham.

Bipolar is something all together different from the "situational" depressions suffered after a death, job loss or family breakup or even from a chronic malaise. The risk/benefit calulation Bruce talked about has to be made.

About 20 years ago, after a friend of mine had made a suicide attempt, I read a book on teen suicide titles A Cry for Help, by a couple of suicide-prevention specialists in the Chicago area.

The conclusion I got from the book (which didn't apply very much to my friend's circumstances -- he'd been misdiagosed with stress instead of depression and misprescribed with anti-stress drugs which increased his depression) summarizes as follows:

"If the parents are Baby Boomer Yuppies, the kid's a near-automatic suicide risk."

Peter:

Bruce pretty much said what I wanted to.

But I had to add that your teaser is as brilliant as what David posted last week.

Jeff/Bruce:

Once again we have a micro/macro challenge. Obviously when one is faced with an ill, distressed or unstable individul, and there is a pill that scientific experimentation says can help, what is the big problem? Let's not condemn people to pain because of archaic views or perspectives. If someone is depressed, let's help them.

Fine, now let us look at the macro situation. DMV-IV is four times as thick as it's 1960's predecessor. There is no doubt that both "counseliing" and the prescribing of drugs to treat emotional conditions is growing exponentially, even explosively. Yet, at the same time, most people, including most on this site, will take it for granted that modern times are better than the past and we are progressing qualitatively. Nobody wants to even countenace the idea that things were better in the past. There is certainly no basis for suggesting the general plight of folks today is worse than in the past, and much evidence to the contrary.

From this, it seems the only logical conclusions are:

A) In the old days, there was far more mental and emotional illness than we ever thought, and it must have been much worse than now, because we've had almost a century of enlightened scientific and medical attention to this problem and therefore must be making improvements. That fits with the modern zeitgeist, but the problem is there is no record of this. Indeed, most of us experience our own families from those generations as quite tough and self-assured characters.

B. Something is very wrong, and we are all becoming more and more emotionally fragile or even disturbed for reasons we don't understand or even want to confront;

What other explanations are there?

Peter:

Since I don't hold psychiatry in particularly high regard, I'm not inclined to defend the practice.

However, if the ability to discern distinctions becomes sharper over time, that will be sufficient to increase the number of entities.

I have no idea the impact of that compared to, say, the whims psychiatry, but it probably shouldn't be disgarded out of hand.

There aren't a heck of a lot more diseases around now than, say, 100 years ago. But doctor people can much more meaningfully distinguish between those that have been there all along. Therefore, there are many more diagnosable diseases now, even though the number of diseases is essentially unchanged.

childhood depression does exist, and hence, so does childhood bipolar. as has been said above, it's all about risk analysis. do doctors overprescribe for these conditions? of course, but moreso because of 1) a legal system that penalizes any doctor not seen as giving standard of care and 2) parents that demand said drugs for poor little suzie (i.e. ritalin for a 4 year old that happens to run around outside a lot)

it's a difficult balancing act, one that requires a health team (not just an MD) and cooperation from the parents. unfortunately, many parents appear to have more pressing concerns (upcoming date with 21 year old babysitter, job, etc)

Giving 'em a pill is certainly easier than chaining them to a wall.

We've become a soft, degenerate people.

Our ancestors were, as Peter says, tough and self-assured.

Methinks there is an effort here to equate everyone diagnosed with depression with bi-polar patients, suicidal idealizers or the insane.

Once again, these pills are now thought to possibly cause suicide. If this is so, then the risk/benefit assessment should be dealing with some pretty dramatic and life-threatening risks, no? Do you really think these incredibly popular and profitable drugs are being largely resticted to these classes, especially among children?

Peter:

The fundamental question is whether the risk of suicide is greater with, or without, the drug.

It isn't as if the alternative is risk free.

BTW--I must emphasize I'm not defending the practice. Harry has it exactly right.

"The answer is parents and doctors who have an unquestioning faith in scientific beneficence and who have deferred all critical judgment to the omniscient medical and drug research industries. "

Peter, why do you assume that people who follow a medical path do so in an uncritical, unquestioning manner? Don't you get tired of dealing with stereotypes after awhile? Could it be that medical science, though not perfect, has had a pretty impressive track record over the last 75 years or so, and that people will also base their decisions on the trustworthiness of their physicians and possibly on the experiences of other people that they personally know who have taken or have had their children take antidepressants?

"Fine for physical diseases, but aren't you assuming that there is a distinct disease called depression that afflicts children and that it should be seen as a medical issue requiring medication?"

Why would you assume that depression doesn't or cannot have a medical component? Why would you assume that such a medical condition could not affect children?

Let me confess here. I take antidepressants. I started taking them about 7 years ago, for about 3 years, then I stopped. After a bout of depression last year, I began taking them again. I will probably take them indefinitely, as I seem to be prone to depression during periods of intense stress.

Looking back on my life, there were periods in my childhood quite similar to the depressive episodes that I have experienced as an adult, so I have no doubt that children can experience depression. My experience with the drug has been overwhelmingly positive, once you find one with the least side effects. If they can have the same results on children, I really cannot see any reason why a child could not be prescribed them. Of course, the suicidal side effects are of a major concern, but there needs to be more information on how many children are affected. There is a small chance that some children can die from vaccinations, but overall more children are saved by the vaccinations than die from them, so it is a risk that is worth taking for parents. Antidepressants are not to be prescribed lightly, but if a child is suffering from depression and is at a risk of suicide, I don't see why a responsible parent should categorically rule out their use.