- The Washington Times - Sunday, May 7, 2000

About 500,000 American children are taking anti-depressants, drugs that have not been app-roved by the U.S. Food and Drug Administration for those younger than 18.

Dr. Peter Breggin, a Bethesda psychiatrist and author of two books on the dangers of anti-depressant use, says his concern is that drugs such as Prozac, Zoloft and Paxil often are given out when a chemical imbalance is not at the root of a child's problem.

"For children, we can always find reasons for them to be depressed school, home life, social life," he says. "Kids need individual assessment and understanding. They need counseling for the family, not just the child. No one has studied the effects of anti-depressant use in children. You are essentially bathing a growing brain in toxins when you give them to children."

Dr. David Fassler, a child and adolescent psychiatrist in Burlington, Vt., and a spokesman for the American Academy of Child and Adolescent Psychiatry, says medication has been extremely helpful for some children but should be part of a comprehensive treatment program that includes counseling and evaluation.

"Children need a comprehensive exam," he says. "We need to find out what is going on at home, school, in the child's early development. Based on a comprehensive evaluation, a child needs a specific treatment plan. That could be individual therapy or family therapy and maybe medication. In my opinion, medication alone is not appropriate treatment."

Dr. Fassler says many drugs prescribed for children are not specifically approved for that purpose.

The fact that selective serotonin re-uptake inhibitors (SSRIs) are not FDA approved for children is not that important in the big picture, he says.

"Many medications we use for children are not formally approved for that use by the FDA," Dr. Fassler says. "I fully support initiatives to undertake expanding research and increase funding. It would be more helpful because it would give us information concerning dosages and side effects. So far, we have seen relatively few side effects, and the drugs are well-tolerated."

As in cases of adult depression, critics say anti-depressants are given out too frequently and some patients may have bizarre side effects and violent behavior while on the drugs.

Dr. Fassler points out a recent report by the U.S. Surgeon General that 20 percent of American children ages 9 and older have a mental disorder, including depression, attention deficit, hyperactivity disorder or bipolar disorder. However, fewer than one in three receives the appropriate treatment.

The National Institute of Mental Health estimates that as many as 1.5 million children and adolescents 2.5 percent of all Americans younger than 18 are seriously depressed.

"Part of the problem is that not enough kids are being seen by mental health professionals who can diagnose and treat accurately," Dr. Fassler says.

As in adult reactions to the drugs, the link between SSRIs and bizarre behavior has not been directly established.

"I personally have not seen the evidence that medication is the problem in those cases," Dr. Fassler says. "Those cases could be tied to an underlying psychiatric problem. Sometimes symptoms of depression are really bipolar disorder, in which case, SSRIs won't help."

In assessing a child, Dr. Fassler says he would ask if the child's behavior represents a change such as falling grades or social withdrawal or a change in sleeping or eating habits. He also would ask if the problem has lasted longer than a few weeks and whether it is interfering with home and school life.

"I would recommend [medicine] in cases where we have tried other interventions such as counseling and therapy or have had similar problems before that responded to medication or if a child is acutely suicidal and I need to do everything I can," Dr. Fassler says. "Seventy to 80 percent of kids can be effectively treated with a combination of counseling and medication."

If a physician recommends treatment, Dr. Fassler recommends asking these questions:

• How fast it will work?

• What are the side effects?

• What other medications should the child avoid?

• How long will he need to take it?

• What is the cost?

• What is known about its helpfulness to other children with the same problems?

"If you are not comfortable with the physician's recommendations, get a second opinion," Dr. Fassler says.

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