Do Kids Need Prozac?

ANDREW CRITTENDON WAS ONLY 7 when an inexplicable bleakness descended on him. ""I lost interest in everything,'' he recalls. ""I just sat in my room and thought about how horrible life was.'' Andrew's mother, Beverly, started to worry when a trip to Six Flags Great Adventure didn't lift his spirits, and her concern turned to terror when the child started talking about suicide. Dr. Graham Emslie, the Dallas-based psychiatrist who diagnosed Andrew's depression, offered to enroll him in a study of Prozac. ""I didn't care what they did,'' Andrew says, ""as long as there was a chance it would make me feel better.'' It did--and he stayed on the drug for four years. At 11, he discovered he no longer needed it. Andrew is now a six-foot-tall ninth grader with his sights set on a career in filmmaking. ""I'm really one of the happiest people I know,'' he says.

A decade after depressed adults started listening to Prozac, a generation of children is tuning in. None of the half-dozen drugs in Prozac's class--the so-called selective serotonin reuptake inhibitors, or SSRIs--has been fully tested in children. But because the drugs are FDA-approved for use in adults, doctors can legally prescribe them to kids as well. The new users span every sector of society, from Manhattan's most elite schools to Atlanta's poorest ones, and their numbers are exploding. ""Five years ago, one camper was taking Prozac and everyone remarked on it,'' says Regina Skyer of Pennsylvania-based Summit Camp, the nation's largest summer camp for learning-disabled children. ""Now a quarter of the kids take it.'' According to the research firm IMS America, children age 6 to 18 received 735,000 SSRI prescriptions in 1996--an increase of 80 percent in just two years. Looking at those numbers, some experts worry that we've embarked on a large and dangerous experiment. Others applaud the trend as our best hope of saving children from lives of despair. And both sides may be right.

As recently as 15 years ago, doctors assumed that only grown-ups got the blues, but depression is now recognized as a major childhood scourge. In any given year, it affects an estimated 5 percent of youngsters 5 to 12 years old, and 10 percent of adolescents (the same rate as adults). The condition is a major factor in the growing tragedy of teen suicide--rates have tripled since the 1950s--and a common cause of school failure and dropout.

Until Prozac came along, any child taking an antidepressant risked serious side effects. The usual treatments--drugs known as tricyclics--caused heart arrhythmias in some patients, and overdoses were potentially fatal. Prozac and its cousins (Zoloft, Paxil, Effexor, Luvox and Serazone) appear far safer. After seeing what they could do for depressed adults, physicians were understandably keen to try them in younger sufferers. And when they start- ed, previously untreated kids emerged in droves.

Those kids may be reaping huge benefits, but hard evidence is still in short supply. In the only study completed so far, researchers at the University of Texas Southwestern Medical Center gave Prozac or a placebo to 96 depressed children and adolescents. After eight weeks, mood ratings had improved in 56 percent of the Prozac-treated kids, versus a third of those on placebo. Those numbers suggest the new drugs are as effective in kids as they are in adults. But the study also turned up a potential side effect not seen in adults: three of the treated children (6 percent) became manic. The drug may not have been to blame, but many experts still worry that long-term use could disrupt children's brain development. ""The SSRIs seem safer than older antidepressants,'' says Dr. Leon Eisenberg of Harvard Medical School, ""but they are still potent medications that change nerve transmission. What happens after two to three years of that?''

That's a serious concern. But depression itself is so dangerous that most experts still come down firmly in favor of treatment. The condition can set off a vicious cycle of lost friends, lost learning, more depression and less chance of catching up. ""Our hearts have been broken again and again,'' says Diane Weaver, whose son Buddy Cumberland tried unsuccessfully to hang himself at the age of 7. Buddy was a cheerful, popular imp when he started first grade. But as the year progressed he developed frequent headaches and became hypersensitive to criticism. By summertime, he had lost interest in his friends and dropped his hobby of tinkering with old electronic gizmos. Second grade bored him so deeply that his parents tried moving him into a third-grade class, but his mood only worsened. A psychiatrist placed him on Paxil after the suicide attempt, and the family says it saved his life. Though Buddy now splits his time between a class for gifted kids and one for the emotionally disturbed, he has reclaimed his curiosity and his humor.

TREATMENT MAKES OBVIOUS sense for kids like Buddy and Andrew, but many critics suspect they're not the only ones receiving it. Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek, Calif., suspects that some parents are trying to cure their kids of anguish that is simply part of growing up. Others worry that kids are receiving antidepressants not as an adjunct to care and counseling but as a cheap substitute. ""Depression in children is often the onset of a long-term illness that the child and family will have to deal with,'' says Dr. P. Anne McBride, a child psychiatrist at New York Hospital-Cornell Medical Center. ""A pill alone is not usually a cure. Support and counseling of the family are important parts of treatment.'' But when the cost-cutting pressure is on, doctors may think that all they can do is prescribe.

What is a parent to do? If you suspect your child is depressed, by all means seek help, says Laurie Flynn, executive director of the National Alliance for the Mentally Ill (NAMI). But if it seems serious, don't rely solely on a family doctor. Child psychiatrists are best trained to distinguish the 40 percent of teenagers who say they're miserable from the 10 percent who are truly depressed. By the same token, 70 percent of children with depression struggle with another impairment, such as attention deficit disorder, obsessive-compulsive disorder or learning disabilities. It takes skill to determine whether one problem is causing the other, and to find the appropriate treatment. NAMI (800-955-NAMI) can help you locate family support groups and can refer you to qualified psychiatrists.

Even with the best care, questions remain. How long should children stay on anti- depressants? What's the right dosage? Will the treatments help reduce the rate of teen suicide? Most of the drugs' manufacturers are now conducting trials in kids--and several are hoping to expand their marketing claims accordingly. Until then, giving kids Prozac is a stopgap solution. But in truly depressed children, it can be a lifesaver.

             1994     1996

Age 6-12      63       176

Age 13-18    347       559

PRESCRIPTIONS, IN THOUSANDS

SOURCE: IMS AMERICA