What do antidepressants and suicides have in common?

A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) work effectively in people younger than 18 and don't raise their risk of suicidal behaviour, a task force of experts concludes. The finding is sure to continue the seesaw debate over how safe these drugs are for children, because other experts have come down hard against some SSRIs. Last fall, the US Food and Drug Administration recommended against the use of one SSRI, Paxil, in people under 18. Several months earlier, British authorities banned the use of Paxil by young people, though it still permits use of another SSRI, Prozac, among minors, reports &to=http://www.health24.co.za' target=_blank>Health 24

The government is trying to determine if popular adult antidepressants sometimes increase the risk of suicide when they're given to children, an emotionally charged controversy that escalated months ago when British authorities sounded an alarm.

A series of public hearings by the Food and Drug Administration beginning Monday focuses on a difficult question, in which parents who blame the drugs for children's deaths are expected to face families who credit the same pills for saving lives.

Depression occurs in about 10 percent of youth and can lead to suicide, especially if untreated. Some 1,883 10- to 19-year-olds killed themselves in 2001, and specialists say there are 10 to 20 attempts for every suicide. No suicides have occurred in studies encompassing 4,000 children. Preliminary data, however, suggest that suicidal behavior and attempts, while infrequent, might be at least twice as frequent among some antidepressant users. Britain put the risk at around 3.2 percent of children given the drugs, compared with 1.5 percent of those given dummy pills, informs &to=http://www.miami.com' target=_blank>Miami.com

After her 11-year-old son began taking the antidepressant Lexapro this summer, Yvette Prayor of Worcester found herself pacing the floors at night. As a nurse, she said, she had heard that such drugs could raise the risk of suicide in young people, and her son already suffered from low self-esteem. But the psychiatrist had said Lexapro could do some good. So she paced, "for fear that if I go to sleep, he's not going to be awake when I wake up." Confusion and concern about whether Paxil and other Prozac-generation antidepressants increase suicidal tendencies in some children and teenagers have become so widespread among parents, doctors, and researchers that the Food and Drug Administration will convene a public hearing tomorrow to take testimony and review the evidence.

The agency is not expected to reach a conclusion until this summer about whether the drugs increase the risk of suicide among children and teenagers. Estimates vary, but perhaps as many as 1 million American young people take the drugs, known as selective serotonin reuptake inhibitors or SSRIs. In Massachusetts, about 1.3 percent, more than 5,000 in all, of children and teens on Medicaid take them, according to the only state records on prescriptions. The key in prescribing SSRIs to young people is to start with a low dose, go slowly and carefully, and treat them at the same time with a sedative or psychotherapy, said Dr. Alexander Bodkin, chief of clinical psychopharmacology research at McLean.

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