The controversy surrounding the use of antidepressants
in children came to an official head last month with the FDA's order
that SSRIs prescribed for children carry a “black box” label-the
strongest warning the agency puts forth-and are accompanied by an
informational guide outlining the medications' risks. The decision
presents valuable opportunities to educate parents on possible side
effects of the drugs but has also spawned confusion among the public,
policymakers and the media. Advocates must know the facts and stand
ready to face this issue head on.
|Since the introduction of the first SSRI
in 1987, adolescent suicide rates have been falling, and are
now at about eight per 100,000 per year compared to more than
11 per 100,000 per year in 1990.
New Obstacles to Care
It is essential to take precautions that
protect children and ensure the safe use of medications. But it is
equally important to ensure that we don't deter consumers, parents
and doctors from safe prescribing practices, or allow this development
to shape mental health policy and funding for services in a detrimental
way. As NMHA said in its Sept. 13 testimony before an FDA advisory
panel, policymakers must approach safety issues in the broadest possible
context to avoid intensifying the stigma surrounding mental illness
that already dissuades parents from seeking care for their children.
The FDA warning must not present its warning in a manner that would
construct barriers to needed care, namely by causing unnecessary fear
in parents. Any action that would worsen the public health crisis
of untreated mental health disorders in children would be devastating
for the one in five children who need mental health treatment.
Advocates Must Respond
Mental health advocates must confront this
issue with clear messages that address the misinformation pervading
recent media reports.
But we face serious challenges in helping the public, policymakers and the media
to understand this issue. For example, alarmed parents across the country have
reacted to the agency's decision by pulling their children off the medicationswhich
poses risks if done suddenly-and interrupting their treatment plans. Conflicting
news stories and negative advertisements are only encouraging such confusion
and panic, and stand to discredit the very real threat of untreated mental illness.
This defies decades of research and our hard-won strides in improving public
understanding of mental health issues.
The confusion surrounding this issue could also endanger state and federal policy.
Lawmakers who fail to understand the context of the panel's recommendation may
use the data in negative ways to justify or enact policies that further restrict
access to SSRIs. More broadly, this issue could affect policymakers' decisions
about funding all psychotropic medication, children's mental health services,
and other mental health protections and treatments.
The FDA Order: What You Need To Know
NMHA offers advocates the following messages they can
use to help clarify this issue among members of the public and the media,
and with policymakers:
- The worst possible situation for children
who have mental
health problems is to go without treatment.
- The parents of children diagnosed with
depression or other
disorder should discuss the risks and benefits of all
treatments with a doctor. If antidepressants are prescribed,
parents and doctors should monitor the children closelyparticularly
in the first few weeks of care.
- Know the warning signs of suicide, and
if a child or adult you know exhibits
symptoms, talk to a doctor or mental
health professional immediately.
- No one should abruptly discontinue
their children's — or their own— antidepressant
use, which can lead to significant side effects.
- Separate “fact from fiction” by
identifying credible sources of
information about how antidepressants
work and what the real risks are.