Tuesday, August 05, 2003

The Problem with Paxil

Depressing news about the anti-depressant Paxil: The FDA has issued a recommendation that the drug not be administered to children and adolescents diagnosed with depression while it reviews "reports of an increased risk of suicidal thinking and suicide attempts" among those users. Of course, as the FDA FAQ points out, it never actually approved Paxil for pediatric use in the first place, but physicians still prescribe it for what is delicately referred to as "an off-label use." And is this because they have a rock-solid knowledge of childhood depression and exactly what is needed to cure it? These words from the FDA don't exactly fill one with confidence:
Childhood depression is different from adult depression. The reasons are not clear but could relate to the continuing development of the child’s brain. It has been difficult to show effectiveness in children of antidepressants known to work in adults and a number of effective adult antidepressants have not been shown to work in childhood depression Children may also react very differently to some medicines and some side effects over a range of drugs are seen in children that are not seen in adults.
So a drug that's not approved for children is being prescribed for something nobody really understands very well. And if instead of making your kid happy it make him want to kill himself? Oops, oh well, try something else.

And yet, I'm sure there are children who have been helped by Paxil. I'm sure there are parents who feel it has saved their children's lives, and will now agonize over whether they really have to find a new drug. It may ultimately be found that there is no risk of suicidal thinking after all, and kids may have to go through the long and complicated withdrawal process for nothing. As leery as I am of medication in situations like this, I can't deny that many good parents whose opinions I trust feel strongly in its favor. It's a decision that every family has to make for themselves.

Still, in this day when medication is so strongly urged and promoted; when doctors tell me it's silly to have reservations; when TV commercials make you wish you had something wrong with you so you could take a pill and be like all those happy people — it's maybe good to have a reminder that a great deal of psychiatric diagnosing and medicating of children is a matter of throwing stuff at the wall and seeing what sticks. Like giving insulin to a diabetic? Not so much.

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