Volume 183 - Issue 5
Depressed youth, suicidality and antidepressants
Authors: Peter R Mansfield, Melissa K Raven and Jon N Jureidini
Med J Aust 2005; 183 (5): 275-276. || doi: 10.5694/j.1326-5377.2005.tb07039.x
Published online: 5 September 2005
Published online: 5 September 2005
Peter R Mansfield,* Melissa K Raven,† Jon N Jureidini‡
* Research Fellow, University of Adelaide, SA; † Lecturer, Flinders University, Adelaide, SA; ‡ Head, Department of Psychological Medicine Women's and Children's Hospital, Adelaide, SA. peter.mansfieldATadelaide.edu.au
To the Editor: Rey and Dudley cite clinical experience as the basis of their recommendation of selective serotonin reuptake inhibitors (SSRIs) — chiefly fluoxetine — for youth with severe depression plus severe impairment or failure of non-drug therapy.1 They do not discuss the evidence on efficacy because they claim that it is “ambiguous enough for scholars to be divided”. It is true that industry-funded scholars are continuing to suggest that SSRIs (chiefly fluoxetine) provide a worthwhile benefit.2 However, the evidence is unambiguous. The four published comparisons of fluoxetine versus placebo for children and adolescents have all been negative on their pre-specified primary endpoints.3,4 A tiny average benefit is likely, but the magnitude of this benefit is unlikely to exceed the magnitude of less frequent but more severe harms. Furthermore, the common clinical impression of worthwhile benefit is to be expected given the large average improvements seen in placebo groups.
Rey and Dudley speculate that psychosocial treatments may be less effective with uncooperative teenagers.1 However, that group may also be at higher risk of the dangers of intermittent use of, and overdosing with, antidepressant drugs.
Rey and Dudley cite Timimi’s critique of the concept of childhood depression5 as supporting “treating depression primarily as a moral or social problem”. However, Timimi did not even allude to depression as a moral problem, and advocated a multi-perspective approach that normalises emotional responses to adverse life experiences and includes interventions addressing biological factors, such as diet, exercise, and cognitive abilities. Rey and Dudley use a related straw-man argument in their final sentence when they suggest that the only alternatives to SSRIs are tricyclic antidepressants, victim blaming, and non-treatment.
Rey and Dudley deny being influenced by the gifts and funding that they have received from drug companies. There is compelling evidence that gifts and funding are effective, on average, for influencing beliefs, especially among people who have an illusion of invulnerability.6 We are not aware of any way that any individual can know that he or she has not been influenced.
Competing interests
We are all office bearers in Healthy Skepticism, an international non-profit organisation whose main aim is to improve health by reducing harm from misleading drug promotion.
References
- Rey JM, Dudley MJ. Depressed youth, suicidality and antidepressants. Med J Aust 2005; 182: 378-379. <eMJA full text>
- March JS, for the TADS Group. Authors of TADS study reply to letter raising concerns. BMJ 2005; 330: 730-731. 0_i1091551
- Jureidini JN, Doecke CJ, Mansfield PR, et al. Efficacy and safety of antidepressants for children and adolescents. BMJ 2004; 328: 879-883. 0_CBBHEJIH
- Jureidini J, Tonkin A, Mansfield PR. TADS study raises concerns. BMJ 2004; 329: 1343-1344. 0_CBBIGGEC
- Timimi S. Rethinking childhood depression. BMJ 2004; 329: 1394-1396. 0_CBBEDCDA
- Katz D, Mansfield P, Goodman R, et al. Psychological aspects of gifts from drug companies. JAMA 2003; 290: 2404-2405. 0_CBBBABEJ