On February 7, 2004, the body of Traci Johnson, a 19-year-old college student, was found hanging by a scarf from a shower rod in a drug company laboratory. Johnson had no apparent signs of depression, and the reason she killed herself was a mystery. What made her death different from other such tragedies is that she was a subject in a trial of an experimental antidepressant. The company, Eli Lilly, noted that four other patients given the drug in earlier trials had also committed suicide. Not long afterward, prompted by Johnson's death and others, the Food and Drug Administration warned doctors that antidepressants might increase the risk of suicide in children and adolescents.
Johnson's death and the FDA's warning underscored the difficulty of treating depression in children. Was the cure worse than the disease? Nearly two decades after doctors began giving antidepressants to children, it is a question they still cannot answer definitively.
Graham Emslie, a psychiatrist at the University of Texas Southwestern Medical Center at Dallas, was one of the first psychiatrists to treat kids with antidepressants. His patients—children and teenagers—were in the grip of life-threatening depression. He wanted something more for them than the talk therapy that at the time was the only option.
Prozac and a growing number of similar successors were just then proving to be effective in treating depression in adults. But the drugs had not been tested in the supple young brains of children. Frustrated by the lack of alternatives, Emslie and others began to prescribe them anyway. They hoped the benefit would outweigh the risks—although there was no evidence to support that.
Despite the unknowns, the use of antidepressants in children and teens exploded during the 1990s. According to Julie M. Zito, a researcher at the University of Maryland who has studied antidepressant use in children, about 1.5 million kids younger than 18 are taking the medications in the U.S. (This figure comes from insurance industry and Medicaid data.)
Now, however, research suggests that suicide is only one of the potential risks. Studies have found that Prozac-like drugs might interfere with normal patterns of growth in children's still developing brains. Although the research is not conclusive, it is possible that kids on antidepressants are trading one psychiatric diagnosis for another. Children who take these drugs—in some instances starting in the preschool years—could find short-term relief and then grow up into edgy, anxious, dysfunctional adults.
Shaping the Wiring?
Amir Raz, a professor of clinical neuroscience in the psychiatry department at McGill University, is one of a handful of researchers raising concerns over the continued use of antidepressants in children and teens. "The human brain is developing exponentially when we are very young," he says. "And exposure to antidepressants may affect or influence the wiring of the brain, especially when it comes to certain elements that have to do with stress, emotion and the regulation of these."
The drugs in question, Prozac and its relatives—including Celexa, Paxil, Zoloft and others—affect brain levels of the neurotransmitter serotonin, which helps to transmit signals between neurons. The drugs are known as selective serotonin reuptake inhibitors, or SSRIs, because they inhibit the removal of serotonin from the synaptic cleft (the space between neurons), leaving more of the transmitter available to exert its effects through neuronal receptors.
Drugs that affect serotonin during developmental years could alter brain function in unpredictable ways.
Raz thinks messing with serotonin in kids is a bad idea. In addition to serving as a chemical messenger, serotonin acts as a growth factor during the first years of life. It encourages the formation of connections, or synapses, between neurons, and it is crucial for the acquisition of a normal response to anxiety-producing events in adulthood. It is also found elsewhere in the body, where it performs a variety of other functions. Drugs that alter serotonin during these critical developmental years could alter brain function in unpredictable ways, Raz says.