Jun 16 2004
A study of major depressive disorder in children and teens that showed that sertraline is slightly more effective than placebo. It also had more side effects. This really is an important study. Kids are already taking Zoloft, and we need to understand the implications of this. Some of the results are troubling, though.
Should children be prescribed Zoloft on a regular basis? Of course not. We don't know the long term effects of prescribing such powerful medications to children. Zoloft, like the more famous Prozac, is a selective serotonin reuptake inhibitor (SSRI). The mechanism of action of these medications is not completely known. We do know that they increase levels of serotonin in the brain and body. New research suggests that they also stimulate the hippocampus to grow new brain cells.
While growing new brain cells sounds like a good thing, we don't know the long term implications of this. Children are actively learning and their brains are reorganizing at a high pace. What effect will more serotonin and new brain cells in the hippocampus have?
Candace Pert, the neuroscientist who discovered endorphins, also cautions against large scale reliance on SSRIs in her book The Molecules of Emotion. Pert is one of the foremost experts on "messenger molecules" - molecules that convey information from one cell to another. She notes that cells in the heart contain serotonin receptor sites - places for serotonin to attach in order to relay a message to the cell. We don't know why these sites are there, but serotonin appears to play some role in cardiac function. How would months or years of extra serotonin affect the heart? Nobody knows.
Caution should also be exercised because of another study that found an increased incidence of suicidal thinking in young people who took paroxitine (Paxil), a similar medication. The FDA has since restricted that medication to new patients age 18 and over. The SSRI Prozac has battled a reputation that it caused suicides for years. Joseph Glenmullen's book Prozac Backlash claims that Eli Lilly & Co. pressured scientists to alter records of physician mentions of suicide attempts.
In the recent Zoloft study 17 of the 189 young sertraline patients dropped out of the study because of adverse events, compared with only 5 who took placebo. Sertraline caused agitation, diarrhea, nausea, vomiting and anorexia in some patients. The children who took Zoloft also lost weight. The long term implications of this weight loss is unknown.
The bottom line - We don't know the long term effect of medicating our children with these powerful drugs. SSRI antidepressants may be helpful for some children and teens who are severely depressed, but psychotherapy is often also effective and has fewer side effects. It may be better to start there and save the antidepressants for those instances when psychotherapy doesn't help.
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Last updated 11/5/05