Mind Over Meds by Andrew Weil MD

Author:Andrew Weil MD
Language: eng
Format: epub
Publisher: Little, Brown and Company
Published: 2017-04-25T04:00:00+00:00

ANTIDEPRESSANTS

Nearly 20 percent of adolescents will have experienced depression by age eighteen. If unaddressed, depression can increase the risk for legal difficulties, drug abuse, physical illness, and problems with school, work, and social functioning. Of greatest concern is the increased risk for suicide, the second most common cause of death among fifteen-to twenty-four-year-olds.

Prior to the 1990s, the only medications available to treat depression had not been shown to be effective in children and were not recommended for them because of significant safety concerns. When the first SSRI, fluoxetine (Prozac), came on the market, it was found to be effective for the treatment of depression in seven-to seventeen-year-olds. SSRIs increase the chemical serotonin in the spaces between brain cells. Many SSRIs are now widely prescribed: sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). SSRI use by children and teens has increased dramatically in the past two decades. A related category of medications, serotonin norepinephrine reuptake inhibitors (SNRIs), affects both the neurotransmitters serotonin and norepinephrine. Examples of SNRIs are venlafaxine (Effexor), desvenlafaxine (Pristiq), and duloxetine (Cymbalta), among others.

But how effective are these drugs in children and teens? A group of studies pooled together showed that, overall, 61 percent of the children and adolescents receiving antidepressants improved (defined as a 50 percent reduction in symptoms), compared to 50 percent of those given a sugar pill. (That is fairly good efficacy for the sugar pill, by the way, and it causes no adverse reactions.) In depressed children twelve or younger, antidepressants were found to be less effective than in adolescents. For treating anxiety disorders they tend to be more effective: the group receiving medication registered approximately a 70 percent improvement, as opposed to 40 percent in the placebo group.

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