The kids are bummed...grab the zoloft

What the hell is this teaching moment all about?

In January 2004, Dr. Andrew Mosholder, an epidemiologist in the FDA's Office of Drug Safety, analysed 22 clinical trials of nine antidepressants and uncovered some damning evidence that indicated that SSRI antidepressants used by children caused a doubling in suicide attempts over kids who were given a placebo (sugar pill).

These studies had been done over the course of many years and then buried by the drug-makers. Dr. Mosholder blew the lid off the data which lead to the FDA holding meetings with industry, parents whose kids had been on SSRIs and killed themselves, doctors and others.

The result: the FDA ordered drug-makers to place black box warnings on all antidepressants that include the following information:

• Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with MDD and other psychiatric disorders.
• Anyone considering the use of an antidepressant in a child or adolescent for any clinical use must balance the risk of increased suicidality with the clinical need.
• Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.
• Families and caregivers should be advised to closely observe the patient and to communicate with the prescriber.
• A statement regarding whether the particular drug is approved for any pediatric indication(s) and, if so, which one(s).

So a Teaching Brief recently posted at MedPageToday.com has me a little baffled. Recall that MedPageToday.com positions itself as the leading source for doctor education.

The Tecahing Brief is called, Childhood Depression Is Understudied and Under-treated. It's a review of an article that just appeared in The Lancet, a British medical journal. The review talks about all the deficits in understanding and treating childhood depression and how many depressed kids are left untreated. And then, there’s this quote from the author, a doctor:

Although tricyclic antidepressants such as Elavil (amitriptyline), selective serotonin reuptake inhibitors such as Prozac and Zoloft (sertraline) and specific norepinephrine reuptake inhibitor (SNRI) such as Strattera (atomoxetine) all appear to work equally well in adults, there is little evidence to support the use of any but the selective serotinin reuptake inhibitors (SSRIs) in kids, Dr. Ryan asserted. (My emphases)

Dr. Ryan! Did you miss the memo? SSRIs lead to kids killing themselves! Oops. You must be pretty embarrassed, Dr. Ryan. Wait 'til the editor of The Lancet finds out that he, too, missed the memo. What an oversight…

...oh, unless you’re an industry shiller. An expert paid to help swing opinion about SSRI prescribing back into a favourable light…but that couldn't be... a doctor putting his self-interest before the patient's? The editor of a major meidcal journal blinded by junk science? No... that doesn't happen...

And as a very nice irony – or clever marketing strategy – the ad that accompanies this article is for Zoloft, an SSRI antidepressant, of course. (Check it out here). This animated antidepressant looks like it's straight from one of the crazy Neopets / Pokemon / Digimon series of animated characters my son loves. Just who are they trying to grab with this ad campaign? Moms or their kids?