P2B Sample Inquiry Essay A

Inquiry Essay: The Effectiveness of Antidepressants on Children and Youth

            I have chosen to write about the effects that antidepressants have on children and youth.  This current issue is affecting many people right now and there are several views that groups have taken on this issue.  This complex issue has no real right or wrong answer for the recent questions raised about the effectiveness and safety of antidepressants for children.  

            I really do not know very much on the issue of the effects that antidepressants have on children, but my general opinion is the fewer drugs the better.  I believe that in most cases, children should learn how to deal with their problems without the use of medication.  One reason I feel this way is because I think that the more medications that people take, the more they put off actually getting to the root of their problems.  I think that medications are just a temporary fix and are not a good way of dealing with your problems.  Another reason I do not think that children should use antidepressants is that they will learn to become dependent on drugs as a way to solve their problems.  I think that this could be a huge problem when they get older and do not know how to deal with some of life’s more serious problems without the help of drugs.  A third reason I don’t think children should use antidepressants is because it is impossible to know the effects that drugs have on individuals, both in the sort and long run.   The effects of the drug could cause more problems in the future for the children. 

            Some factors that my have influenced my view are my community where I grew up.  I grew up in a small town with a focus on art and a large part of the population was into the “natural” way of doing things.  This may be why I tend to think the fewer drugs the better and other methods might be more effective including yoga, acupuncture, or even just counseling.

            My values and beliefs came from my parents and church.  Both of these had pretty conservative values and beliefs and maybe the more conservative background is an influence on my opinions also.  This may be one reason I think that new drugs are not necessarily better than the old ways of dealing with things. 

            After researching the issue of the effectiveness of antidepressants on children and youth, I have found several sources explaining various views on the issue.  The first article I want to discuss, “APA Comments on New FDA Warning”, tells how psychiatrists are concerned that the black box warning labels the FDA has issued on antidepressants may affect the children that really need them most.  This is made clear when American Psychiatric Association president Michelle B. Riba, M.D., M.S., said, “We restated our continued deep concern that a ‘black box’ warning on antidepressants may have a chilling effect on appropriate prescribing for patients” (1).  I found this information somewhat alarming.  In my first position I never really considered the children that are potentially benefiting from taking antidepressants.  I was thinking more about the suicide risks involved with the medicine, rather than the suicides that the medicine may be preventing.  However, after reading through this source I realized that these drugs really might help some kids.  Dr. Riba says, in reference to a review of 15 clinical trials on more than 2,000 youths, “since prescribing has become widespread, there has been a dramatic drop---- averaging 33%---- in rates of youth suicide in 15 countries” (1).  This is an impressive drop in the number of suicides committed by youth.  This really made me think about how antidepressants may make a positive change in severely depressed children.  It seems clear based on information found in this source that some children’s lives are actually being saved because of these drugs.  This information forced me to revise my initial opinion to consider the children and youth who truly are benefiting from antidepressants.

            The second article that influenced my views, “Facing the evidence: antidepressant treatment in children and adolescents”, discusses the risks involved for children and youth who are prescribed antidepressants.  This article tests some of the other information provided from the other sources.  The information in this article is based on the research of the author Jane Garland.  Garland says, “In addition to their weak or nonexistent evidence of efficacy, SSRIs may have serious adverse effects on children.  Although rates of suicidal ideation and suicide attempts are low in the SSRI trials reviewed by regulatory agencies (2%-5%), observations in clinical trials and case reports indicate that up to 25% of children placed on SSRIs for any disorder will experience other psychiatric adverse effects including agitation, irritability and behavioural disinhibition”(1).  

             I also found some of this information alarming and somewhat contradictory to the information I found in “APA Comments on New FDA Warning”.  While writing my first reaction to the issue, I had no idea that antidepressants really might hold such dangerous risks for children.  I found out that some researchers do not even believe that any antidepressants are very effective for treating childhood depression.  Garland says, “The disappointing reality is that antidepressant medications have minimal to no effectiveness in childhood depression beyond a placebo effect” (2).  It is difficult to know the truth, but this information makes it extremely important for proper diagnosis for children before they are put on antidepressants.  I was surprised by the number of children who are on antidepressants and that the largest increase was for children who were in preschool.  It is hard for me to believe that a large number of preschoolers are truly depressed.  This supports my initial opinion that the effects of the antidepressants are not clear and there may be a lot of damage happening that doctors are unaware of and cannot determine.  After reviewing the information in this article, I think it is important to limit the number of children on antidepressants to only those who really need them, not necessarily to all, as I felt in my first response.

            The third article I want to discuss deals with the middle of the road approach.  This is the idea that while certain antidepressants may benefit severely depressed children and youth, prescriptions are being given out too easily without proper diagnosis. In “Recognizing Depression in Children”, Kathryn Murphy describes how an accurate diagnosis is important for full recovery and the importance of “ruling out any medical condition that may be causing the symptoms” (5).  Murphy also describes the importance of therapy for children saying, “Since long-term patterns of thinking and feeling are not well-established in children, therapy can be quite effective” (50.  Murphy is in favor of teaching therapy in combination with the drugs and says, “Their [children’s] mental health depends not only on their life experiences—good and bad—but on how they learn to cope with them” (1). 

            Murphy’s article shows some interesting views.  I agree with her idea that only children who have undergone a psychiatric evaluation should be put on approved antidepressants (4).  In my initial idea I didn’t consider diagnosing children before putting them on medication.  Now, it seems that this is the only safe way.  Murphy talks about how a full recovery requires a proper diagnosis and that therapy is very effective for children (5).  The idea of therapy supports my initial views, but at first I didn’t realize the success that therapy combined with medication had for children (Murphy 1).  My first opinion is supported by Murphy when she says, “If we teach our children that pills make them feel better, how can we tell them not to try a joint or a few drinks to lift their spirits” (1).  This is similar to my concern that children will become dependent on drugs for all their problems if that is what they are taught at a young age that drugs can ease their pain.  I think now, however, that this is not a reason for not prescribing antidepressants to children as I thought in my initial opinion, but it is a good reason to make sure the children that receive the drugs really need them.  I think this also supports the idea that therapy can be very helpful to help teach a way to deal with problems without the drugs. 

            Initially, I said the fewer drugs the better. However, after reading through a lot of information, I think that sometimes it is necessary to prescribe antidepressants to children.  The information I found in my sources shows that, where necessary, antidepressants should be prescribed, but with limits and only after a careful diagnosis.  I think that this is a very smart way to look at the issue.  It is important that these drugs are available for those who truly benefit from them, but they should be given with therapy, which was shown to be the most effective method.  It is also important that those receiving the antidepressants are going to benefit from them and that they are not going to make the child’s problems worse.  I still think that too many children are getting prescriptions for antidepressants but I believe that this can be changed with better diagnoses combined with therapy for those taking the antidepressants.