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Several errors mar Slate’s story on antidepressant use in kids

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2 Star

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Prozac May Be the Only Drug That Effectively Treats Depression in Kids

Our Review Summary

Depressed teenager sitting lonely outdoorsThis story covers a meta-analysis led by a researcher at the University of Oxford (UK) that examined peer-reviewed studies on the effects of 14 antidepressants on children and adolescents diagnosed with major depressive disorder. Published in the Lancet, the study found that only fluoxetine, marketed in the U.S. under the name Prozac, was shown in trials to be significantly more effective than placebo, though its clinical effectiveness isn’t clear from available data. The study also found “robust evidence” that the drug venlafaxine (Effexor) raises the risk of suicidal behavior.

The fact that Prozac is singled out in the headline as possibly “the only drug that effectively treats depression in kids” may lead readers to think that there is solid evidence of Prozac’s safety and efficacy, which there isn’t. But more importantly, the story included several errors, which are primarily detailed in the “Harms” criterion below. Example: The story says that “since 2004, the FDA has advised that antidepressants not be prescribed to individuals under 24 due to the increased risk in suicidality.” This is not true–the FDA did not make such a blanket statement–they note the increased risk of suicidality, but leave it up to physicians to weigh the possible risks vs possible benefits.

 

Why This Matters

Depression is common in young people, affecting an estimated 2.8 percent of children under 13 and 5.6 percent of teens, according to published research. Antidepressant prescribing for children and adolescents has increased despite questions about safety and efficacy.  Most clinical guidelines call for counseling as the preferred treatment for young people with depression. It remains to be seen whether this meta-analysis, which its authors say “represents the most comprehensive synthesis of data” and is the first to compare and rank antidepressants for young people with major depressive disorder, will prompt clinicians and patients’ families to reconsider their use.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not discuss the cost of antidepressants, though does mention that the alternative, cognitive behavioral therapy, “is a high-cost intervention in terms of both dollars and time invested.” A cost comparison would have been useful since the study encourages a shift away from drugs and toward therapy. Seeing a therapist for psychotherapy may not be so high a cost if the patient learns some lifetime skills and insights that help lessen and prevent depression, which tends to be recurrent.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story explains that only one of 14 antidepressants examined in the study — fluoxetine — “was significantly better than a placebo in treating depressing in children and adolescents,” and that it “outperformed all other antidepressants in both efficacy and tolerability.”

Yet, the story did not mention a really important caveat to that: It’s not known if this finding is clinically meaningful, for a number of reasons the authors list in the study. As well, the study noted that fluoxetine should be considered the best choice for young patients who do not have access to psychotherapy or have not responded to non-pharmacological interventions.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story describes some harms and uncertainty associated with antidepressant use in young people whose brains are not fully developed, including an increased risk of suicide.

But, unfortunately, the story goes beyond the evidence, and includes erroneous information.

The story says: “Since 2004, the FDA has advised that antidepressants not be prescribed to individuals under 24 due to the increased risk in suicidality.” This is not true–the FDA did not make such a blanket statement–they note the increased risk of suicidality, but leave it up to physicians to weigh the possible risks vs possible benefits.

It also says: “FDA has deemed that Prozac has demonstrated benefits that outweigh one of the suspected downsides of antidepressants in kids and teens: disrupting brain development.” But, FDA doesn’t address brain development in their evaluation of drugs.

The story then says: “research on antidepressants suggest they negatively affect brain plasticity and memory” and cites two rather dated animal studies that that don’t seem well described by the story.  Antidepressants do seem to affect brain plasticity, but in a good way, as opposed to stress. We’re aware of no adverse effects on memory documented in humans with antidepressant treatment (although depression adversely affects memory).

Also, the reference the author cites for antidepressants sparking a chemical reaction to increase the risk of suicide is about psychosis, not suicide, at least as far as we can tell from the abstract.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story does not explain the scope of the study, which examined 34 trials of 14 drugs on a total of 5,260 patients. Further, the study authors point to numerous weaknesses with trial data, including potential bias and problems with study methodology that were not mentioned in the story.

Some of these limitations mean that although there’s evidence that fluoxetine might reduce depressive symptoms, “the extent to which this reduction is clinically meaningful is still uncertain,” according to the study. Further the study says, “Without access to individual patient-level data, we cannot be confident about the accuracy of information contained in published studies or even clinical study reports.”

Does the story commit disease-mongering?

Satisfactory

The story does not engage in disease mongering.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story does not mention that the study was funded by the Chinese government through the National Basic Research Program of China or that the researchers collectively have financial ties to numerous drug companies.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story discusses cognitive behavioral therapy, which it says is recommended by guidelines from the psychiatric associations in most countries and “has been shown to work, at least by participants’ own assessment of their depression levels.” It also mentions the high cost of cognitive behavioral therapy and the fact that it “may not always be readily available,” which could explain the growing reliance on antidepressant drugs.

However, the story is incorrect when it states Prozac is the only drug approved to treat depression in people under 18. Escitalopram (Lexapro) is also approved by the FDA to treat adolescents for depression.

It also offers up conflicting information. In the last sentence, it links to a Cochrane meta-analysis and says “therapy and medication are more effective together than in isolation.” But that’s not what the analysis concluded. Instead, it said: “We do not know whether psychological therapy, antidepressant medication or a combination of the two is most effective to treat depressive disorders in children and adolescents.”

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story says all the 14 antidepressants studied were “commercially available.”

Does the story establish the true novelty of the approach?

Satisfactory

While the story could have provided more context on previous research, it states that the findings confirm something that’s already widely understood by clinicians.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to rely solely on a news release.

Total Score: 4 of 10 Satisfactory

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