Wishful thinking: antidepressant drugs in childhood depression.

The use of selective serotonin reuptake inhibitors (SSRIs) in children under 18 inhibitors (SSRIs) in children under 18 years old increased tenfold (from 0.5 to years old increased tenfold (from 0., despite the existence of training and theoretical models existence of training and theoretical models for the treatment of mental disorders that for the treatment of mental disorders that are similar to those in the UK. Reasons are similar to those in the UK. Reasons for the increasing rates of use are likely to for the increasing rates of use are likely to include heavy promotion of both medi-include heavy promotion of both medication and illness, distortion of the pub-cation and illness, distortion of the published data related to safety and efficacy, lished data related to safety and efficacy, and underestimation by clinicians of the and underestimation by clinicians of the importance of the placebo response importance of the placebo response (Jureidini (Jureidini et al et al, 2004 , 2004a a). Over the past 2). Over the past 2 years, serious concerns have been raised years, serious concerns have been raised about the benefit-to-harm ratio of all anti-about the benefit-to-harm ratio of all anti-depressants for children, leading to limits depressants for children, leading to limits on the use of some drugs and warning state-on the use of some drugs and warning statements on drug labelling. Nevertheless, a ments on drug labelling. Nevertheless, a view persists that scepticism about these view persists that scepticism about these drugs is misplaced. Unfortunately this drugs is misplaced. Unfortunately this view, which owes more to wishful thinking view, which owes more to wishful thinking than science, has permeated guidelines pro-than science, has permeated guidelines produced by professional and regulatory duced by professional and regulatory authorities, particularly in the USA. On authorities, particularly in the USA. On what basis are these recommendations what basis are these recommendations being made? being made? The evidence for efficacy has been dis-The evidence for efficacy has been disappointing. At least five unpublished trials appointing. At least five unpublished trials using a placebo control have failed to show using a placebo control have failed to show an advantage for antidepressants over an advantage for antidepressants over placebo. Among eight published trials, four placebo. Among eight published trials, four found no statistically significant advantage found no statistically significant advantage for antidepressants over placebo on any for antidepressants over placebo on any primary …