Writing in the open access journal PLoS Medicine, Dr Raz says that when it comes to treating CAD, "there are few compelling data sets, free of funding from drug companies, concerning the efficacy of antidepressant medications over and above their placebo value."
In his analysis, Dr Raz looks at some of the reasons behind the current dispute over the value of SSRI antidepressants for treating depressed children and adolescents.
"The recent history of SSRIs is replete with inconsistent verdicts about their safety," he says. For example, despite issuing a "black box" warning label on antidepressants stating that they may increase the risk of suicidal thinking and behavior in depressed children and adolescents, the FDA went on to endorse the safety of these drugs for treating CAD.
In addressing possible implications of SSRI use for CAD, Dr Raz points to data in mouse studies suggesting that exposure to SSRIs early in life produces abnormal emotional behaviors in adults. "Some exploratory findings suggest that artificial perturbation of serotonin function in early life may alter the normal development of brain systems related to stress, motor development, and motor control."
Another factor, says Dr Raz, that further confounds the debate over SSRIs for CAD is that while some studies have shown statistically significant effects, these effects may not be meaningful in the real world of clinical practice. Dr Irving Kirsch and Dr David Antonuccio, who gave testimony to the FDA in 2004 on the efficacy of SSRIs for CAD, also concluded that the effect of these drugs may be statistically significant, but possibly not clinically significant.
Dr Raz says that while some mental health experts "dismiss investigators such as Kirsch and Antonuccio as 'outliers' or inherently biased against the drug industry, such 'outlying' accounts should nevertheless be examined."
Given all of the limitations surrounding the data on SSRIs, Dr Raz urges patients and physicians to "demand stronger evidence for the efficacy of antidepressants for CAD."
Citation: Raz A (2006) Perspectives on the efficacy of antidepressants for child and adolescent depression. PLoS Med 3(1): e9.
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