Zoloft Blues

Can drugs such as Zoloft be held responsible for aggression and suicide in children? The recent trial of Christopher Pittman, who as a twelve year-old boy killed his grandparents and set their house on fire, raises difficult questions about the role of antidepressants in a society that increasingly sees children as being overmedicated. Yesterday, the jury found Pittman guilty of murder and sentenced him to 30 years in prison. While the defense tried to argue that the drugs caused him to become “intoxicated” and act in a way he otherwise never would have, the jury rejected this notion and sided with the prosecution’s argument that the Zoloft defense was a smokescreen and that the boy’s intense anger promulgated his actions. The Pittman case would have immediately been thrown out a few years ago, but recent developments have catapulted this case and others like it to the national stage.

On October 15, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory in which drug manufacturers were required to label antidepressants with a “black box”—the most severe warning outside of an outright ban—describing the risk of suicidal behavior to children and adolescents. This action was promoted by a Columbia University study showing that two to three percent of children taking antidepressants had increased suicidal thoughts and actions, though the FDA has not shown antidepressants to be the precise cause. According to Medco Health Solutions, the last year has seen a 10 percent reduction in antidepressant prescriptions for patients under 18, in large part due to the FDA’s action. Amongst all antidepressants, only Prozac has been approved by the FDA to treat pediatric depression. Zoloft, though it has not specifically been approved to treat depression in children, has been approved by the FDA to treat pediatric obsessive compulsive disorder. However, an FDA-approved drug can be used to treat any population, including children, even if it has never been clinically tested on children.

Numerous studies have established the link between depression and suicide, and antidepressants themselves have been shown to ease the symptoms of depression, including suicidal behavior. News stories about the potential negative effects of these drugs have been well-publicized, but stories about the thousands of individuals who are helped by these drugs fail to attract mention. According the National Institute of Mental Health, suicide is the third leading cause of death amongst adolescents, so there is a great danger in not prescribing antidepressants to those who need them most. Thus, the risks of medication must be weighed against the risks of not delivering critical treatment. A recent UCLA study has shown a correlation between a decline in suicide rates and the introduction of the current family of antidepressants into the market. Nevertheless, more research needs to be conducted to conclusively determine the safest course of action.

Unfortunately, medicines for mental disorders are still not considered as legitimate in the eyes of the public as drugs for treating hypertension or high cholesterol. While there are simple tests to determine whether someone has these physical conditions, separating genuinely depressed children from those suffering from temporary setbacks can be a tricky process, and the process is certainly not always done right. The assumption that a drug tested only on adults is safe for children is a potentially dangerous one, as children’s minds and bodies are still growing. The lack of comprehensive clinical trials for children makes it difficult to tell whether many of these antidepressants are truly safe for children, so physicians and parents naturally have severe doubts about prescribing such medications. Thus, if these medicines are truly safe and effective, then the children who actually need them might not always receive them in time, with potentially disastrous consequences.

Yet the issue of clinical trials on children is itself a conundrum. Is it ethical for parents to make the decision to put their children through drug testing? It is possible that this could result in major side effects that last even when the child is an adult. But, is it any better to place kids on antidepressants that have never been sufficiently tested on maturing minds and bodies? There was certainly not enough evidence to prove that Zoloft caused Christopher Pittman to commit murder, as antidepressants have so far been related to suicidal ideation and not violence. This absence of the link between antidepressants and violence no doubt contributed to the jury’s guilty verdict. But because of the lack of clinical trials demonstrating their effects on children, it is also not necessarily possible to conclude that the antidepressant had absolutely no effect on his developing brain. Ultimately, the jury had to make an extremely serious decision based on a drug that has not been properly tested on children. The lack of definitive research on the effects of antidepressants on children is alarming, and such clinical trials are sorely needed.

Hersh Sagreiya ’07, a Crimson editorial editor, is a biochemical sciences concentrator in Kirkland House.