A proposal that antidepressants carry a prominent warning that the drugs can increase the risk of suicide in children has made some family practitioners and pediatricians hesitant to prescribe the medications.
But doctors said they will likely send young patients to psychiatrists, many of whom believe in the drugs and will continue prescribing them.
Based on a recommendation this week by two federal advisory panels, the Food and Drug Administration is likely to order drug makers to include the most stringent warning label -- a "black box" -- in packaging, advertisements and information sent to doctors.
The committees analyzed data from nearly two dozen clinical trials and concluded that minors given the drugs were 2% to 3% more likely to have suicidal thoughts than those given placebos. The same trials also failed to show that the drugs worked in children, with the exception of Prozac. Nobody in the clinical trials committed suicide.
Some psychiatrists said they were unlikely to be dissuaded from writing prescriptions. They consider the trials too limited in scope and argue that it is far from clear that the drugs do no good. In 2002, 10.8 million antidepressant prescriptions were for children, about 7% of the total, according to the FDA.
The recommendation from the FDA committees "is going to force more discussion between doctors and patients," said Dr. Carl Feinstein, a child psychiatrist at Stanford University. "Doctors are reluctant to change prescribing practice because they have a lot of experience that tells them the drugs are effective."
The most important message from the debate, doctors said, is that young patients taking the medications should be closely monitored, particularly when they are starting a regimen or changing dosage.
That is why nonpsychiatrists said they would be more likely to defer to their expert peers rather than prescribe the drugs themselves.
According to the FDA's most recent statistics, from 2002, psychiatrists already write about 65% of antidepressant prescriptions for people under age 18.
Family practitioners and pediatricians account for just over 25%. Some of those doctors, such as Dr. Eleanore Meyer, a Santa Monica pediatrician, prescribe the drugs only in consultation with psychologists or social workers, who provide therapy but are not licensed to offer medication.
With the new proposal, she said she would refer depressed patients to psychiatrists. "We're going to be pretty hesitant to use these medicines," she said.
