Escaping From The Darkness
	Drugs like Prozac, Paxil and Luvox can work wonders for clinically depressed kids. But what about the long-term consequences? By Howard Chua-Eoan

Monday, June 23, 2003; 2:31 p.m. EST
Megan Kellar is bubbly and bouncing and lip-synching to the Backstreet Boys. Get down, get down and move it all around! The sixth-grader is dancing to the synthesized bubble-gum beat at a talent show at the John Muir Elementary School in Parma, Ohio. Get down, get down and move it all around! There is nothing down about Megan, even as she gets down in front of the audience. Her mother remembers a similar effervescence half a dozen years ago. "She'd be singing to herself and making up songs all the time," says Linda Kellar. And sure enough, that part of her is still there. "Megan's such a happy child," the mother of a girl on Megan's baseball team remarked to Linda. Yes, Linda agreed, but there's something you ought to know. Megan is clinically depressed and on the antidepressant Paxil. Says Linda: "She couldn't believe it."

Six years ago, Linda wouldn't have believed that her daughter was clinically depressed either. But shortly after her parents separated, Megan stopped singing. When other kids came over to play, she would lie down in the yard and just watch. At Christmas she wouldn't decorate the tree. Linda thought her daughter was simply melancholy over her parents' split and took her to see a counselor. That seemed to help for a while. Then for about eight months, when Megan was 10, she cried constantly and wouldn't go to school. She lost her appetite and got so weak that at one point she couldn't get out of bed. When a doctor recommended Paxil in conjunction with therapy, Linda recoiled. "I did not want to put my baby on an antidepressant," she says. Then she relented because, she says, "Megan wasn't living her childhood." Linda noticed changes in just two weeks. Soon Megan was singing again. "She's not drugged or doped," says Linda. "She still cries when she sees Old Yeller and still has moody days." But, as Megan says, "I'm back to normal, like I used to be."

Megan Kellar shares her kind of normality with hundreds of thousands of other American kids. Each year an estimated 500,000 to 1 million prescriptions for antidepressants are written for children and teens. On the one hand, the benefits are apparent and important. Experts estimate that as many as 1 in 20 American preteens and adolescents suffer from clinical depression. It is something they cannot outgrow. Depression cycles over and over again throughout a lifetime, peaking during episodes of emotional distress, subsiding only to well up again at the next crisis. And as research increasingly shows, depression is often a marker for other disorders, including the syndrome that used to be called manic depression and is now known as bipolar disorder. If undetected and untreated in preteens, depressive episodes can lead to severe anxiety or manic outbursts not only in adulthood but as early as adolescence.

On the other hand, come the questions. How do we tell which kids are at risk? Has science fully apprised us of the effects on kids of medication designed for an adult brain? Have we set out on a path that will produce a generation that escapes the pain only to lose the character-building properties of angst?

To medicate or not to medicate? The dilemma can be traced back to 1987, when the FDA approved Prozac as the first of a new class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Prozac had none of the more serious side effects and risks of the earlier antidepressants and worked faster to control depressive symptoms. Prozac and the other SSRIs (they now include Zoloft, Paxil, Luvox and Celexa) had one other advantage over the older, tricyclic antidepressants: children responded to them. One of the few recent studies on the subject showed that among depressed children ages 8 to 18, 56% improved while on Prozac, in contrast to 33% on a placebo. Says Dr. David Fassler, chair of the American Psychiatric Association's Council on Adolescents and Their Families: "Physicians have a lot of experience using the medications with adult patients with good results, and recent research increases their general level of comfort in using them with children and adolescents."

But which kids?

Not so long ago, many psychiatrists argued that children and young teens could not get depressed because they were not mature enough to internalize their anger. Today, says Fassler, "we realize that depression does occur in childhood and adolescence and that it occurs more often in children than we previously realized."

Still, depression is slightly harder to diagnose in adolescents than in adults, and not because teens are expected to be moodier and more withdrawn. They are less likely to realize that they are depressed and thus less likely to seek help. "Younger kids also have more difficulty expressing their feelings in words," says Dr. Boris Birmaher, a child psychiatrist at the University of Pittsburgh. "When kids become depressed, they become irritable, act out, have temper tantrums and other behavioral problems. It's hard to ascertain that these are the symptoms of depression unless you ask them questions in a language they can understand."

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