Bitter Pills

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Severe depression does occur in adolescents, and there's a risk of suicide in these cases, says the Institute of Psychiatry's Newman. But she suspects doctors are overprescribing antidepressants across the board. "It's important they distinguish between normal sadness and clinical depression," she says. "We all need to feel sad sometimes. We don't want a society in which people run off to get prescribed rather than feel normal emotions." While Parker acknowledges that sometimes people who don't need SSRIs receive them, he doesn't think the drugs should be confined to those with severe depression. "Anxious worriers are the new breed of depression," he says. "They're the ones for whom it's nothing like as gray, and the suicide risk is not as great, but they're living lives of quiet desperation, or irritability, or crabbiness, (feelings) that drive their depression." He's concerned about the backlash against the drugs, which he concedes were oversold at first. His worry is that before long authorities, influenced by the "excessive beating" being handed out to the SSRIs, may ban their use by adolescents.

Others have very different concerns. Lucire wants the TGA to write to every G.P. in the country - in the manner of the drug companies - telling them to recall all their SSRI patients and check them for side effects. Jureidini is worried that doctors with links to the drug industry - as consultants or advisers - may be influencing TGA policy on psychiatric drugs. The obligation to disclose isn't there in this case, and that is "out of step with worldwide practice," he says.

Gil Anaf, president of Australia's National Association of Practising Psychiatrists, frowns on a system that steers depressed people toward G.P.s, who often lack the time and expertise to make the right call on treatment. Because the cost of SSRIs is subsidized by the government, it's cheaper for patients to be on drugs than to spend a lot of time on the couches of psychoanalysts like Anaf. Anaf isn't anti-drugs. Within that small proportion of depressed patients who are at risk of harming themselves, he says, the antidepressants work well in 70-80% of cases. "The problem is that the new generation of psychiatrists is being exposed less and less to the good results of (psycho) therapy, and more and more to the average results of medication. It's going to be seen eventually to be the norm to prescribe, as if there's never been anything else."

At the Women's and Children's Hospital in Adelaide, Jureidini and others are bucking that trend. The strong showing of placebos in antidepressant trials should tell us something, he says. Subjects in the control group typically receive more than a sugar pill: they have their histories taken and they're monitored and encouraged. In many cases, this personal attention makes them feel better. So why not build on the placebo effect? Jureidini's team is working with 20 GPs in a soon-to-be-expanded pilot program that embraces, he says, a "third way" of treating depression in children and adolescents: instead of drugs or formal talk therapies, they get "rehabilitation" based on exercise, dietary changes, better sleep habits - and talk, to try to find out "what's worrying the kid rather than what's wrong with him." Many doctors would call these chicken-soup remedies. But in all but perhaps the worst cases, says Jureidini, why not try them before reaching for the prescription pad?