In my clinical work, I often encounter parents who are concerned about putting their kids on psychiatric medications. In the case of anti-depressants, such concerns are grounded on a large literature that has linked anti-depressant use by adolescents with a mild increase in the risk of suicide. Contrary to some common explanations, it is not simply that kids who are more likely to attempt suicide (those who are clinically depressed) are also more likely to receive anti-depressant medication, since the increased risk for suicide has been observed during randomized clinical trials (RTCs). That is, in many RTCs, those clinically depressed kids who are randomly assigned to a medication have been found to be more likely to attempt suicide than their equally depressed peers who happened to be randomly assigned to a placebo. It is indeed the exposure to the active treatment that leads to the increase risk for suicide. Although there are some questions still being debated (e.g., effect of age, type of medication, type of disorder, etc), there is a general agreement that anti-depressant medication use during adolescence leads to a mild but real increase in the risk for suicide. The more pertinent questions are 1) why is this the case? And more importantly… 2) what are the implications for clinical practice ? I’m going to touch on these two questions during the next few weeks. Today, I want to discuss a recent article published in the Journal Pediatrics that examined the risk of suicide among adolescents taking anti-depressant medications in Canada. The main goal of the study was to examine whether the kind of medication (brand or type) resulted in different levels of risk. In other words, are all medications created equal in terms of their effects on suicide risk for adolescents? Read More

I should preface this ‘review’ by disclosing that I’m the corresponding author of this study. I don’t usually review my own work at Child-Psych but I think this particular study will be of especial interest to parents, educators, and clinicians.

Last week the Journal of Clinical Psychiatry published one of our studies that examined age and gender differences in the presentation of clinical depression among children and adolescents. The study was part of a large NIMH-funded Program Project on child depression led by my collaborator and recent mentor Maria Kovacs. For those who may not be familiar with Dr. Kovacs’ work, she is one of the world leaders in child depression research. She has been studying childhood onset depression for several decades and is the creator of the Child Depression Inventory – one of the most used child assessment instruments in the world.

During the last decade her team has been following an unusually large sample of children and adolescents diagnosed with clinical depression in Hungary. As part of that study, we recently analyzed and published data that allowed us to closely examine how depression is manifested among these children and adolescents. We were particularly interested in examining whether there were specific differences in the presentation of depression between boys and girls, as well as between younger children (as young as 7 years of age) and adolescents. Read More

In the current issue of Archives of General Psychiatry, Joan Luby and her team at Washington University in St. Louis presented the findings of a powerful longitudinal study of depression in early childhood. In this new article, Dr. Luby examined the continuity and stability of early childhood depression. Specifically, her team wanted to explore whether preschool depression was a transient developmental phase or a more chronic condition. Surprisingly, this question has not been fully answered mostly because of the limited knowledge we have about early childhood depression.

The study included 306 preschool children (age 3 to 5) recruited from community sources in the St. Louis area. However, this is not a normative community sample, as the recruitment strategy was designed to recruit children at risk for depression and other psychiatric disorders (for example due to a family history of depression). This is a common and appropriate recruitment technique when the objective of the study is to examine the disease process rather than to provide normative or epidemiological information about the condition.  The participating children and their parents underwent a series assessments upon entry to the study (baseline) and then 12 (wave 1) and 24 (wave 2) months later. Read More