So-Called Alternative Treatments

The editorial in the American Journal of Psychiatry is miffed that the FDA warned about antidepressant-induced suicidality without providing another alternative. But the so-called alternatives for treating depression in children—psychosocial and educational interventions—should have already become the only treatments for childhood depression. 

As I describe in The Heart of Being Helpful (1997b) and in The Antidepressant Pact Book (2001a), depression ultimately is loss of hope. It is despair over ever having a worthwhile or happy life. A depressed, unhappy child has lost hope and begun to give up trying to handle life successfully. 

In children, the causes of this despair and loss of hope are almost always apparent in the first consultation session, providing it involves the family and includes an evaluation of the child s school life. In children, depression almost always revolves around problems at school and in the home, everything from bullying at school and abuse at home to academic school failure, painful peer relationships, and family conflicts over how to raise the child. The treatment of depression in children requires, first, finding out how and why the child became depressed and, second, helping the child, the family, the school, and all the other participants in the child s life restore hope in the child. Children have many needs, including a stable family, rational discipline, unconditional love, stimulating educational environments, physical security, and emotional safety. The object of therapy is to identify the unmet needs and to help adults meet them. 

Overall, there has been an important movement at the FDA in the direction of warning the public and the medical profession about the risks associated with antidepressants, but it has taken much too long, and 

Jureidini et al. (2004) stated that the funding for Emslie et al. (1997) was attributed to the National Institute of Mental Health in the article, but [Food and Drug Administration] data show that study was sponsored by Eh Lilly (p. 880). 

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