News coverage of antidepressants for kids uneven

Media coverage of the warnings on antidepressants and children’s risk of suicidal behavior often failed to give the public the whole story, according to a study published Monday.

The study, by researchers at the Yale University School of Public Health, concludes that many print and TV news stories did not give enough information on the actions the U.S. Food and Drug Administration (FDA) took in 2003 and 2004 on pediatric antidepressant use.

Safety concerns about the medications first surfaced in 2003, when research linked the drug paroxetine (Paxil) to an increased risk of suicidal thoughts and behavior in children and teenagers.

After an investigation, the FDA in 2005 added a so-called “black box” warning—the agency’s strongest warning—on the use of all antidepressants in children and teens to draw attention to the possible risks. In 2007, it extended the warnings to adults between the ages of 18 and 24.

Many psychiatrists have criticized the warnings, saying that they scare people away from effective treatment for depression, which is the leading cause of suicide. And studies have suggested that the warnings triggered not only a drop-off in pediatric antidepressant use, but may also have contributed to an 8 percent rise in suicide among minors in 2004, the biggest one-year gain in 15 years.

Critics have also charged that media coverage of the FDA warnings played a primary role in the declining use of antidepressants in children.

For the new study, published in the journal Pediatrics, Drs. Colleen L Barry and Susan H. Busch analyzed the quality of media stories on the issue when it was at its height—after three separate FDA actions in 2003 and 2004.

Looking at 167 stories from major newspapers and TV networks, the researchers found that 98 percent correctly stated that pediatric antidepressant use was linked to suicidal thoughts and behavior, and not to the risk of suicide itself.

However, news coverage was more mixed when it came to including “key health messages” that the FDA emphasized in its warnings, according to Barry and Busch.

Few stories (13 percent) mentioned that if a child is taken off an antidepressant, he or she should not quit abruptly, but first take gradually lowered doses. Only 43 percent of stories mentioned the importance of monitoring children who are on antidepressants, the researchers say, while just 40 percent noted that fluoxetine ( Prozac) was actually the only antidepressant specifically approved for pediatric depression.

The exclusion of these messages is an important issue, Barry and Busch write, because giving parents this information might have helped lessen any risks from kids’ antidepressant use.

The study also included measures of the neutrality of news reporting.

It found that when stories used anecdotes, 89 percent featured a child who had been harmed by antidepressant use, while only 36 percent included a child who had been helped.

On the other hand, experts interviewed for the stories were more likely to say that the benefits of pediatric antidepressant use outweighed the risks than vice-versa.

The net effect, according to Barry and Busch, was that the majority of stories—62 percent—conveyed a neutral message. However, they note, the remaining stories were much more likely to give the impression that the risks of antidepressants outweighed the benefits, rather than the other way around.

How all of this might have affected children’s and teens’ antidepressant use is “beyond the scope” of this study, the researchers write.

However, they add, the findings highlight the fact that as medical decision-making grows more complicated, “health care journalists are increasingly challenged to convey complex health information to the public.”

SOURCE: Pediatrics, January 2010.