AMA supports youth antidepressant access

Chicago -- When Melvyn Sterling, MD, an internist from Orange, Calif., was the director of the emergency department for a university medical center, he treated thousands of suicide attempts among young people.

This experience, along with what he considers to be a continuing lack of conclusive evidence proving that the use of antidepressants by those younger than 18 increases suicide risk, led Dr. Sterling, also the chair of the American Medical Association's Council on Scientific Affairs, to support efforts to ensure that access to these drugs for this age group, when appropriate, is allowed to continue.

"To deny patients access to what could be the most important medication in their lives when the data is equivocal would be very, very sad," said Dr. Sterling, who presented the CSA's report on the subject at the AMA Annual Meeting in June.

In turn, AMA delegates endorsed the CSA's findings -- agreeing that these drugs should continue to be available if indicated by "prudent clinical judgment" and that well-designed studies are urgently needed to answer the question of whether there truly is a link between suicide and the use of these drugs.

Responding to concerns that the continuing controversy might have restricted access to those who need it, the AMA will also urge that the "black box" warnings added to these drugs in October 2004 be treated as precautionary statements that should require careful monitoring of patients but should not impede patient access. In addition, the AMA wants the Food and Drug Administration to evaluate the impact of the new warnings.

"Depression in children is a serious problem," said CSA Chair-elect John F. Schneider, MD, PhD. "There are risks of suicide if they're not treated."

In related action, the AMA adopted new policy acknowledging teen and young adult suicide as a serious health concern and now plans to compile a report on related resources. This report, scheduled to be presented at the 2006 Interim Meeting, will aid physician efforts to address the problem.

"Bringing national attention to the issue is an important step in beginning to combat such a difficult matter," said Christopher DeRienzo, a second-year medical student at Duke University in Durham, N.C., who proposed the resolution.

In addition, the Association considered the problem of suicide, depression and substance abuse issues on college campuses. The AMA intends to promote guidelines regarding access to mental health services on campus, and the Association's Council on Scientific Affairs, which was renamed the Council on Science and Public Health at last month's meeting, will produce a report on the efficacy of prevention programs in this setting.

This step was a result of increasing awareness that, because of the availability of antidepressants, more young people are now in higher education settings who would not have functioned at this level in the past. But this patient group could be overburdening college mental health services.

"More and more young people are coming to college with an existing diagnosis and treatment history," said David Fassler, MD, a delegate from the American Academy of Child and Adolescent Psychiatry.

"Some of those students might not have made it beyond high school in previous generations, but this means that more and more young people need access to comprehensive mental health care," Dr. Fassler said.