Selective serotonin reuptake inhibitors (SSRIs) should remain available for
use in children and adolescents, including for unlabeled uses, according to a
report adopted by the AMA House of Delegates at the organization's annual
policy-making meeting in Chicago last month.
The report was written by the AMA's Council on Scientific Affairs (CSA) in
response to a resolution brought to the house at last year's meeting by APA
and the American Academy of Child and Adolescent Psychiatry (AACAP).
The report also states that current clinical evidence indicates that
fluoxetine is an effective SSRI in children and adolescents with major
depressive disorder, and it calls for a review of how FDA regulatory actions
impact prescribing patterns, patient compliance, and access to
"A causal role for antidepressants in increasing suicides in children
and adolescents has not been established," the CSA report states.
The council's report was adopted without debate on the floor of the house
and had widespread support from pediatricians and other physicians during
reference committee hearings. Along with several other actions that originated
with the APA Section Council on Psychiatry and were approved virtually without
opposition (see story on page
8), the council's report on SSRIs is evidence of the growing
influence of psychiatry within the house of medicine, APA leaders say.
"This is an excellent example of the importance of psychiatry's
involvement in the house of medicine," said John McIntyre, M.D., chair
of the Section Council on Psychiatry and head of APA's delegation. "This
issue was identified by APA and AACAP last year, and as the report was being
prepared, there was dialogue between the AMA and APA around the content of the
"This is a major issue for our patients," he added. "We
are now at a level of participation that when issues come up that involve our
patients, we can be confident that we will be part of the solution."
David Fassler, M.D., vice chair of the Section Council on Psychiatry and
AACAP's delegate, was the author of the original resolution calling for the
report. He said during reference committee hearings that the report would
likely do much to dispel public and professional confusion that has surrounded
the FDA's action regarding antidepressants and children.
"The conclusions and recommendations... confirm that medication can
be an effective and important component of treatment for children and
adolescents with depression," Fassler said. "The report also
acknowledges the importance of continued access to the full range of these
medications, and it calls for ongoing research with an emphasis on larger
studies and long-term follow-up, which will ultimately give us more clinically
relevant data regarding both the safety and efficacy of these
(Reference committee hearings are held prior to the convening of the House
of Delegates and offer an opportunity for any AMA member and invited public
representatives to voice opinions on all reports and resolutions brought to
the House. On the basis of testimony heard at the reference committee, a
recommendation is made to the full house to adopt, amend, or not adopt those
reports and resolutions; a decision is also sometimes made to refer an item
for deliberation to the AMA Board of Trustees or to an appropriate
Melvyn Sterling, M.D., an internist and chair of the CSA, urged adoption of
the report during reference committee hearings, saying the issue was one of
the most important facing physicians who treat children and adolescents.
"As director of an emergency department of a university medical
center, I have treated thousands" of people who have made suicide
attempts, Sterling said. "I view this as one of the most important
conditions that we as physicians and a society have to deal with. We have to
deal with suicidality and with the awesome social and economic impact of
depression on our society. For us to deny patients access to what could be the
most important medication in their lives, when the data [about suicide] are
actually equivocal, I think would be very, very sad."
The CSA report summarizes recent regulatory actions related to the labeling
of antidepressants and their use in children and adolescents; evaluates the
apparent safety and efficacy of antidepressants, particularly the SSRIs in
children and adolescents; and reviews the evidence on whether these drugs may
have a causal role in the emergence of suicidality or other harmful behavior
The report concludes with four recommendations:
In related action, the House of Delegates adopted, without debate, a second
resolution put forward by APA and AACAP that asks the AMA to endorse efforts
to train additional qualified clinical investigators in pediatrics, child
psychiatry, and therapeutics to conduct studies related to the effects of
psychotropic drugs in children, adolescents, and young adults.
That resolution also asks the AMA to promote efforts to educate physicians
about the appropriate use of psychotropic medications for children,
adolescents, and young adults.
More information about these and other actions taken at the AMA's
2005 annual meeting are posted online at<www.ama-assn.org/ama/pub/category/14887.html>.▪