"A total of 477 patients in the six studies were treated with paroxetine, fluoxetine, sertraline, or venlafaxine (23% dropouts), and 464 were treated with placebo (25% dropouts). Of 42 reported measures, only 14 showed a statistical advantage for an antidepressant.

...As regards unpublished studies, we note from a report from the US Food and Drug Administration Center for Drug Evaluation and Research that only one of nine showed a statistical advantage for drug over placebo."

(Source:  Jon N Jureidini, Christopher J Doecke, Peter R Mansfield, Michelle M Haby, David B Menkes, and Anne L Tonkin, "Efficacy and safety of antidepressants for children and Adolescents, British Medical Journal, Volume 328, 10 April 2004, p. 879-883; http://bmj.bmjjournals.com/cgi/reprint/328/7444/879.)  

"'If the drugs were highly advantageous over placebo, then you'd live with the risks,' Jon Jureidini, a child psychiatrist in Adelaide and the study's lead author, said in an interview. 'If the drugs were completely safe, then you might argue that there's nothing wrong with giving something that's only slightly better than a placebo.'

However, Dr. Jureidini said, neither is true, so antidepressants should not be prescribed for children and adolescents except in extreme circumstances.

'We strongly want to say that non-child-psychiatrists should not be initiating the prescribing of' the antidepressants known as selective serotonin reuptake inhibitors or S.S.R.I.'s, a class that includes Eli Lilly's Prozac, Pfizer's Zoloft, and GlaxoSmithKline's Paxil, Dr. Jureidini said."

(Source: Gardiner Harris, "Study Advises Against Drugs for Children in Depression," The New York Times, April 9, 2004;  http://www.nytimes.com/2004/04/09/health/09DRUG.html.)

The offspring of America's most affluent households enjoy the best of everything - clothes, computers, entertainment, automobiles. So why are so many of them mired in depression and neurosis? Pondering the psychological distress of many affluent adolescents recently led psychologist Suniya S. Luthar of Columbia University to scrutinize their problematic family lives.

Writing in the pages of Child Development, Luthar confronts the strangely elevated incidence of "adjustment disturbances" among children from affluent households. Why is it, she asks, that in recent surveys "affluent youth reported significantly higher levels of anxiety [than inner-city youth] across several domains and greater depression?" Why is it these well-off teens "also reported higher substance use than inner-city students?" Why is it that "the most affluent youth ... reported the least happiness and those in the lowest S[ocio] E[conomic] S[tatus] reported the most?" And why is it that "among suburban girls in the 10th grade, one in five reported clinically significant levels of depressive symptoms, reflecting rates 3 times as high as those among normative samples?"

After careful investigation of the social circumstances in which affluent youth develop their psychological problems, Luthar identifies two root causes of these problems: "excessive pressures to achieve and isolation from parents (both literal and emotional)."

To explain the "isolation from parents" that Luthar implicates as a cause of psychological malaise among affluent teens, she looks closely at these teens' home lives. Many of these teens, she notes, come from families characterized by "high use of market-based services" and only "low levels of cooperation for shared goals" pursued together by family members "outside the marketplace." Predictably enough Luthar sees in these families "growing use of the market to acquire child care and other services historically provided by family and neighbors." Because of their families' reliance on market-based services, "children in wealthy families are often cared for by housekeepers or nannies."

Though Luther detects profound psychological difficulties for teens left in the care of housekeepers, she sees even greater difficulties for those left entirely to their own devices. "Junior high students from upper-income families," she remarks, "are often alone at home for several hours a week."

In this era of two-career households, Luthar traces "the erosion of family-time together" to "the demands of affluent parents' career obligations." Those demands probably help explain why in recent surveys of American adolescents, "closeness to parents was inversely linked with household income."

But parental careerism is not the only reason many teens now feel isolated from their parents: Luther notes how "the divorce rate doubled" in the second half of the 20th-century, so helping to create a "social recession" paradoxically linked to "material prosperity."

Luther acknowledges that even if they are vaguely aware of some of the costs, many upper-class parents are "reluctant to give up their high-paying careers" because doing so "could imply reductions in opportunities for their children."

But the opportunity psychologically distressed children may most need may be simply that of spending more time with their parents.