Prozac 'no better than placebo' for treating children with depression, experts
theguardian.com175 points by pseudolus a day ago
175 points by pseudolus a day ago
Drugs of the SSRI category (which Prozac belongs to) are by no means safe or well-tolerated. They have all sorts of severe, life-altering, mostly permanent side effects: https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
Additionally, there's very little - if any - evidence they actually work the way they're purported to.
There are countless heartbreaking stories of people who were prescribed these drugs not knowing what they were subscribing to. In many cases, the effects of those drugs are worse than the symptoms they are supposed to alleviate. With "I Don't Wanna Be Me" there's even a song by Type O Negative (from Peter Steele's own experience with Prozac) about the devastating effects SSRIs can have on a person's life.
These drugs are handed out like candy while the physicians prescribing them often point-blank deny any side effects or even attribute those to the illness they are meant to treat.
I'd go as far as to say that prescribing these drugs for any but the most severe or otherwise untreatable cases violates the "First, do no harm." ethical principle of medicine.
I was very young when my mom started Prozac but do remember how angry and sad she was before compared to after.
Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
Your anecdote has nothing to do with whether it's better than a placebo or not.
His anecdote explicitly mentions the possibility of it being a placebo.
No it doesn't. It doesn't contain the word "placebo." Can you quote where it "explicitly mentions" what you're saying it does?
> If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
I was acknowledging that the "good days" could be due to Prozac or could be a placebo effect, but since being on Prozac correlates with having significantly more good days, and I experience virtually no ill effects, I choose to continue with it.
Wow, a shockingly argumentative tone for someone who is just flat out wrong.
Beyond the response someone else commented explaining exactly where the comparison was mentioned, the anecdote itself is useful in offering an experience of someone who's life has been changed by the drug.
In any case, the study mentioned in the article is a meta-analysis about children, not adults, so there is no onus on OP to qualify anything about placebo or not.
> my 7-year-old son just started half that dose
This is horrifying.
We had/have a lot of reservations about it too, and discussed it at length with our pediatrician over months of observation. We decided what was more horrifying was hearing a 7-year-old — who has supportive family and friends, good health, no traumatic events, no major life changes going on, never worries where food/shelter is coming from — say he feels like "he shouldn't be on Earth anymore" and suddenly react with extreme physical anxiety to almost everything. It was bad enough that he couldn't really implement any of the coping skills he learned in therapy. His therapist hoped that medication would bring him to a baseline where he was able to benefit more from therapy. My family's historical success with Prozac also made the decision more palatable since depression appears to be hereditary.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
You seem to be handling the naysayers pretty well. But, still wanted to compliment you for sharing and encourage you not to let them get to you.
It sounds like you made a wise decision given your personal and family history and your son is benefiting.
I'd be more interested in where your 7-year-old even learned phrases like "I feel like I shouldn't be on Earth anymore."
Yes, us too. Beats us. Sure wasn't around our house, and we can't imagine any family/friends/TV/whatever he may have learned it from.
Children are intelligent and creative and this is normal.
Children speak like this and then I correct them. I explain it isn't helpful, explain why they are blessed, how their life could be worse, and provide them alternative phrases while they explain their emotional state.
Depression is caused by laziness and anxiety by hopelessness. My kids know that they aren't permitted to be lazy or say they are bored. They don't have anxiety because they have hope despite circumstances.
It sounds to me how a someone would describe feeling suicidal when they don't know the word for it.
Ya, when I'm sad I can come up with pretty creative language to express it. It does feel really tough to know that a seven year old feels like that :(
As someone with bad mental health since I was ~5 and parents who refused to acknowledge it - I think you're making the right decision.
There is however also benefit in updating your priors as new research comes out. I won't say this particular research discounts your experience. But maybe some day your son will prefer a different medication.
It's also horrifying to hear your 7-year old child talk about committing suicide when you have a deep family history of depression, anxiety, and suicide.
Have some empathy.
No, it's not.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
You don't understand what having extreme anxiety at that age feels like.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
The main issue I see is that the anxiety pill is a way to treat the symptoms, not the cause.
Do you think that there is a way to treat the underlying cause and not the symptoms?
How do you know an anxiety pill is treating symptoms only? What if the cause is physiological, and the pill treats that? It is entirely possible to sit in your therapist's office and mutually shrug because neither of you can find an underlying reason for your anxiety. Sometimes anxiety just is.
Why? If a kid has diabetes, would it be horrifying to treat it? Why would it be different for a neurochemistry issue that makes the same kid tired and sad all the time?
Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."
Please share your qualifications for making a statement like this- do you work in biology? Are you knowledgeable about the underlying biology here, and the limitations of medical publications?
I hope you do realize that this comment thread is linked to an article that includes the words "Prozac no better than placebo" in its headline?
Yes, I do. I don't consider articles in the regular press to be even remotely worth looking at due to their high rate of inaccuracy. Here's the paper that the article refers to: https://www.jclinepi.com/article/S0895-4356%2825%2900349-X/f...
Not that I agree or disagree with the underlying claim but a call to "credentialism" to dismiss someone's opinion is not as strong in 2025 as you think it is.
The last few years have been a proof that even the "experts" are following strong political or personal ideology.
Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
In this area, having credentials makes a difference. Experts matter.
Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
Sorry but strong disagree here.
I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life.
As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis.
We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
I think it's good to read papers and be curious.
It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment.
Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters.
There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.