No one knows just how many children may be experiencing medication reactions, because, under Canada’s voluntary reporting system, as few as one per cent of suspected reactions are ever reported.This much is known: About one in five children will experience a bout of depression before they turn 18, and depression is the number one cause of suicide.

According to IMS Health, which tracks prescription drug use in Canada, youth aged 19 and under made 465,000 visits to doctors for depression last year. Seventy-five per cent of those visits ended with a recommendation for an antidepressant, and, in the vast majority of cases, it was for an SSRI. Even walk-in clinics are sending children home with a prescription for an SSRI.

The antidepressants hit the market in the late 1980s just as doctors were growing increasingly frustrated with the older tricyclic antidepressants, drugs that are not only largely ineffective in children, they’re extremely toxic in overdose.

The SSRIs were touted as being safer for adults, and doctors didn’t wait long to start prescribing the pills to children and teens. The hope was that what worked in depressed adults would work in depressed kids. Today, SSRIs are prescribed not just for depression, but for behaviour control, “generalized anxiety disorders�? school phobias, obsessive-compulsive disorder, “social maladjustment�? migraine headaches, eating disorders and menstrual symptoms.

Drug companies say they do not market SSRIs to children. (In the U.S., only Prozac has been approved for use in pediatric depression.) But, at a U.S. Food and Drug Administration public hearing in February on SSRI use in children, several parents testified they received free drug samples from their child’s doctor.The committee heard from 65 speakers, many of them parents of children who had committed or attempted suicide or homicide after only a short time on the antidepressants. Mark Miller described how his 13-year-old son Matt killed himself after taking his seventh tablet of Zoloft. Sara Bostock’s daughter Cecily had been taking Paxil for two weeks the night she got up and stabbed herself twice in the chest with a chef’s knife.

Health Canada says signs of a potential increased risk of suicidality emerged only last year after regulators took a closer look at how some companies were coding their safety data. Most lumped suicide-related events under the vague term “emotional lability.�?It was only after the companies and the regulators went back to the databases and plugged in words such as “attempt�? “cut�? “damage�? “death�? “die�? “dying�? “gas�? “hang�?and “harm�? that a suicidal “signal�?jumped out.

None of the 4,000 children enrolled in clinical trials of the drugs completed suicide. What’s more, at the FDA hearings, officials cautioned that reports of self-harm need to be interpreted with caution. A review of 109 children and teens in the U.S. who were reported as having one or more possible suicide-related events while on SSRIs found, for example, that most cases of “cutting�?involved superficial wounds. “Overdoses�?ranged from serious overdoses to a person who took 20 per cent more medication than was prescribed.

Back in Ottawa, Tammy Robinson believes in her heart SSRIs made her family’s life more miserable.Over the past three years, Andrea has been diagnosed with oppositional defiance disorder, obsessive-compulsive disorder, attention deficit disorder and bipolar depression. She was put on a potent anti-psychotic drug before doctors switched her to Celexa, then Effexor. Both times she became more irritable and explosive within weeks of starting the drugs, her parents say. She was also taking lithium at the time, but when Andrea was on lithium alone for a period of three to four weeks, she never experienced an increase in aggression or self-harm, her parents say.

When Andrea’s doctor took her off Effexor, cutting her dose from 112.5 mg to zero in just six days, “she fell apart,�?Tammy says. She had a panic attack at school one day and bolted from her classroom. Teachers found her lying beneath a pile of coats in the fetal position.

Andrea went through eight different medication changes before her parents succeeded in their battle to get a thorough psychiatric assessment. The results arrived last week: non-verbal learning disorder and severe sensory integration dysfunction, a brain disorder in which children can’t properly process sensory information, such as touch, sights, smells and sounds.

“I finally feel like we’re on the right track to getting the help she needs,�?says Tammy, who now helps other families of children with mental illness through a voluntary group called Parents Lifeline of Eastern Ontario (  www.pleo.on.ca ).

“But it’s taken us three long years to get where we’re going. What worries me now is, how many wrong medications was she on?�?/FONT>