Most kids get no therapy with antidepressants

At least half of U.S. children who take antidepressants aren't in therapy, a large study suggests, and that delays recovery while greatly increasing the number of kids on the medication who are suicidal.

"Therapy with antidepressants is the standard of care. But is it what's going on in the real world? No," says Sheila Marcus, child and adolescent psychiatry chief at the University of Michigan Medical School.

The report tracks insurance claims for antidepressants from a database of 6.8 million children and teens from 2002 to 2006. The analysis was done by the health care business of Thomson Reuters, a research firm.

In the six months after getting at least one new prescription for antidepressants in 2006, just over 40% of children had insurance claims for one or more therapy sessions, says Tami Mark, the Thomson study leader.

The Food and Drug Administration has put the strongest safety warning on antidepressants, saying they could increase suicidal behavior in people 24 or younger.

A government study last year found that depressed kids recover most rapidly with antidepressants and counseling that teaches problem-solving and stress management. Also, 15% of children on Prozac only were suicidal -- either thinking about killing themselves or trying to -- compared with 8% on Prozac plus therapy and 6% receiving therapy alone.

The low therapy-claim rates in the new study could be partly a result of some parents paying out-of-pocket or not taking children for counseling because of poor insurance coverage, Mark says.

A federal law passed last week requires employers with more than 50 workers to provide comparable benefits for mental health and medical care. "Lack of insurance has been a big barrier for kids with mental illness," she says.

There's also a great shortage of child psychiatrists, Marcus says.

Some children probably went off antidepressants because of side effects or because they improved, so they weren't referred for counseling, says Kevin Kalikow, a child psychiatrist in Mount Kisco, N.Y.

Many parents are embarrassed to take their kids for therapy, says Jana Martin, a child psychologist in Long Beach, Calif.

"If kids take a pill, the parents don't feel it's as bad a reflection on them. The pill helps, but if kids get bullied on the playground, it doesn't teach them how to respond and not get depressed, while therapy does. You can't go take another pill every time someone bullies you."