Psychiatric Quarterly, Vol. 76, No. 3, Fall 2005 (
Addressing Discrepancies Between the Child
Psychopharmacology Literature and Prescribing Practices
Raul R. Silva, M.D.
This special section is dedicated to select themes in child and adoles-
cent psychiatry. Research efforts in child psychiatric populations have
a tendency to lag behind that of their adult counterparts. This has left
many physicians who prescribe to children in the lurch. Clinically, child
psychiatrist make many decisions that are not always empirically val-
idated by the literature. Furthermore, when it comes to prescribing
medications to this age group, much of what is done in the community
is not Food and Drug Administration (FDA) approved.
The recent furor regarding a child’s potential to develop suicidal
ideations and/or behaviors as a consequence of taking selective sero-
tonin reuptake inhibitors (SSRI’s) highlights the dilemma faced by
those who prescribe psychotropic medications to children. For decades
there had not been a double blind placebo controlled trial that demon-
strated meaningful differences between the antidepressants and
placebo treatment in depressed children. Nevertheless, over the last
ten years the antidepressants were the second most frequently pre-
scribed group of psychiatric medications for individuals below the age
of 20. It is perplexing that there are such glaring discrepancies between
evidenced based results and clinician’s prescribing patterns in pediatric
psychiatry. By January of 2003, based on the ﬁrst and only positive dou-
ble blind, placebo controlled study of the efﬁcacy of an antidepressant in
childhood depression, the FDA approved ﬂuoxetine for that indication.
Ironically, almost two years later the FDA would direct the manufac-
turers of all antidepressants to include a box warning and expanded
warning statements regarding increased risk of suicidality in youth.
This decision needs to be reconciled with the fact that over the last
2005 Springer Science+Business Media, Inc.