By MARC K. SIEGEL

September 28, 2003 -- A Recent study in the Journal of the American Medical Association concludes that a commonly used anti-depressant, Zoloft, is safe and effective in children. Psychiatrists, pediatricians and troubled parents everywhere are sure to take this as further evidence that troubled kids ought to be medicated

I have a problem with this approach. And I suspect that many children would agree with me if only they were given the chance.

For one thing, this type of study - JAMA has published three of them this year alone - interpret mood using a depression-rating scale. That scale is based on a subjective set of questions that don't take into account what's causing the depression in the first place.

And it turns out that half of the kids being studied are being raised in homes without their biological fathers. And no questionnaire can assess what doping up a kid, who is being raised without his father, does for self esteem.

Also, these drugs have side affects that are difficult to quantify. Sexual function may be affected and orgasm delayed, both of which can be devastating to a teen whose sexuality is just starting to develop.

Other side affects including drowsiness, constipation, nervousness, nausea, and dizziness. I recall prescribing an anti-depressant for a patient once for pain rather than depression. He called to complain that the pill was making him depressed. "How can it?" I said. "Because of the constipation it causes," he replied.

Many child psychiatrists agree that it's difficult to distinguish anxiety due to a poor home life from a true psychiatric disorder. But pressured by anxious parents - many of whom are themselves medicated and can't control their children - doctors feel compelled to prescribe.

If the child then does better in school or behaves in a more orderly manner, the doctor (pediatrician or psychiatrist) may feel justified in the treatment. But children may also grow out of their disturbed stages, and a label and its treatment may be difficult to shake once applied.

I know a child named Michael who is a devastating example of what is wrong with the medication model. Michael has been living apart from his father since the age of 1. Now 12, he has been diagnosed with depression and Attention Deficit Hyperactivity Disorder.

His supposed ADHD is being treated with so much Ritalin that he has developed neurological tics and can't sleep at night. Clonidine was prescribed to reverse these affects, but that made him drowsy and apathetic.

For Michael's apathy - perceived as depression - he gets Zoloft. His grades improved, and his scores improved on the depression scale, but now he has disturbing waking dreams (possibly a side affect of the Zoloft) where he sees himself the victim of a fatal car crash.

Children should not be seen as chemistry experiments. They have at least as much right to their potential as the parents, teachers and doctors who control their development. There is a place in the doctor's black bag for anti-depressants - as long as doctors are willing to not always use them.

Dr. Marc Siegel is associate professor of Medicine at NYU Medical School.

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