Debate grows over antidepressant use among preschoolers

But others believe it definitely exists and needs to be dealt with. Graham Emslie, a psychiatry professor in Dallas, Texas, and author of several studies on antidepressants, estimates that as many five percent of all adolescents, which includes toddlers, suffer from severe depression.

"It's not very often that we have to treat preschoolers," he says. "I don't think a depressed preschooler should get medicine until a lot of other things are exhausted first." Nonetheless, he agrees that it should be done in some cases.

Others argue that the real reason behind the rise in preschooler prescriptions is simple profits. "The drug representatives ... have access to every doctor, to every clinic, wherever they can they push their wares," says Vera Sharav, president of the Alliance for Human Research Protection, an advocacy group in New York. "They're interested in pushing sales. It's turned medicine inside out."

Regardless of root causes, however, no one disputes that the longterm effects of these drugs remain uncertain. "This is like two blind persons touching the same elephant," says Thomas Moore, a health policy analyst at George Washington University, whose own research shows far more prescriptions among the very young than the numbers cited by Express Scripts.

Dozens of conflicting studies, in fact, are vying for the attention of the Food and Drug Administration (FDA) - among them a report released by Jane Garland, a Canadian expert, in February finding that antidepressants prescribed to adolescents are largely ineffective. Great Britain banned the prescription of Paxil to adolescents last summer due to suicidal behavior possibly resulting from the drug. The FDA has agreed to investigate the effects of about a dozen mood-altering drugs on adolescents.

The drug industry, for its part, says that antidepressants are safe and greatly benefit many troubled adolescents. But company officials do caution against overuse of the pills, especially among preschoolers. "We believe medication should be prescribed only after a careful diagnosis is made, and medication would be continued only if it clearly benefits the child," says Jennifer Yoder, spokeswoman for Eli Lilly & Co., the maker of Prozac.

Because medication is often more affordable than psychotherapy, some critics say there may be a greater incentive for doctors to prescribe a pill than hours with a therapist - and easier for parents to afford. Ms. Sharav, for one, worries that access to antidepressants, coupled with heavy advertising and a lack of label warnings, leads many parents to medicate their children.

"Because they are misled by the ads and societal pressure, parents think it's OK to use these drugs to control the behavior of their children," she says. "But bad behavior may come from a lot of reasons, including that no one is there to pay attention to these young children. It's not pleasant for women to reassess that, but it does need to be reassessed."

Battaglini, however, has reassessed. She resisted drugs for months, but in the end trusts her doctor: "You know what? I'm not exactly sure if it is an antidepressant. But between the school psychologist, myself, and the doctor, we decided to give it a try."

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