Antidepressants don't work for teens, kids: study

PARIS, France - Most available antidepressants are ineffective for children and teenagers with major depression, and some may be unsafe, according to an overview of medical literature published Thursday.

Only one drug, fluoxetine, was found to work better at relieving the symptoms of depression than a look-alike placebo with no active ingredients, said the study, published in The Lancet.

Another drug, venlafaxine, was linked with an increased risk of suicidal thoughts and attempts compared with placebo and five other antidepressants, it reported.

More broadly, there is a paucity of well-designed clinical trials on the impact of these drugs on youngsters, the authors cautioned.

"The balance of risks and benefits of antidepressants for the treatment of major depression does not seem to offer a clear advantage in children and teenagers," said co-author Peng Xie from The First Affiliated Hospital of Chongqing Medical University in China.

The international team of researchers recommended that youths taking such medications be monitored closely regardless of the antidepressant chosen, particularly at the beginning of treatment.

They also called for more transparency and information sharing, lamenting in particular the lack of data at the individual level.

"We can’t be completely confident about the accuracy of the information contained in published and unpublished trials," lead author Andrea Cipriani at the University of Oxford said in a statement.

"Delay in implementing responsible data sharing policies has negative consequences for medical research and patient outcomes."

Major depressive disorder affects about 3 percent of children aged 6 to 12 years, and about 6 percent of teenagers aged 13 to 18 years.

Many clinical guidelines recommend psychological treatments as the first-line treatment for depression.

But in the United States, for example, the use of antidepressants has slowly increased between 2005 and 2012.

The proportion of US children and teenagers taking antidepressants climbed from 1.3 to 1.6 percent, and in Britain from 0.7 percent to 1.1 percent, the study showed.

Sertraline is the most widely prescribed antidepressant in the USA, and fluoxetine is the most common in Britain.

The study covered 34 clinical trials involving 5,260 participants, aged 9 to 18.

Two-thirds of the trials were funded by pharmaceutical companies.

In a comment, also in The Lancet, Jon Jureidini from the University of Adelaide in Australia questioned whether the lack of data about individual patients obscured the true number of suicidal events.

"Claims that appropriate access to such data is incompatible with intellectual property constraints and patient privacy must be strongly resisted."

source: www.abs-cbnnews.com

Baby's HIV 'cure not a fluke,' US researchers say

WASHINGTON - A little girl who was treated for HIV shortly after birth still shows no sign of infection at age three, suggesting her apparent cure was not a fluke, US researchers said Wednesday.

The story of the first child known to have been cured of HIV through early treatment with powerful doses of antiretroviral drugs -- what researchers call "sustained remission" rather than a cure -- was initially announced in March when she was two and a half.

A handful of HIV-infected adults around the world have been described in medical literature as newly free of the disease, most famously Timothy Brown, also known as "the Berlin patient," who was given a bone marrow transplant for leukemia that wiped out his HIV as well.

But no easy method has emerged to eradicate the three-decade-old human immunodeficiency virus that infects 34 million people globally and is responsible for 1.8 million deaths each year.

The girl's updated case report in the New England Journal of Medicine also sought to answer questions raised by outside experts over whether she was ever really infected, by describing DNA and RNA tests that were positive for HIV just over a day after birth.

The child was given antiretroviral drugs until the age of age 18 months and, after a year and half without treatment, no sign of the disease has returned, the article said.

"Our findings suggest that this child's remission is not a mere fluke but the likely result of aggressive and very early therapy that may have prevented the virus from taking a hold in the child's immune cells," said lead author Deborah Persaud, a virologist and pediatric HIV expert at the Johns Hopkins Children's Center.

The child's mother gave birth to her prematurely, about a month early, and had not received any prenatal care. She was unaware that she was HIV positive until she was tested at the Mississippi hospital where she delivered.

The newborn also tested positive for HIV, and the high level found in her blood suggested that she had become infected with human immunodeficiency virus while in the womb, researchers said.

She also showed signs of HIV in blood tests at 19 days of age, data that "support the authors' perspective that the infant was truly infected," said an accompanying editorial by Scott Hammer, a leading HIV scientists at Columbia University Medical Center.

"The big question, of course, is, 'Is the child cured of HIV infection?' The best answer at this moment is a definitive 'maybe,'" he wrote.

A longer term follow up of the child is needed, he said, cautioning that her case may be "unique," even as it shows a proof of principle that may lead to more rigorous studies down the road.

The child was given antiretroviral drugs for the first 15-18 months of her life, when she was lost to follow up.

Her mother brought her back to doctors at 23 months of age, saying she had last given her anti-HIV medication at age 18 months.

"This happened almost by accident," said Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases.

"It wasn't that the doctor said 'let's stop the therapy.' This is not recommended for home use," he told AFP.

Tests at 23 months were negative for HIV, and by the time the child reached 30 months of age, tests still showed no sign of HIV or HIV antibodies, said the study.

"We're thrilled that the child remains off medication and has no detectable virus replicating," said pediatrician Hannah Gay of the University of Mississippi Medical Center.

"We've continued to follow the child, obviously, and she continues to do very well," said Gay, who first treated her.

"There is no sign of the return of HIV, and we will continue to follow her for the long term."

The girl's medical team believes the reason for her success was the early intervention, and they hope to investigate whether treating other infected infants within hours or days of birth could show similar outcomes.

A US-government funded study is set to begin in low and middle income countries in 2014 that would test the method in HIV-infected newborns on a wider scale, Fauci said.

source: www.abs-cbnnews.com