The new black box warnings about SSRIs and children were directed toward depressed children and adolescents, and extra caution was raised about possible increased suicide risk. However, SSRIs are not prescribed for depressed children - in fact they are prescribed for a wide variety of behavioral disorders in children that include 'disruptive behavior disorder' ('explosive child') and severe anxiety disorder. The question is what effects could they be having on these children, and how well is the safety known?
The serotonin system is widely distributed throughout the brain and it appears to be involved in many processes important for behavior - including arousal, aggression, activation of the autonomic system, pain modulation, and pain modulation. The links provide additional background to the serotonin story. The illicit drug ecstasy is nicknamed the hug drug for the euphoric and empathetic outpourings that can come from its use. After the effect wears off, though, there appears to be a rebound and users are more aggressive or tend to perceive statements in a more aggressive fashion.
These studies again raise cautions about what we know and don't know about serotonin drugs in developing children. Serotonin is a neurotransmitter which is usually regulated in specific locations in precise ways in response to brain activation. Pharmacology is still very non-specific in its action at different sites and in its effects on neurotransmitter levels over time. SSRIs should not be thought of simply restoring something that a child lacks. SSRIs should not be considered lightly these drugs clearly affect much more than aggression or anxiety, and they may unwittingly affect 'good' serotonin-drive pathways (empathy, motivation)as well.
Serotonin, Aggression, Empathy
SSRIs and Apathy
The Empathy Drug
Not Seeing All the Data
The "file drawer" phenomenon: suppressing clinical evidence