Using NewsHour Extra Feature Stories

Overview: NewsHour Extra features stories can help students identify and interpret key issues in current events. This activity anticipates one class period, but the follow-up essay might be assigned as homework, or in another period.

Warm Up: Use initiating questions to introduce the topic and find out how much your students know.

Main Activity: Have students read NewsHour Extra's feature story and answer the questions on the reading comprehension handout.

Discussion: Use discussion questions to encourage students to think about how the issues outlined in the story affect their lives and express and debate different opinions.

Follow-up: Students can write an 500-word editorial on the topic expressing their views and send it to NewsHour Extra [extra@newshour.org] for possible publication.

Evaluation: Students are graded on their answers to reading comprehension questions and/or their editorial.

Story: Most Antidepressants Deemed Unsafe in Children, 4/26/04
http://www.pbs.org/newshour/extra/features/jan-june04/depressed_4-26.html

Initiating Questions:

1. What is depression? Do you think depression is something that affects teens? How?

2. Have you ever felt really sad or depressed for more than a few days at a time? What did you do?

3. Do you think that all drugs given to patients should be tested on the target population? For example, drugs prescribed for children should be tested first on children. Drugs prescribed for women should be tested on women. Why or why not?

Reading Comprehension Questions: (click here for printout)

1. Why is the Lancet study significant?

The British study is a "meta-analysis" -- the first comprehensive scientific review of both published studies and unpublished data that pharmaceutical companies have said they own and have the right to withhold. The British government allowed the scientists access to the unpublished, largely negative, data.

2. What did the Lancet study conclude? What impacted this conclusion considerably?

The report concluded that young patients, aged 5-18, should not take four popular antidepressants -- Paxil, Zoloft, Effexor and Celexa -- because there was a clear risk of suicidal behavior among those taking the drugs and no benefit. The fifth drug studied -- Prozac -- was found to be effective for depressed children and did not have an elevated risk of suicide.

The authors of the study said the unpublished research had a major impact on the report's findings.

"In each of the published articles, the authors concluded the drug was either effective, safe or both," said Tim Kendall, one of the authors of the study. "When you look at the combined evidence, it is ineffective, unsafe or both."

3. How did the drug companies respond to the Lancet study?

The drug companies contend that their products are safe and deny they are risking the lives of younger patients in order to sell more prescriptions.

"The use in children of our drug in particular, is a very, very, very small percentage of the overall total prescriptions of this product," Mariann Caprino, spokeswoman for Pfizer Inc., which makes Zoloft, told The Washington Post. "To suggest that we are motivated by profiting off of children is ludicrous."

4. What is depression and how many children and adolescents suffer from it?

It is estimated that between 2 percent and 6 percent of all children and adolescents suffer from depression. Depression is a mood disorder in which sad, lonely, irritable or weary feelings don't go away and prevent a person from living a productive life.

5. What is one biological sign that researchers think is associated with depression? What have they created to help with this? How do they work?

There isn't a medical test for depression but researchers have discovered that those with depression often have an imbalance of neurotransmitters -- the chemical messengers that allow brain cells to communicate with each other.

One class of antidepressant drugs are known as selective serotonin reuptake inhibitors (SSRIs). They work by increasing the levels of serotonin, a neurotransmitter, in the brain. These increases can change a person's mood. All five antidepressants in the Lancet study are SSRIs.

6. What are "off-label" prescriptions and why are they important in understanding the antidepressant debate?

Much of the controversy surrounding antidepressants and children is that few of the drugs are specifically created for them. Instead, physicians prescribe them for "off-label" use. Off-label means the drugs have not been systematically studied for safety and effectiveness for the purpose the doctors prescribe them -- for example, to treat depression in children or adolescents -- but can be given to patients based on clinical experience and medication knowledge.

7. How have different government agencies in different countries reacted to the antidepressant debate?

In England studies like the one in Lancet and the growing concern of a link between the antidepressants and suicide caused the British government to recommend against most depressants, except Prozac, for children.

On Thursday European Union regulators recommended that Paxil not be given to children and adolescents.

In the United States, the FDA has been more cautious. In March the agency requested that drug manufacturers strengthen their warnings about the possible links between the drug use by adolescents and suicidal thoughts and behaviors.

The agency also asked an expert committee at Columbia University to review drug-company data and to create a definition of what is suicidal thinking and suicidal behavior. The report, due this summer, could influence any final FDA decision.

Discussion Activity (more research might be needed):

1. If you were a parent with a depressed teenage child would you allow your child to take antidepressants? Under what circumstances? Why or why not?

2. Should "off-label" prescription use be allowed? Why or why not? What are the implications of stopping them?

3. Should drug companies have to share all data from clinical studies about their products with outside researchers? Why or why not? How might research sponsored by a drug company be different from research sponsored by a government agency like the FDA?

Write a 300-500 word essay on any of these topics providing clear examples. Send your completed editorial to NewsHour Extra [extra@newshour.org]. Exceptional essays might be published on our Web site.