Prozac 'no better than placebo' for treating children with depression, experts

Suicidality and Risk Mechanisms

• Several participants describe close family members becoming acutely suicidal or even homicidal shortly after starting or adjusting Prozac, including in the 1990s before black‑box warnings.
• Two competing explanations recur:
  • “Energy-before-mood” model: meds lift lethargy and willpower before mood improves, enabling people who already want to die to act on those thoughts.
  • “Drug-induced ideation” model: SSRIs can abruptly generate overwhelming suicidal or psychotic impulses that weren’t there before.
• Mania or bipolar disorder unmasked by SSRIs is mentioned as a plausible mechanism in some extreme reactions.
• People emphasize that increased suicidality is a known class risk for many CNS drugs, hence the need for close monitoring, not automatic rejection of treatment.

Mixed Personal Outcomes with SSRIs

• A large number of anecdotes report SSRIs (including Prozac) as “life-saving” or “night and day,” especially for severe anxiety and major depression, often after years of trying lifestyle changes and therapy.
• Others report little benefit or severe side effects: emotional blunting, loss of libido, weight gain, dissociation, brain fog, withdrawal syndromes, and in a few cases long‑lasting anhedonia or sexual dysfunction.
• Many stress that responses are highly individual and often require trial‑and‑error across drug classes (SSRIs, SNRIs, NDRIs, etc.) and doses.

Children, Diagnosis, and Safety Concerns

• The article’s child focus is repeatedly highlighted; some argue Prozac may help adults but not be better than placebo in children.
• Several parents describe dramatic improvements in severely depressed or anxious children on fluoxetine; critics counter that children’s brains are developing and long‑term harms are under‑studied.
• There is debate over whether pediatric depression is “real” vs mislabeling normal distress, and concern about misdiagnosis (e.g., underlying bipolar disorder).

Placebo, Evidence, and Trial Design

• Commenters note meta‑analyses showing only marginal average benefit over placebo, publication bias, and short (6–12 week) trials versus multi‑year real‑world use.
• Some argue that “no better than placebo” at the group level can still hide large benefits for specific subgroups; others say approvals would likely fail under today’s evidentiary standards.
• Ethical questions arise: if something works mainly via placebo, is it acceptable to prescribe it without saying so?

Biology vs Environment and Alternatives

• One camp sees depression primarily as a brain disorder with strong familial patterns; another sees it mainly as a signal of bad circumstances, alienating work, or lack of meaning.
• Many argue both factors coexist: medication can create a “platform” to do therapy, change life circumstances, exercise, socialize, or pursue spiritual practices.
• Lifestyle interventions (exercise, light exposure, social connection, diet, religion) are frequently proposed as low‑risk adjuncts; others warn these are often impossible to start when someone is severely ill.