Francis G. Martin, Alan F. Holmer, Ivan Gergel

Your article on the "promise" of pharmacological treatment for
depressed children reflects the selective attention and often narrow vision
characteristic of our times (Pharmaceuticals: Antideptessant Makers Study
Kids' Market," Market place, April 4). While most recent neuropsychological
research points powerfully to the Impact of environmental factors (families,
schools and other relatIonships) on not only behavior but also brain
chemistrv (for example, the role of serotonin levels In aggression,
impulsivity and certain affective disonders), your article Illumlnates how
adults prefer to absolve themselves of the responsibility of forging the
necessary relationships to ensure optimal development, choosing Instead the
route of the quick fix.
Thus, while 3% to 5% of our population may have Attention Deficit
Disorder, the quest for betterbehaved children who are easier to manage
brings the prescription level for Ritalin and similar medications to more
than 20% in many populations. The use of potentially addictive drugs with
multiple side effects such as Xanex, Prozac, Zololt, etc., on developing
children, without substantial testing on this vulnerable population, shows
us once again how drug company profits and an easier life for adults can
take priority over what is in the best Interest of children. How seductively
delightful to believe these drugs can neatly cure what ails our children,
partIcularly in the absence of necessary longterm and ongoing therapeutic,
growthenhancing relatlonslaips. Managed care will love thisyet another
opportunity to offer less treatment to children, while convincing
subscrIbers they are offering more service.
Frances G. MARTIN, PH.D. ElItins Park, Pa,

Your article on manufactuners' attempts to determine the safety and efficacy
of antidepressants in children portrayed this effort as a marketing ploy
aimed at a patticularly vulnerable population.
Manufactuters are gathering data on the effects of antidepreasants
and other drugs on.adolescents in response to a direct request from the Food
and Drug Administration. The EVA is understandably concerned about the fact
that although antidepressants have not been specifically approved for use by
patients under 18, more than half a million children are using them.
Children do suffer from depression, obsessivecompoisive disorder,
panic diso~ der and other forms of mental illness. Ac cording to the
American Academy of ChId and Adolescent Psychiatry, about 5% of children~and
teenagers suffer from serious depression. Untreated, depression can lead to
very serious pnoblems, including drug abuse and suicide.
Antidepressant medications have helped millions of peopl&, including
children, emerge from the darkness of mental illness. The FDA Is right that
the effects of these drug~specIlIcallv on adolescents need to be studied.
We believe these stud les will be useful to physicians and parents and will
help children lead happier, health ier, longer and more pr'oductive lives.
Alan F. HOLMER,
President of Pharmaceutical Research and
Manufacturers of America, Washington

Your article states that antidepressant makers are taking aim at children.
As statistics in your article point out, the prevalence of psychiatric
illnesses among the young makes finding the most effec tive ways of
identifying and treatmg these conditions paramount. Physicians and
pharmaceutical companies are mak ing an earnest effort to address the
urgent need fcr scientific data and appro priate treatment.
To clarify one statement in your article: SmithKline Beecham
develcped the orangeflavored liquid form of Paxil not for "the youngest
tykes," but to provide an alternative to patients such as the elderly, who
may have difficulty swallowing
Ivan GERGEL, M.D. Group Directcr Clinical Research,
Development and Medical Affairs North America
SmithKline Beecham, Collegeville. Pa.