, Volume 4, Issue 3, pp 277–297 | Cite as

Neurological entanglements: The case of paediatric depressions, SSRIs and suicidal ideation

  • Elizabeth A Wilson
Original Article


This article explores the neurological entanglements that are the stuff of depressive states in treatment. My particular concern is the use of selective serotonin reuptake inhibitors in depressed paediatric populations. The use of antidepressants to treat childhood and adolescent depressions has become more frequent in recent years, and more controversial. My ambition is not to intervene into these debates directly, but to push some of our thinking about the substrata of depression in new directions. I am interested in what philosophies of the body and what theories of mind the psychological literatures about paediatric depression lean on, and silently promote. Drawing on neurological and clinical trial data, the article argues that depressive states are neither caused nor cured by singular events (a gene; a pharmaceutical); rather they are complex, non-deterministic sedimentations of pharmaco-affective, ideo-chemical and neuro-social affiliations.


neuroscience depression SSRI childhood intra-action 


  1. American Psychiatric Association. (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Arlington, TX: American Psychiatric Association.Google Scholar
  2. Barad, K. (2007) Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  3. Birmes, P., Coppin, D., Schmitt, L. and Lauque, D. (2003) Serotonin syndrome: A brief review. Canadian Medical Association Journal 168 (11): 1439–1442.Google Scholar
  4. Boyer, E. and Shannon, M. (2005) The serotonin syndrome. The New England Journal of Medicine 352 (11): 1112–1120.CrossRefGoogle Scholar
  5. Brent, D. et al (2009) Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI – Resistant depression in adolescents (TORDIA) study. American Journal of Psychiatry 166: 418–426.CrossRefGoogle Scholar
  6. Bridge, J. et al (2007) Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment. A meta-analysis of randomized controlled trials. Journal of the American Medical Association 297 (15): 1683–1696.CrossRefGoogle Scholar
  7. Bridge, J., Birmanher, B., Iynegar, S., Barbe, R. and Brent, D.A. (2009) Placebo response in randomized controlled trials of antidepressants for pediatric major depressive disorder. American Journal of Psychiatry 166 (1): 42–49.CrossRefGoogle Scholar
  8. Caspi, A. et al (2003) Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science 301: 386–389.CrossRefGoogle Scholar
  9. Committee for Safety of Medicines. (2004) Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitor Antidepressants,
  10. Dunkley, E., Isbister, G., Sibbritt, D., Dawson, A. and Whyte, I. (2003) The hunter serotonin toxicity criteria: Simple and accurate diagnostic decision rules for serotonin toxicity. QJM 96: 635–642.CrossRefGoogle Scholar
  11. European Medicines Agency. (2005) European Medicines Agency finalises review of antidepressants in children/adolescents,, accessed 25 May 2011.
  12. Fleischer, R. (dir.) (1966) Fantastic Voyage, Twentieth Century Fox Film Corporation.Google Scholar
  13. Fonagy, P. (2010) The changing shape of clinical practice: Driven by science or by pragmatics? Psychoanalytic Psychology 24 (1): 22–43.CrossRefGoogle Scholar
  14. Freud, S. (1909/1955) Notes upon a case of obsessional neurosis. In: J. Strachey (ed.) The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 10. London: Hogarth Press, pp. 155–249.Google Scholar
  15. Garland, E.J., Kutcher, S. and Virani, A. (2009) 2008 position paper on using SSRIs in children and adolescents. Journal of Canadian Academy of Child and Adolescent Psychiatry 18 (2): 160–165.Google Scholar
  16. Gibbons, R. et al (2007) Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. American Journal of Psychiatry 164: 1356–1363.CrossRefGoogle Scholar
  17. Glannon, W. (2002) The psychology and physiology of depression. Philosophy, Psychiatry, and Psychology 9: 265–269.CrossRefGoogle Scholar
  18. Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Anchor Books.Google Scholar
  19. Hammad, T., Laughren, T. and Racoosin, J. (2006) Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry 63: 332–339.CrossRefGoogle Scholar
  20. Harrington, R., Rutter, M. and Fombonne, E. (1996) Developmental pathways in depression: Multiple meanings, antecedents, and endpoints. Development and Psychopathology 8: 601–616.CrossRefGoogle Scholar
  21. Healy, D. (1999) The Antidepressant Era. Cambridge, MA: Harvard University Press.Google Scholar
  22. Healy, D. (2004) Let Them Eat Prozac. The Unhealthy Relationship between the Pharmaceutical Industry and Depression. New York: New York University Press.Google Scholar
  23. Jurist, E. (2010) Elliot Jurist interviews Peter Fonagy. Psychoanalytic Psychology 27 (1): 2–7.CrossRefGoogle Scholar
  24. Laing, R.D. and Esterson, A. (1964) Sanity, Madness and the Family. Harmondsworth, UK: Penguin.Google Scholar
  25. Liebert, R. and Gavey, N. (2009) ‘There are always two sides to these things’: Managing the dilemma of serious adverse effects from SSRIs. Social Science & Medicine 68: 1882–1891.CrossRefGoogle Scholar
  26. Miller, A. (2007) Social neuroscience of child and adolescent depression. Brain and Cognition 65: 47–68.CrossRefGoogle Scholar
  27. Moncrieff, J. (2008) The creation of the concept of an antidepressant: An historical analysis. Social Science & Medicine 66: 2346–2355.CrossRefGoogle Scholar
  28. National Institute for Health and Clinical Excellence [NICE]. (2005) Depression in Children and Young People (Quick Reference Guide), Clinical Guideline 28: September. London: National Institute for Health and Clinical Excellence.Google Scholar
  29. Oates, J. and Sjoerdsma, A. (1960) Neurologic effects of tryptophan in patients receiving a monoamine oxidase inhibitor. Neurology 10: 1076–1078.CrossRefGoogle Scholar
  30. Oyama, S. (2000) The Ontogeny of Information: Developmental Systems and Evolution. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  31. Petryna, A., Lakoff, A. and Kleinman, A. (2006) Global Pharmaceuticals: Ethics, Markets, Practices. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  32. Risch, N. et al (2009) Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression. A meta-analysis. The Journal of the American Medical Association 301 (23): 2462–2471.CrossRefGoogle Scholar
  33. Rose, N. (1990) Governing the Soul: The Shaping of the Private Self. London: Routledge.Google Scholar
  34. Rosenhan, D. (1973) On being sane in insane places. Science 179: 250–258.CrossRefGoogle Scholar
  35. Rutter, M. (2008) Biological implications of gene-environment interaction. Journal of Abnormal Child Psychology 36: 969–975.CrossRefGoogle Scholar
  36. Singh, I. and Rose, N. (2006) Neuro-forum: An introduction. BioSocieties: An Interdisciplinary Journal for the Social Studies of Life Sciences 1: 97–102.CrossRefGoogle Scholar
  37. Sternbach, H. (1991) The serotonin syndrome. American Journal of Psychiatry 148 (6): 705–713.CrossRefGoogle Scholar
  38. Teicher, M., Glod, C. and Cole, J. (1990) Emergence of intense suicidal preoccupation during fluoxetine treatment. American Journal of Psychiatry 147 (2): 207–210.CrossRefGoogle Scholar
  39. Timimi, S. (2002) Pathological Child Psychiatry and the Medicalization of Childhood. New York: Brunner-Routledge.Google Scholar
  40. Tomkins, S. (1963) Affect, Imagery, Consciousness. Volume II. The Negative Affects. New York: Springer.Google Scholar
  41. US Food and Drug Administration. (2007) Revisions to product labeling,, accessed 25 May 2011.
  42. Wermter, A.-K. et al (2010) From nature versus nurture, via nature and nurture, to gene x environment interaction in mental disorders. European Child & Adolescent Psychiatry 19 (3): 199–210.CrossRefGoogle Scholar
  43. Wheeler, B., Gunnell, D., Metcalfe, C., Stephens, P. and Martin, R. (2008) The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: Ecological study. British Medical Journal 336: 542–545.CrossRefGoogle Scholar
  44. Whittington, C., Kendall, T., Fonagy, P., Cottrell, D., Cotgrove, A. and Boddington, A. (2004) Selective serotonin reuptake inhibitors in childhood depression: Systematic review of published versus unpublished data. The Lancet 363: 1341–1345.CrossRefGoogle Scholar
  45. Wilson, E.A. (1998) Neural Geographies: Feminism and the Microstructure of Cognition. New York: Routledge.Google Scholar
  46. Wilson, E.A. (2004) Gut feminism. Differences: A Journal of Feminist Cultural Studies 15 (3): 66–94.CrossRefGoogle Scholar
  47. Wilson, E.A. (2006) Ingesting placebo. Australian Feminist Studies 23 (55): 31–42.CrossRefGoogle Scholar
  48. Wilson, E.A. (2008) The work of antidepressants: Preliminary notes on how to build an alliance between feminism and psychopharmacology. BioSocieties: An Interdisciplinary Journal for the Social Studies of Life Sciences 1: 125–131.CrossRefGoogle Scholar

Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2011

Authors and Affiliations

  • Elizabeth A Wilson
    • 1
  1. 1.Department of Women'sGender and Sexuality Studies, Emory UniversityAtlantaUSA

Personalised recommendations