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Dr. Thomas Johnson discusses the risks of giving SSRIs like Paxil to children and the potential that plant-based diets that include citrus fruit have to prevent and treat depression.

Assessing, Preventing and Treating Childhood Depression Without Paxil or Other SSRIs
From Dr. Thomas Johnson, NCSP, CPQ - Health Psychologist
July 2025

Images from Canva

On June 23, 2025 I received a podcast by the CEO and Founder of Academia.edu, Dr. Richard Price, featuring an article I wrote over 20 years ago and was published by the National Association of School Psychologists Communique and republished by the Alliance For Human Research Protection (www.ahrp.org, December 18, 2003).

On June 10, 2003, the UK government’s Medicines and Healthcare Products Regulatory Agency issued a warning that Seroxat (Paxil in the US) must not be used in the treatment of children with depression. The agency took this stand after reviewing data from nine studies based on more than a thousand children. The City Editor of the Daily Mail in England, Alex Brummer, reported that GlaxoSmithKline "may have suppressed a series of negative studies on its key antidepressant drug Seroxat, known as Paxil in the US. In a highly unusual move, a team from the Good Clinical Practice Unit of the Medicines and Healthcare Products Regulatory Agency (MHRA) demanded access to all of GSK’s files and studies on Seroxat" (www.thisislondon.co.uk/news/business/articles). After their review of the studies, the UK agency concluded that "the risk of suicidal thoughts and self-harm was two to three times greater among those on Seroxat compared to those on a placebo drug" (www.number10.gov.uk).

FDA Action

Following the UK ruling on Paxil, the American-based Alliance for Human Research Protection (www.ahrp.org) and other patient advocacy groups asked the FDA to immediately investigate this research to determine if the agency should take similar action. Approximately one week later, on June 19, 2003, the FDA took similar action, saying “that no one under age eighteen should be prescribed the drug Paxil for major depression because the adult antidepressant may increase a child’s risk of suicide.”

After the FDA black box warning manufactures of other selective serotonin reuptake inhibitors SSRIs) issued their own warnings. For example, in my article I referenced the manufacturer, Wyeth, saying of their antidepressant Effexor, that this drug “ was not effective in treating depression or anxiety and was associated with increased ‘reports of hostility and especially in Major Depressive Disorder, suicide-related adverse events such as suicidal ideation and self-harm.’ (i.e. see www.ctv.ca/servlet/ArticleNews/story/CTVNews/1056372105025_14/)

After listening to Dr. Richard Price’s podcast and reviewing and re-reading my article that he was highlighting, I decided to conduct online research to help answer the question of whether or not prescribers have been following the strongly worded directive that Paxil and other SSRIs should not be prescribed for children because of the risk of increased depression and suicidality.

Representative of what I found was the following:

Antidepressant Dispensing: A recent study (Chua et al, Pediatrics, March 2024) analyzed more than 221 million antidepressant prescriptions dispensed between 2016 and 2022 that were included in the all-payer IQVIA Longitudinal Prescription Database of retail, mail-order, and long-term-care pharmacies. The monthly antidepressant-dispensing rate for U.S. adolescents and young adults aged 12 to 25 years increased by 66.3% from 2016 to 2022… More than 67% of antidepressant prescriptions dispensed between 2016 and 2022 were selective serotonin reuptake inhibitors.” (SSRIs). U. Pharmacist May 14, 2024, 49 (5):14

It was disappointing to see that prescribers have not only defied the FDA admonitions not to prescribe SSRIs because of the many adverse effects that can occur, especially suicidality; but the rate of prescribing has increased dramatically. The question that must be asked is - what are the alternatives to these drugs and why aren’t prescribers recommending them?

In a previous article written for Ethical Human Psychology and Psychiatry entitled Antidepressants and Alternative Ways of Supporting Children Struggling with Depression 2010 12(3) I made a strong case for conducting thorough multidisciplinary assessments to facilitate understanding of what may be causing or promoting depression. I included a case study to facilitate the readers understanding of how that could be accomplished.

On 6/2/25 I received an unsolicited AI review of this article from academia.edu. The summary is listed here:

“The article provides an extensive overview of approaches to supporting children and adolescents experiencing depression. It juxtaposes the mainstream from collegial perspective - epitomized by the widespread use of antidepressants - with alternative non pharmaceutical interventions and emphasizing sleep hygiene, nutrition, exercise, psychotherapy, and stress management by incorporating both data-driven findings and anecdotal evidence. The author highlights perceived limitations in standard pharmaceutical practices while proposing complimentary or alternative treatments. The concluding materials including parent and teacher handouts plus a case study offers practical strategies, situation examples and suggestions aimed at real world application.” (P.3)

The underlying theoretical model for this case for me was the Harvard Medical School’s Stress Control: Techniques for Preventing and Easing Stress publication which emphasizes a plant-based diet, sleep/meditation, exercise, and person centered and/or cognitive restructuring counseling. The model also has a section on unhealthy responses such as “taking prescription or over the counter drugs that promise some form of relief, such as sleeping pills, muscle relaxants or anti-anxiety pills.” (p.10). This model has been expanded recently by publication of the 2025 Harvard Medical School’s A Guide to Cognitive Fitness. This publication focuses on 7 steps to build optimum cognitive fitness including eat a plant-based diet, exercise regularly, get enough sleep, challenge your brain, nurture social contacts, manage your stress, and cultivate positivity and identify your purpose.

The interested reader can read my analysis and reviews in four recent postings on the All-Creatures.org web site. The reader should know that a plant-based diet - the Mediterranean Diet - has been found to help prevent and/or treat depression. Up until recently scientists had not identified which food(s) within the diet has the potency to prevent depression in the first place. There are those in the nutrition community who have emphasized the possible health benefits of fish because of the presence of omega 3 fatty acids. Readers may be surprised to learn that fish do not produce it but get it by consuming algae. Vegans get it directly by consuming algae in supplements.

Scientists have tried to identify the food or foods that have antidepressant effects in the Mediterranean diet. I was surprised to learn recently that it is oranges and not apples, bananas or any other plant food responsible for these effects. The question has remained as to whether fish or fish oil can be consumed to prevent or treat depression. The Physicians Committee for Responsible Medicine (PCRM) report that fish should not be viewed as a health food. The interested reader can go to the PCRM web site and see why these medical scientists and practitioners are warning readers to avoid fish because it “is a leading exposure to heavy medals and other contaminants and is frequently the subject of government health – risk advisories.” Additionally, there are concerns about the heavy presence of parasites in many of the fish that are being consumed. See Nasty Parasites Infecting Fish and You’re Eating Them | Dr. Neal Barnard - Exam Room available on YouTube. Parasites, dead or alive, can have significant adverse effects on health, including the development of depression. Also, I highly recommend my June 2023 All-Creatures.org article and the documentary Eating Our Way to Extinction for documentation of the many unhealthy effects of eating seafood.

The July/August 2025 issue of Harvard Magazine points out that researchers have known for years that eating a Mediterranean diet - which emphasizes vegetables, fruit and other plant-based foods reduces depression risk. As indicated above a recent study by Harvard scientists has now zeroed in on one aspect of the diet, citrus fruit, confirming that eating an orange a day may prevent depression. The project also takes important steps towards understanding how this simple habit might affect mood.

“The explanation may lie in the gut microbiome the teeming ecosystem of microscopic organisms that live in the human digestive tract and interact with human physiology, including the brain and the nervous system…. Growing evidence confirms that gut microorganisms’ influence mood states.” (P.9) Can an Orange a Day Stave off Depression? Harvard Magazine July/August 2025 issue.

While diet is listed by the Harvard Medical School scientists and practicing physicians as the foundation for improving cognitive fitness and overall health it is important to build on the other 6 steps listed in the newly published Harvard Medical School’s A Guide to Cognitive Fitness.

In my clinical experience positivity and having a strong sense of purpose are particularly important and I would like to mention an example from history that stands out for me is the founder of the Methodist faith, John Wesley.

Jennie Richards wrote the following in her publication Johns Wesley, Founder of Methodism, Promoted a Vegetarian Diet. See Humainedecisions.com/john Wesley-founder-methodism- promoted-a-vegetarian-diet. She writes:

“John Wesley (1703-1791) was the founder of the Methodist movement and the Christian denomination of Methodism. He was a revered and prolific English preacher and theologian who was considered light years ahead of his time. Wesley strongly advocated and believed in eating a plant-based diet. He felt good physical and spiritual health went together and vegetarianism was the diet most compatible with Christian values like mercy, compassion and kindness. He was against any and all cruelty to animals or causing their suffering by killing them for food and believed that a vegetarian diet was the best foundation for developing a spiritual practice and relationship with God.(P.1)

Moving on in the article she writes:

“Even three centuries back, Wesley observed and thought that eating animal foods was harmful to people’s physical health, including the eating of eggs and dairy. He reasoned that animal products made people sick causing chronic disease, infections and food poisoning.

His medical doctor advised Wesley to stop eating animal products, and when he did and he became a vegetarian—his chronic health problems disappeared. Wesley was not only concerned about the spiritual welfare of people but was also very concerned about providing practical medical advice and healing for the average person who may not have access to medical professionals. He realized that medicine in England was accessible only to the wealthy. He sought to share simple, easy and natural remedies to treat illnesses and promote physical healing, prompting him to write the book, Primitive Physic, or an Easy and Natural Method of Curing Most Diseases. His book was a bestseller in his day and sold more books than anything else he wrote and today is still being published.” (P.3)

One of Wesley’s founding principles was, “Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as ever you can.” (P.4)

It may be reassuring to those of us who are vegans and avoid eating animal flesh, eggs and meat that the plant-based diet we eat may lessen the chances of depression and are protective of experiencing clinical depression. However, the question remains as to how to make the knowledge in this article and the many studies and articles on the PCRM web site available to helping professionals and people in general?

Dr. Barnard and many of us who are members of PCRM and write articles that you are reading now are providing knowledge and ethical guides to interested readers. On a personal level I need to continue doing the research and encourage those I meet to become better informed as the prevention and recovery from depression can be a mater of life and death. Also, finding web sites like All-Creatures.org and others that have many participants can be very helpful. For example, academia.edu reports that they now have 270 million registered users and 55 million research papers posted.

In summary and conclusion, on June 23, 2025 I received a podcast by the CEO and Founder of Academia.edu , Dr. Richard Price, featuring an article I wrote over 20 years ago and was published by the National Association of School Psychologists Communique and republished by the Alliance For Human Research Protection (www.ahrp.org December 18, 2003 edition). The title of my article was Drug Regulators Warn Against Using Paxil With Children (Communique, 32(2)). In this article I wrote:

On June 10, 2003, the UK government’s Medicines and Healthcare Products Regulatory Agency issued a warning that Seroxat (Paxil in the US) must not be used in the treatment of children with depression. The agency took this stand after reviewing data from nine studies based on more than a thousand children.

After pressure and research provided to the FDA, they followed the British equivalent to the FDA and issued a strongly worded directive not to prescribe SSRIs because of lack of effectiveness and life-threatening side effects like suicidality.

This article is a follow up to the warnings by the FDA. Unfortunately, not only did prescribing health care providers not stop prescribing SSRIs they increased the amount of prescribing. I make the case again for thorough multidisciplinary assessments and the use of healthy and safe alternatives-based on the Harvard Medical School’s A Guide to Cognitive Fitness, PCRM and other evidence-based research guides to the prevention and treatment of childhood depression going forward.

Biographical Notes

Dr. Thomas B. Johnson completed his graduate studies at Brown University (US Public Health Fellowship in social psychiatry and medical sociology), Harvard University (master’s degree in counseling psychology), UC-Berkeley (doctor’s degree in counseling psychology) and Duke University (doctoral internship in psychological services). He is a licensed psychologist, nationally certified school psychologist and a health psychologist and certified by the National Register of Health Services Psychologists. He has served as a faculty member at Bates College, Rutgers University and the University of Southern Maine. He was a contributing editor of the NASP Communique for 10 years as their editor for alternative and complimentary approaches to health and learning. He is currently a regular contributor to All-Creatures.org. He has been providing a full range of psychological services over many years including assessments, consultations, education, psychotherapy, supervision and research. He now serves as a consulting psychologist and heath research scientist.

Learn more about Dr. Thomas Johnson and see his other contributions to All-Creatures here!

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Posted on All-Creatures: July 8, 2025
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