Antidepressant use in Children – Should it raise concerns?

The World Health Organisation (WHO) has raised concerns over the rise in the use of antidepressant medication in children the BBC has reported.

A new study shows that there was a 54% increase in the number of children prescribed them in the UK between 2005 and 2012. There were also significant increases in prescription rates in Denmark, Germany, the US and the Netherlands over the same period.

Antidepressants are a recognised treatment for managing depression in children but the National Institute for Health and Care Excellence (NICE) clinical guidelines state they should not be offered initially for symptoms of mild depression, and in more serious cases antidepressants are only meant to be used in conjunction with psychological therapies.
The WHO said the research published in the European Journal of Neuropsychopharmacology raises serious questions.

Dr Shekhar Saxena, Director of Mental Health at the WHO said “Antidepressant use amongst young people is and has been a matter of concern because of two reasons. One, are more people being prescribed antidepressants without sufficient reason? And second, can antidepressants do any major harm?”

One problem faced in primary care is the huge waiting list that children face for therapy, or “talking therapy” as it is often known. Waiting lists range from 8 weeks (if you’re lucky) to months, so in the interim, children are prescribed antidepressants.

Antidepressants can only often treat the symptoms; they don’t get to the root cause of the issue. NICE has recognised that accessing child and adolescent mental health services is a growing problem. Prof Mark Baker, director of clinical practice at NICE said that this may have led to more severe cases of depression in young people being managed in primary care for longer.

NICE guidelines state that antidepressants should be prescribed at specialist level, but there is still pressure on the system in dealing with those children showing moderate symptoms of depression. Dr Rebecca Payne of the Royal College of General Practitioners (RCGP) said that “the mild end the school counsellors pick up, the more severe end can access specialist psychologist and psychiatric help. The problem is everybody in the middle and these are the groups that we might have prescribed antidepressants in the past.”
NICE currently recommends GPs should refer children to specialists for anything more than mild depression that might need pharmacological treatment, and that antidepressants should only be used in conjunction with talking therapies in younger people. However, GPs have warned that pressures on Child and Adolescent Mental Health Services mean they have to prescribe sometimes.
PULSE reported that Dr Maureen Baker, chair of the RCGP, said the “vast majority of antidepressants for children and young people are prescribed in secondary care”, but added that “with such long waits for patients to see a specialist or to get a psychological therapy referral, drug therapy is sometimes seen as the only option for GPs to best support patients, who may be in extreme distress, and their family”.

Dr Saxena said that further studies were needed to look at how and why antidepressants are being used with children and for how long as there is no reason for many years of prescriptions being continuously given.

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