Do not prescribe anti-depressants to children with mild depression, government urges

September 28, 2005
by Angela Hussain.

GPs and psychiatrists should not prescribe anti-depressants as a first line treatment to under 18s with mild depression, a government guideline released today urges.

The guideline states this is because SSRI antidepressants, the most widely prescribed group of antidepressants, carry a risk of suicidal behaviour.

Under 18s with continuing mild depression should, instead, be provided with non-directive supportive therapy, group cognitive behavioural therapy or self help, says the guideline by the government's National Institute for Clinical Excellence (NICE)

The guideline's recommendations follow an announcement in 2003 by the drug regulatory body, the Medicines and Healthcare Products Regulatory Agency, that SSRIs are associated with increased suicide-related behaviour and hostility in young people. Prozac was exempted.

It is estimated that there are 40,000 children taking anti-depressants for depression, anxiety and other problems.

Nice's guideline does state, however, that doctors can prescribe antidepressants to children with moderate to severe depression, but only if psychological therapy is also being provided.

However, the guideline urges professionals to be alert to suicidal behaviour after a child is prescribed anti-depressants.

It states: "A child or young person prescribed an antidepressant should be closely monitored for the appearance of suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment, by the prescribing doctor and the healthcare professional delivering the psychological therapy."

The guideline also recommends that under 18s with moderate to severe depression should be offered, as a first-line treatment, a psychological therapy such as cognitive behavioural therapy, interpersonal therapy or family therapy of at least three months.

Andrew Dillon, chief executive of NICE, said:"This guideline makes it clear that psychological treatments are the most effective way to treat depression in children and young people."

The guideline has been welcomed by mental health groups. But concerns have been voiced that there is a huge shortage of professionals to provide psychological therapy.

Dinah Morley, deputy director of the charity YoungMinds said: "The very significant shortage of practitioners able to deliver these therapies is a cause for concern."

Read for yourself: NICE's clinical guideline on the treatment and management of depression in children and young people (pdf)

See also:
June 6, 2005: Euro panel to decide on Prozac for children - arbitration begins on conflicting opinion on safety of Prozac to treat depression for under 18s across Europe.

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