There has been a large increase in the number of British children prescribed anti-depressants, according to research published in the journal European Neuropsychopharmacology.
The research, led by Dr Christian Bachmann of Berlin’s Charité University Hospital, found that prescription rates increased by 54 per cent between 2005 and 2012. In Denmark the figure is higher still, at 60 per cent.
In 2003, NIMH (the National Institute of Mental Health) warned that most anti-depressants are unsuitable for children, following several pieces of research which claimed that the drugs increased the likelihood of suicide in adolescents. This claim was bolstered by a clinical review published in January.
Dr Shekhar Saxena, the World Health Organisation’s mental health director, told the BBC: ‘Anti-depressant use among young people is and has been a matter of concern because of two reasons. One, are more people being prescribed anti-depressants without sufficient reason? And second, can anti-depressants do any major harm?’
Saxena is also concerned by the prevalence of off-label prescriptions, in this case drugs that are not licensed for use by children. ‘These are medicines which have not been tried among young people [and] have no justification for being used widely in young people.
‘There are legal regulations and professional guidelines and off-label use of drugs many times crosses both of them. That’s something the World Health Organisation is very concerned about.’
The WHO say that the research should encourage health authorities to reconsider the way they treat childhood depression. Dr Saxena said: ‘There is no reason for many years of prescriptions being continuously given. Adolescents and young people are in the phase of development — they develop out of everything, including their own depression.’
This is a source of concern, not only in the UK but also in countries such as Denmark and Germany where similar rising patterns of anti-depressant prescribing in children have been shown. The exact reasons why this should be occurring in the UK are complex, but falling levels of funding in secondary care mental health services is a key one. In general, GPs are usually reluctant to prescribe anti-depressants to under-18s but may occasionally feel obliged to because of difficulty in accessing local psychosocial intervention services.
There may also be a confounding factor here where anti-depressants are being prescribed inappropriately because an incorrect mental health diagnosis has been made. Because the long-term effect of anti-depressant medication in children remains unclear, this is a timely reminder to the profession that, whenever possible, non-drug treatments should always be considered as the first line option when considering a diagnosis of depression in the under-18 age group.
Research score: 4/5