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The waiting game

GPs urged to avoid antidepressants in children due to suicide concerns

GPs should avoid prescribing antidepressant medication to children and adolescents where possible, after researchers found more aggressive and suicidal behaviour connected to use of SSRIs and SNRIs than previously reported.

The team, from University College London, conducted a meta-analysis of 70 clinical trials of antidepressant drugs and found that antidepressants double the risk of suicide and aggressive behaviour in children and teenagers – although they found no relationship in adults.

However, the researchers said they believe that the numbers identified in their analysis may underestimate the true risks, because industry trials have under-reported serious harms and withheld patient data. 

This means that the risk of these and other potential harms such as suicidal thoughts and akathisia – a movement disorder associated with a feeling of restlessness – cannot be properly estimated.

NICE already advises against prescribing paroxetine specifically in adolescents and children as it causes a significant increase in the risk of harms, including suicidal ideation and behaviour. However, the latest findings suggest the harms could be more widespread.

In one example highlighted by the paper, a patient receiving fluoxetine – the current first-line pharmacotherapy option for children and young people according to NICE – had their suicide attempt misreported as ‘elevated liver enzymes’ in adverse events data.

The researchers concluded that the lack of data for serious harms means that the true risk for using antidepressants is still largely unknown, and recommended only minimal use of the drugs in children and teens.

They wrote: ‘We suggest minimal use of antidepressants in children, adolescents, and young adults, as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant.’

NICE currently recommends antidepressants should only be used cautiously in young people, in combination with psychological therapy in children over 12, and only once psychological therapy has failed in younger children.


Readers' comments (9)

  • Antidepressants should be avoided in all age groups. They are placebo and the whole industry is a con.

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  • Vinci Ho

    Personslly, would use only fluoxetine(nothing else) in older than 16 and under 20 years old. Refer any at 16 and under right away.

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  • Thanks, medical student above. You'll go far with an enquiring mind like that.

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  • Excellent no medication - so refer all to childrens' mental health services - only to get a reply back saying we don't feel this is appropriate for our services - send them to fictional counselling services which don't exist in our area for children.

    All that leaves is a cup of tea and a hug - No wait caffeine is bad, and a hug may end up with social services referring you to the GMC.

    Just leave them as suicidal it is then.

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  • A decision for those clever hospital doctors then.

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  • I thought it was already standard practice to avoid primary care initiation of antidepressants in under 18s. Is that not the case?

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  • Well this is old news surely. I thought it has been common knowledge for at least 10 years that SSRIs are linked to increased suicidal ideation and self harm in this group?

    However parents demand something be done, CAMHS always find a reason not to deal with it and counselling services are practically non-existent and/or have 12 month waiting list.

    Where are the options?

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  • So no medication, psychological services hopelessly overstretched... Er, what do we do with them?
    "Please refrain from attempting suicide for the next 18m while we wait for camhs appointment"? (By which time they'll be bounced to adult services or will be dead).

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  • Congratulations Anonymous Medical Student. 28 January 2016.

    It would appear that you have valid insight into the distortion and lack of academic integrity in many of the Pharma controlled, data manipulated SSRI "double blind" clinical trials. - eg. ? Study 329 and STAR D? I sincerely hope that you do "go far" via your courageous and evidence based post.
    We need a new generation of primary and secondary care physicians who have the critical wisdom to begin to reduce the devastating morbidity and mortality resulting from the academic misconduct which has been demonstrated during the last 5+ years of "psychopharmacology". Thank you and well done.

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