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GPs have been plunged into further confusion over the use of selective serotonin reuptake inhibitors in children and adolescents after European drug regulators broadened warnings to include fluoxetine (Prozac).

The European Medicines Agency recommended a full EU-wide investigation into the safety of SSRIs in young people after its scientific committee concluded there were 'public health concerns' surrounding the entire class.

The committee found 'a signal of an increase in suicidal behaviour, including suicide attempts and self-harm'. It reiterated SSRIs were 'not authorised Europe-wide for the treatment of depression or anxiety in children or adolescents'.

The warnings came just three weeks after NICE draft guidelines appeared to relax rules on the use of SSRIs in children, advising sertraline or citalopram could be used if fluoxetine was unsuccessful.

The UK's Committee on Safety of Medicines had earlier ruled fluoxetine was the only SSRI that should be prescribed to children or adolescents.

Primary care mental health experts said GPs should refuse to initiate any SSRI in younger patients while there was no consensus over their use.

Dr Chris Manning, chief executive of Primary Care Mental Health and Education, said: 'The information is very confusing. GPs would be mad to do anything other than refer to a specialist. There is no point expecting GPs to go on prescribing in such a confused situation.'

But Dr Manning warned that secondary care services were 'non-existent' and that the situation had reached 'crisis point'.

Professor Andree Tylee, professor of primary care mental health at the Institute of Psychiatry, said having three different sets of guidance 'complicated matters'.

Conflicting advice on

SSRIs in children

and adolescents

December 2003 The CSM warns doctors not to use most SSRIs in children and adolescents but says the balance of risks and benefits remains positive for fluoxetine

September 2004 The US Food and Drug Administration tells a hearing in Washington that all SSRIs, including fluoxetine, increase suicidal thoughts in children

November 2004 NICE draft guidance softens the line on SSRIs, recommending fluoxetine first-line and sertraline or citalopram if it is not effective

December 2004 The EMEA contradicts NICE, warning no SSRIs should be used in patients under 18

By Emma Wilkinson

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