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No evidence for warnings on antidepressants in children

Children are missing out on

antidepressants unnecessarily because of a failure to properly balance the risks and benefits of treatment, mental health experts have warned.

A major systematic review has concluded the current warnings on the dangers of antidepressants in young people are not based on good evidence, writes Daniel Cressey.

The team behind the analysis insisted the benefits were 'much greater' than the risks for young people with a variety of mental health problems.

They found suggestions of

an increase in suicidal ideation faded into insignificance when results were pooled, and concluded antidepressants should be considered first-line treatments in children.

Advice from the UK drug

regulator warns trials show an 'increase in harmful outcomes' for paediatric use of anti-

depressants, with only fluoxetine shown to be effective.

But study leader Professor David Brent, professor of psychiatry at the University of Pittsburgh Medical Center in the US, said he believed many warnings had been over-cautious: 'The strength of evidence supports the cautious and well-monitored use of antidepressants as a first-line treatment option.'

His study, published online by JAMA, pooled data from 27 trials on major depressive disorder, obsessive-compulsive disorder or other anxiety disorders.

For major depression, absolute response rates were 11 per cent better in treatment than placebo groups. In obsessive compulsive disorder, the difference was 20 per cent and in non-obsessive compulsive anxiety disorder 37 per cent. The risk of suicidal ideation was not significantly increased in any of the treatment categories.

Dr Chris Manning, chief executive of Primary Care Mental Health and Education, said: 'I've never been able to accept that if SSRIs contribute to suicide at the rate claimed we would be seeing falling suicide rates in all countries where they are widely prescribed. Figures such as these are compelling. It's not carte blanche for GPs to write scripts for SSRIs but it's something they need to look at.'

Professor Ian Wong, professor of paediatric medicines at the School of Pharmacy in London, said: 'There is another risk, which is the risk of not prescribing.'

dcressey@cmpmedica.com

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