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GPs are abandoning the use of SSRIs in children in response to drug safety warnings, a new study shows.

Prescribing rates have plummetted not only in depression but also in anxiety disorders, for which SSRIs are still licensed.

Researchers warned that many children appeared to be missing out on treatments they needed because of widespread nervousness among GPs over the use of psycho-tropic drugs.

Study leader Dr Ian Wong, director of the Centre for Paediatric Pharmacy Research in London, said: 'If these patients have come off drugs can they all receive psychotherapies? I don't think so. One reason GPs prescribed so many antidepressants was because there were not enough people offering psychotherapies.'

He added: 'Other data shows that antipsychotic medication has also gone down. In the UK, we have a genuine trend that using psychotropic drugs in children has gone down.'

GP prescribing of all SSRIs other than fluoxetine dropped by a third, from 3.1 children per 1,000 in 2002 to 2.0 per 1,000 in 2004, after the Committee on Safety of Medicines provisionally advised against their use in 2003.

Prescribing for anxiety disorders dropped from 0.4 per 1,000 to 0.3 per 1,000 over the same period, even though fluvoxamine maleate and sertraline are still licensed for treating obsessive compulsive disorder in children.

Prescribing of fluoxetine ­ which the CSM still recommends for depression ­ increased only slightly from 2.1 per 1,000 in 2002 to 2.3 per 1,000 in 2004, suggesting many children had come off medication altogether.

Professor Andre Tylee, professor of primary care mental health at King's College, London, said: 'Most GPs are now unwilling to prescribe antidepressants since the recent guidelines, and this would apply for indications other than depression as well.'

He added: 'It seems to be a widespread effect of scaring GPs off prescribing.'

GP prescribing of SSRIs had been rising sharply at

the time of the CSM warning (see Pulse, November 22, 2004).

The study will appear in Drug Safety.

By Cato Pedder

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