Antidepressant warning for children, teens

The risks outweigh the benefits for most antidepressants prescribed to children. Photo: SuppliedAntidepressants prescribed for children are ineffective and may cause serious harm, including suicide attempts, a major review shows.
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The findings had “disturbing implications” for treating major depression in children, warns an Australian psychiatrist, as the use of antidepressants and antipsychotics continues to rise among children as young as two yearsold.

The risks outweighed the potential benefits of antidepressant use for children for 13out of 14antidepressants prescribed to children and teenagers, with only fluoxetine (Prozac) well tolerated, the analysis of 34 clinical trials involving 5260 patients found.

The drug venlafaxine (Efexor) was linked with an increased risk of patients experiencing suicidal thought and suicide attempts compared with a placebo, found the most comprehensive review of medications to treat major depression in children and teenager.

But the rate of serious harms linked to other antidepressants, including paroxetine, sertraline, and citaloprammay be underestimated due to selective reporting, the burying of unpublished trials showing adverse effectsand poorly designed trials, the researchers warned in the review published in The Lancet on Thursday.

The effectiveness of fluoxetine may also have been exaggerated due to the smaller sample sizes of those trials, suggested the the international team researchers ledby Oxford University psychiatrist Associate Professor Andrea Cipriani.

“We cannot rule out the possibility that some unpublished studies are still missing or that published reports might overestimate the efficacy of treatments,” they wrote.

“The balance of risks and benefits of antidepressants for the treatment of major depression does not seem to offer a clear advantage in children orteenagers, with probably only the exception of fluoxetine,” they concluded.

Data from the Department of Human Services showed more than 1000 children aged from just two to six yearsold were using antidepressants, and a further 26,000 children under the age of 16 were also prescribed the medications between 2012 and 2013.

The number of children prescribed antidepressants in Australia jumped dramatically in recent years, found a University of Sydney study published in the Australian and New Zealand Journal of Psychiatry.

Antidepressant prescriptions rose 16 per centfrom just under 12.5 million in 2009 to 14.5 million in 2012, according to PBS data. Antipsychotics scripts jumped close to 23 per centfrom 2.5 million to 3.2 million over the same period.

The biggest rise in antidepressant and antipsychotic prescriptions was among 10-14 year olds, rising 35.5 per centand 49 per centrespectively.

Australian child psychiatrist at the University of Adelaide Jon Jureidini said the review’s findings had “disturbing implications for clinical practice”.

In an accompanying editorial. Professor Jureidini said doctors considering whether to prescribe antidepressants to childrenshould assume the benefits of antidepressant drugs are oversold, and that harms are more serious than reported.

“For antidepressants in adolescents, this equation will rarely favour prescribing; in younger children, almost never,” he said.

Psychotherapies, particularly cognitive behavioural therapy or interpersonal therapy, are recommended as first line treatments for children with major depression, and Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants, such asfluoxetine, can be prescribed to children and teenagers who don’t have access toor don’t respond to psychotherapy.

But Professor Jureidini says doctors should “not be pressured into prescribing just because they have no capacity to offer evidence-based psychotherapy”.

The effects of misreporting meant that antidepressants were likely more dangerous and less effective than previously thought, “so there is little reason to think that any antidepressant is better than nothing for young people”, he said.

The Royal Australian College of Psychiatrists warns against abruptly ceasing antidepressant treatment in children. The college recommends starting with a low dose, monitoring the child closely and advising parents to be on the lookout for adverse symptoms.

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