Antidepressant crackdown having 'little effect'

Suicide rates in 12- to 17-year-olds fall consistently for 15 years regardless of prescribing restrictions.

The crackdown on antidepressant prescribing to under-18s has made no difference in suicide or self-harm rates among the young, according to UK researchers.

Since 2003, only fluoxetine (Prozac) has been allowed to be prescribed to under-18s following concerns that antidepressant use could increase the risk of suicide in young people with depression.

Earlier this month, the MHRA released even tougher rules, and all antidepressants will have to carry warnings of suicide risk in the young.

However, analysis of data on 12 to 17 year olds in the UK from 1993 to 2005 shows that while antidepressant prescribing has fallen, this had no influence on suicide or self-harm trends.

Researchers analysed three sets of data for 12- to 17-year-olds: prescribing trends in the UK; mortality data in England and Wales; and hospital admission figures for England.

This showed that antidepressant prescribing had doubled between 1999 and 2003, reaching 539,000 scrips. But by 2005 this had fallen to 322,000.

However, the rate of suicide in this age group, although falling, has been doing so at a steady annual rate of 3.9 per cent in boys and 3 per cent in girls since 1993.

Hospital admission rates for self harm have continued to rise between 1999 and 2005, with annual increases of 1.1 per cent in boys and 5.7 per cent in girls.

Dr Bill Beeby, chairman of the GPC prescribing subcommittee and a GP in Middlesbrough, said: 'The guidance on prescribing to under-18s hasn't changed and that is that it should be done by specialist services.'

Nevertheless, he said it was interesting that drugs associated with an increased suicide risk had not affected suicide rates after the introduction of tougher legislation.

'It's still very early days in terms of data,' added Dr Beeby.

BMJ Online 2008

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