Benefits of child SSRI use outweighs the risk

The benefits of antidepressant use in children and adolescents outweighs any risks, claim US researchers.

The comments follow a meta-analysis of 27 trials of SSRIs and second generation antidepressants in patients under 19 who had major depressive disorder, obsessive compulsive disorder (OCD) or another anxiety disorder.

Patients taking antidepressants were found to have less than a 1 per cent risk of suicidal ideation, compared with those on placebo. No completed suicides occurred.

Antidepressants appeared efficacious for all indications, especially non-OCD anxiety. For both depression and anxiety, adolescents responded better than children.

The findings support ‘the cautious and well-monitored’ use of antidepressants as first-line treatment in children and adolescents with these disorders, say the researchers from the Western Psychiatric Institute and Clinic in Pennsylvania.

In the UK only fluoxetine (Prozac) can be given to patients with depression who are under 18. The MHRA made the ruling following a 2003 trial suggesting that paroxetine (Seroxat) increased suicide risk in the young.

The finding of the meta-analysis appears to go against NICE guidance issued in 2005 that stated even children with moderate to severe depression should receive psychological therapy before treatment with antidepressants is initiated.

Professor Eric Taylor, a paediatric psychologist at the Maudsley hospital in London, said:
‘It’s one of the pieces of evidence that is calling into question NICE guidance.

‘In severely depressed patients, the benefits (of antidepressants) outweigh the risks.’

But this may not be the case for non-typical depression and GPs should refer all cases of child depression promptly, he added.

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