Researchers, led by NCMH Principal Investigator Dr Ann John, looked at routinely collected data from 358,000 registered patients between 6 and 18 years old, living in Wales between 2003 and 2013. Their analysis identified a 28% increase in antidepressant subscribing, mainly in older adolescents. Just over half of new prescriptions were associated with depression, the rest were associated with other diagnoses such as anxiety and pain.
“These findings add to the growing debate over increasing prescribing of anti-depressants to children and young people.” said Dr Ann John. “The main issue is whether they are being prescribed with enough cause. The rise in prescribing may reflect a genuine increase in depression and its symptoms, or increased awareness and better treatment by GPs, or poor access to psychological therapies and specialist care, or even increased help-seeking.
Whatever the explanation it’s important that each individual young person is listened to and gets the right kind of help for their problem. We need to support those who support young people and their families, helping them to act in keeping with current guidance.”
Mental health in adolescence
One in ten children and young people have a diagnosable mental health problem, and research has found that around 50% of all mental health problems are established by age 14. Concerns about under-diagnosis and under-treatment contrast with worries about over-prescribing and the medicalisation of unhappiness in young people.
Dr John added “The teenage years are a phase of gaining independence, engaging with the world and testing boundaries. This can result in a normal developmental range of emotional responses – stress, loneliness, sadness and frustration. For others the mental health issues are more serious, and historically they were often not recognised, talked about or treated. It can be hard to distinguish between what is emotional turmoil and what warrants a mental health diagnosis in a young person.
We need to ensure GPs are trained to really understand the lives and moods of young people, as well as knowing what warning signs they should look out for. For some young people reassurance that this is within the range of normal human experience may be appropriate. For others, talking therapies may be the best option, as they have a proven track record of improving symptoms for those with mild and moderate depression.
In more serious cases, anti-depressants should be used together with talking therapies. Improving access to talking therapies is very important. Otherwise, if waiting times are too long, it’s more likely that a prescription will be given.”
The study also found that citalopram was the most frequently prescribed antidepressant, accounting for around 40% of all prescriptions. This is despite NICE guidelines stating that children and young people should first be prescribed fluoxetine, and citalopram should only be used if fluoxetine isn’t working.
Dr John added “The only antidepressant licensed for use in children and young people is fluoxetine and the recent study showed that it is the only that works. Citalopram should only be prescribed when fluoxetine isn’t working but what we found is that citalopram is being given as one of the first antidepressants to lots of children. So it’s off-label prescribing and it has a known toxicity in overdose, there were warnings given about it in 2011. A third of that prescribing was given to 18 year olds. All the rest of that was given to kids off label and outside prescribing guidelines.”
The results of the study were published in Psychological Medicine in September 2016. Read the full article [open access].