Healthy Skepticism Library item: 316

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Publication type: news

Hannan E, Dunn A.
Unease over effects of medication
The Age 2004 Apr 26

Full text:

George Halasz, a child and adolescent psychiatrist at Monash Medical Centre, has no doubt that antidepressants are overprescribed to Australian children.

“I believe there is a manufactured epidemic going on,” he said.

Dr Halasz believes depression and attention deficit hyperactivity disorder are misdiagnosed in children. For example, grief can be misread as depression and could lead to children being medicated and tagged as “flawed products”.

Experts agree that the understanding of the effects of antidepressants in children and young people is grossly inadequate, particularly given that prescription numbers rose to 250,000 last year.

And one of the main problems is the paucity of high-quality trials of the medication in children and adolescents. This means that no one can say for sure what the effects of long-term use of the drugs by children might be, nor how good they are at treating childhood depression or anxiety.

Daryl Efron, a pediatrician at the Royal Children’s Hospital, said there was good evidence that antidepressants were effective in treating children with anxiety disorders.

While more research was needed, given that most trials were sponsored by drug companies, there was no need to “throw out the baby with the bathwater”.

However, there was a strong argument that the prescribing of all psychotropic drugs, including antidepressants, should be limited to pediatricians and child psychiatrists.

“To try and understand why children are dysfunctional in the way they present requires expertise and also time,” he said. “GPs have neither the expertise and certainly not the time to evaluate these kids properly.”

George Patton, VicHealth professor of adolescent health, said antidepressants worked in the short term, but there was not enough research on their long-term impact.

Research funded by pharmaceutical companies was likely to look at short-term effects, Professor Patton said.

“But if you are talking about a disorder that begins in the teens and continues into adult life, it’s not the short-term outcomes that are most important. It’s what happens in the medium and long term.”

Lena Sanci, a senior lecturer in general practice at Melbourne University, said it was not practical to restrict prescription of “selective serotonin re-uptake inhibitors” (SSRIs) to specialists.

“I think that’s a difficult argument, because there aren’t enough pediatricians and psychiatrists to go around,” she said.

GPs were also concerned they did not have adequate support services and had to help young people in a 15-minute consultation.

Louise Newman, chairwoman of the faculty of child and adolescent psychiatry of the Royal Australian and New Zealand College of Psychiatrists, said she was concerned at the increased use of antidepressants in younger people.

“We know that depression has been increasing in the Western world,” she said. “We know we have these targeted campaigns about getting to depression early and intervening early. Maybe the price we pay for those sorts of campaigns is that actually some people are getting them who don’t need them.

The other possibility is that GPs are quick to go to antidepressants because there is a lack of services.”