Healthy Skepticism Library item: 317
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Publication type: news
Hannan E, Dunn A.
Child depression drugs soar
The Age 2004 Apr 4
Full text:
Use of antidepressants in children and adolescents soared during 2003, with an increasing number of doctors prescribing drugs that Australian health authorities explicitly warn should not be given to children.
New Federal Government figures reveal that 250,000 antidepressant prescriptions were issued to children and adolescents last year, a 30,000 increase on 2002.
The Government’s drug regulator, which is reviewing the use of the drugs in children, told The Age that several drugs were likely to be ruled inappropriate for use in patients under 20.
The Therapeutic Goods Administration is also considering restricting access to antidepressants currently available to children and adolescents through the Pharmaceutical Benefits Scheme.
Under the proposal, discounted antidepressant prescriptions would be available only on the written recommendation of a child psychiatrist or pediatrician.
The action comes amid mounting international concern about the safety of a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) in children and adolescents.
Evaluations of clinical data by British and American authorities have found evidence of increased suicidal behaviour among adolescents taking some of the SSRIs.
Britain concluded that the risks outweighed the benefits for all SSRIs except Prozac.
The Australian Government has recommended two brands, Efexor and Aropax, should not be used in children and adolescents. It says data regarding the efficacy and safety of SSRIs in children is inconclusive, and doctors should prescribe them cautiously.
Figures provided by the Health Insurance Commission show more than one-fifth, or almost 56,000, of the antidepressant prescriptions issued last year were written in Victoria. Nationwide, three-quarters were written for adolescents aged 15 to 19 years while 9727 scripts were issued to children aged five to nine years.
More than 650 prescriptions were issued to children up to four years of age. Psychiatrists said the drugs prescribed to these children were predominantly used to treat autism and severe behavioural disorders.
According to research by the University of NSW general practice statistics and classification unit, GPs issued up to 88,000 prescriptions for antidepressants to children and adolescents last year.
Louise Newman, chairwoman of the faculty of child and adolescent psychiatry of the Royal Australian and New Zealand College of Psychiatrists, said the college had urged the TGA to ban GPs from prescribing antidepressants to children and adolescents.
However, she acknowledged the proposal might be impractical due to a shortage of child psychiatric services. The college had also called for increased monitoring and recommended prescribers report to the Health Insurance Commission whether the antidepressants had been effective.
The TGA’s principal medical adviser, John McEwen, said there was a “real possibility” the Australian review would find that the use of some antidepressants in children and adolescents was inappropriate.
He said the Government was awaiting the findings of an investigation into SSRIs by the US Food and Drug Administration.
Australian Medical Association vice-president Mukesh Haikerwal said it needed to be acknowledged that depression was a common condition in young people – too common for its treatment to be restricted to specialists.
