Drug link to child suicide queried by expert

Psychiatrist Patricia Casey has questioned a study which warns of children, who are prescribed a common antidepressant, being at a higher risk of suicide and aggressive behaviour.

Researchers had said that children and adolescent had a double risk of aggression and suicide when taking selective serotonin and serotonin-norepinephrine reuptake inhibitor drugs to combat depression.

The authors recommended “minimal use of anti-depressants in children, adolescents and young adults” after releasing their findings.

However, the researchers did emphasise there is not enough patient data available from clinical trials to assess the true risk of all associated serious harms.

The study, published in the British Medical Journal, examined clinical study reports of 70 trials with 18,526 patients.

The researchers from Denmark found no significant link between antidepressants and suicide and aggression among adults but, in children and adolescents, the risk doubled.

“We suggest minimal use of antidepressants in children, adolescents and young adults as the serious harms seem to be greater and as their effect seems to be below what is clinically relevant,” the authors wrote.

They suggested that alternative treatments, such as exercise or psychotherapy, might have some benefit and should be considered.

Prof Casey, however, said the jury was still out on the risks and benefits of prescribing the antidepressants, commonly known as SSRIs.

She believed psychiatrists dealing with children and adolescents should decide on a case-by-case basis.

“If a child is depressed and is not responding to evidence based treatment on offer, like talking therapies or some other anti-depressant, the psychiatrist might only then go and prescribe the SSRIs,” she said.

“I am not a child or adolescent psychiatrist — I deal with adults. But I know from speaking to colleagues that there are differing views on prescribing SSRIs. Some say no, SSRIs should not be prescribed while others say, yes, we should, otherwise there will a greater risk of dying by suicide.”

Prof Casey said it was found in the US and in the Netherlands that the suicide rate in children and adolescents increased after members of that group stopped being prescribed SSRIs.

This was noticed particularly in the Netherlands, where the drugs carry a ‘black box’ warning.

“Child psychiatrists should not be eliminating SSRIs totally from their armory but using them when other treatments don’t work because there is now clear evidence of an increase in suicide in young people that appears to approximate to the time when the reduction in their prescription occurred,” said Prof Casey.

However, the research led a British expert to call for stricter prescribing rules.

Professor of evidence-based psychological therapies at University of Reading, Shirley Reynolds said only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.

“Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication,” she said.

“But do the results mean that children and young people should never be prescribed antidepressant medication? No.



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