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Hot topic - Antidepressants advice for children11 December 2003 - written by Bupa's Health Information Team On 10 December 2003, the UK Committee on the Safety of Medicines (CSM) released new guidance to doctors on the prescribing of antidepressant medicines for children. It advised doctors not to prescribe a certain range of antidepressants (known as SSRIs) for children with depression below the age of 18 years, with the exception of one drug - fluoxetine (brand name Prozac). This advice does not affect the treatment of adults. Below the CSM's advice and its implications are explored. What is the UK Committee on Safety of Medicines (CSM) advice about antidepressants for children?The CSM has advised doctors that the following drugs - all from a range of drugs known as SSRIs - are contraindicated (not suitable) to treat depression in children and teenagers under the age of 18 years:
This is because the CSM has found that the clinical evidence for these drugs suggests that the benefits of using them do not outweigh the risks of unwanted side-effects that these drugs can cause. Some of the problems that are associated with these drugs include: insomnia, weight loss, loss of appetite, self harm and suicidal thoughts. However, the CSM also advised that one SSRI drug had shown in clinical trials that its benefits outweigh the possible risks of use and may still be prescribed. The drug is fluoxetine (brand name Prozac). How many children currently take SSRIs?The CSM believes that 40,000 children in Britain currently take SSRIs. How many children likely to be affected by this advice?The CSM believes that approximately 20,000 children are taking one of the SSRI drugs that are now thought to be unsuitable and these children may need to have their treatment changed. The other 20,000 are thought to be taking Prozac and do not need to change their medication. What should children and parents do if they are currently taking one of the drugs that the advice has been issued about?The main message is that all children taking SSRIs for depression should not stop their treatment. This is because these drugs can cause withdrawal symptoms if they are stopped suddenly. If parents or children are concerned, the CSM advises that they should make an appointment to see their doctor to discuss their worries, review the options available and agree a course of action. During the meeting with the doctor, a number of choices may be available:
The drugs are "contraindicated" - is that the same as banned?The short answer is no. Contraindicated means that the overall clinical trial evidence suggests that the contraindicated drug does not show sufficient benefit in a particular group of people (in this case children) and that the drug carries the risk of a significant adverse effect. Contraindication sends a strong signal that a drug should not be generally given to a specific group of people. However, a contraindicated drug may be useful for a particular individual in the group. Because of this, sometimes specialists (in this case child and adolescent psychiatrists) may recommend the drug for a specific patient because they believe the benefits of the drug outweigh the risks for that individual. In addition, a contraindicated drug may be licensed to treat another condition because the benefits of its use for that condition outweigh its risks. For example, some SSRIs are licensed for the treatment of childhood obsessive compulsive disorder. No drugs are licensed for use in childhood depression, does this mean that children shouldn't be treated at all?There has not been sufficient research to allow antidepressant drugs to be licensed for use in children, but this does not mean that drug therapy should be ruled out. Doctors use both caution and their clinical judgement to decide whether or not drug therapy will help a child. The doctor will consider all the risks and benefits before making this decision and the CSM's recommendations are aimed and helping with this decision-making process. What about the use of these drugs for Obessive Compulsive Disorder (OCD) in children?The recommendations of the CSM are for the use of SSRIs in the treatment of depression in children only. Two SSRIs (Lustral and Faverin) are currently licensed for the treatment of OCD in children and they are still considered to be valid treatment options. If you are concerned about your child's treatment for OCD, or your child is taking an SSRI other than Lustral or Faverin for the condition, it may be worth discussing this with your doctor. However it is not advisable to simply stop the medication, any changes should be made in consultation with your doctor. What about adults taking SSRIs for depression?All SSRIs are effective in treating adult depressive illnesses and the advice to adults taking SSRIs for these conditions has not changed. Why is the advice different for adults when compared with children?According to the CSM, children react differently to drugs in comparison to adults (over the age of 18 years) and children can experience side-effects that adults don't. In addition, the CSM explains that childhood depression appears to be different to adult depression, due to a number of reasons:
For all these reasons, drugs that are helpful in treating adult depression may have no effect on children or may have side-effects that don't affect adults. Further informationBupa resources:
External website:
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