2 May 1999
Newest Depression Medications Widely Prescribed For Children
According to a University of North Carolina at Chapel Hill study, a majority of family physicians and paediatricians are treating children with Prozac-type drugs for mild to moderate mental illness. This is despite a lack of scientific evidence to support their safety and effectiveness in youngsters.
The findings, which, focuses on the serotonin selective reuptake inhibitors (SSRIs), the newest class of antidepressant drugs. Though these drugs only have US Food and Drug Administration approval for patients over 18 years of age, since 1982 SSRIs have been increasingly prescribed for children. The research was presented at the Paediatrics Academic Societies Annual Conference in San Francisco by Dr. Jerry L. Rushton, a paediatrician and Robert Wood Johnson Clinical Scholar at the University of North Carolina at Chapel Hill.
"Our survey data suggest that despite a lack of research support, adequate training and comfort with the management of depression, SSRIs are gaining physician acceptance and becoming incorporated into primary care practice," says Rushton.
According to survey responses from nearly 600 family doctors, 72 percent acknowledged having prescribed an SSRI for a patient younger than 18 years of age. Just 8 percent reported having received adequate training in the management of childhood depression, and 16 percent "reported feeling comfortable" with the care of depressed children.
"We found that SSRIs were the most common type of medication used for childhood depression, comprising 69 percent of all primary care prescriptions," Rushton says. He notes that 67 percent of respondents said they had written SSRI prescriptions for children and young adolescents with mild to moderate depression.
In addition, 57 percent acknowledged having prescribed an SSRI for a diagnosis other than depression in a child younger than 18 years of age. These included children diagnosed with attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), aggression/conduct disorder, and enuresis (bed-wetting).
As Rushton and his colleagues point out, these are problems for which the evidence does not support SSRI safety and effectiveness in children. Except for OCD, such problems are not approved indications for prescribing SSRIs to adults.
"Anecdotally, we hear of widespread use of SSRIs for possibly questionable indications," Rushton says. He compares this to the controversy over the use of Ritalin for ADHD.
"We wondered if a similar process was starting with attention deficit and Prozac, the most commonly prescribed SSRI in children. Thirty-six percent of physicians have used SSRIs for ADHD. What does that mean - are these children being properly diagnosed, and what are the outcomes of treatment with these drugs?"
As the researcher points out, the long-term effects of many "psychoactive" drugs, including SSRIs, on a developing central nervous system are unknown. But SSRIs have a variety of documented side effects in adolescents and children including sleep disturbances and behavioural changes. Moreover, no clear age and dosage guidelines exist for these medications and prescription practices are based on studies in adults and anecdotal experience with children.
"I think these medications are starting to show promise. We don't have all the data and guidelines, but it stands to reason that SSRIs should be used for childhood depression. They probably are safer than the older tricyclic antidepressants. However, they should be used with caution and monitored closely, not used haphazardly for transient symptoms - not for school problems nor nebulous behavioural problems," Rushton says.
The new survey also highlighted several factors that may influence SSRI prescribing practices for children, including physician specialty, degree of comfort with the management of childhood depression, and availability of referral to mental health specialists.