Why are primary school children being prescribed antidepressants?
Mental illness is showing at ever younger ages – but are drugs the answer, asks Victoria Lambert
When Ben Williams was seven, he began exhibiting the signs of depression, says his mother Jane. “Then one day, I can recall sitting at the top of the stairs with him crying, and he said: ‘Mummy, I am not destined to have a happy life. I’d be better off dead.’ I had no idea where the words came from. I couldn’t believe it.”
Jane, 42, who runs her own coaching and secretarial business in Colne, Lancashire, went to her local GP but was told her son was simply going through a phase.
“I said, ‘are you kidding me?’”, she recalls. “I had to battle to get him some help, seeing different GPs until finally I got a referral to Child and Adolescents Mental Health Services (CAMHS). Even this didn’t help, because Ben didn’t find it easy to talk to strangers.”
The turning point came in 2010 when, aged 10, Ben tried to kill himself. Afterwards he was prescribed a low dose of antidepressants, becoming one of the growing number of children who take these drugs.
New statistics this week showed that doctors handed out 198,906 prescriptions for drugs to treat depression and anxiety to children younger than 18 between April 2015 and September 2016. And 12,756 of these were given to children aged seven to 12, with 617 assigned to those aged younger than six.
Dr Helen Webberley of mywebdoctor.co.uk is on the front line: “As a GP and gender specialist,” she says, “I work with children with a variety of problems, but this statistic really does shock me.
“Depression can occur in two broad ways. It can happen out of the blue for no reason (extraordinarily rare in children) or it can happen because stress, anxiety and difficulties have been going on for so long that the brain’s ‘coping chemicals’ – serotonin and noradrenaline – can get depleted and they need a top-up with medicines (antidepressants).
“For children to be suffering for so long that their coping chemicals get used up, they must be going through some tough times, and this clearly needs exploring.”
Dr Marc Bush, chief policy adviser at mental health charity Young Minds, is concerned about the potential for over medicalisation: “Children taking adult medication will see brain and physical development affected.
“They should only be offered when appropriate and alongside other support such as family or individual therapy.”
Antidepressants, however, do have a place in treatment. Olivia Fiertag, consultant child and adolescent psychiatrist at Nightingale Hospital, explains: “Each child is different, and often antidepressants are not the first-choice treatment for young children with depression or anxiety (with therapy often being the first choice) but in some circumstances, yes, a doctor may recommend antidepressants and any prescribing should be done under the supervision of a child psychiatrist.”
She points out: “Most children with depression respond very well to treatment and make a good recovery.”
Jane Williams was relieved Ben had been given tangible help: “With a physical illness, you’d take paracetamol, so why not take something for a mental health problem?”
Perhaps the greatest concern, then, is not just that so many children are being prescribed anti-depressants but that they need them in the first place.
“Child mental health services are overstretched,” says Dr Webberley, “and the waiting lists are long.”
Despite NHS England’s plans to expand CAMHS so that an additional 70,000 patients can access help each year by 2020/21, Professor Tim Kendall, NHS England national clinical director for mental health, warned in April it will struggle to recruit the 1,700 extra therapists needed as the service is already short-staffed.
“The NHS says one in three will be seen,” says Dr Bush, “but what about the other two in three – we can’t just leave them to pharmaceutical intervention.”
Dr Webberley would like to see more early intervention. “I would like to think that prescribing antidepressants for children was an absolute last resort, and that there would have been support for that child and their family at a much earlier stage.” Dr Bush agrees: “At Young Minds, we can’t even answer all the calls we get from parents and guardians ringing us to say they are at an absolute loss.”
That’s a feeling Jane Williams knows. Ben is now 17 and is no longer prescribed antidepressants as he has made several suicide threats so can only take them under medical supervision. But as he won’t talk to a crisis team, they cannot access any help. “I babysit him. We live in limbo. There needs to be more funding for mental health, but parents need guidance too. You never think it will happen to your child until it does.”