Antidepressants for young ‘do not work’

Drugs could do more harm than good warns study as it finds only one drug out of 14 helped under-19s

THE majority of antidepressants do not work on children and teenagers and prescribing them could do more harm than good, a study in The Lancet has suggested.

A review of clinical trial evidence found that out of 14 antidepressant drugs, only one, fluoxetine – marketed as Prozac – was better than a placebo at relieving the symptoms of young people with major depressive disorder.

Another drug, venlafaxine, was associated with an increased risk of suicidal thoughts and suicide attempts.

Although fluoxetine is the only drug currently recommended for young people by the National Institute for Health and Care Excellence (Nice), clinicians have previously warned that others are still being prescribed.

Researchers at Oxford University who conducted the review said the effectiveness and safety of antidepressants taken by young people remained unclear because of the poor design and selective reporting of trials, many funded by drug companies. They recommended close monitoring of young people on antidepressants, regardless of which drugs were prescribed, especially at the start of treatment.

Dr Andrea Cipriani, from Oxford University, said: “We need to be careful about prescribing antidepressants for this very fragile population.

“If we talk about major depressive disorder it’s quite a prevalent disorder in children and adolescents.”

She added: “Looking at the overall evidence, the benefits outweigh the risks and tolerability only for fluoxetine. Psychological intervention should be the first line of treatment.” Major depressive disorder affects about three per cent of children aged six to 12 and six per cent of teenagers aged 13 to 18.

In 2004, the US Food and Drug Administration (FDA) issued a warning against the use of antidepressants in young people up to the age of 24 because of concerns about suicide risk. Yet in the UK, the proportion of youngsters aged 19 and under taking antidepressants rose from 0.7 per cent to 1.1 per cent between 2005 and 2011.

The analysis covered 34 trials involving 5,260 participants with an average age of nine to 18. Due to a lack of reliable data, the researchers said it was not possible to carry out a comprehensive analysis of suicide risk for all drugs.

Pharmaceutical companies funded 65 per cent of the trials.

Dr Bernadka Dubicka, of the Faculty of Child and Adolescent Mental Health at the Royal College of Psychiatrists said he agreed antidepressants should be used judiciously and monitored carefully.

“However, in those young people with a highly impairing and potentially life-threatening depressive disorder, where non-pharmacological interventions have not been successful, then pharmacological treatment remains an important treatment option.”