Antidepressant Utilisation and Suicide Attempts in Children and Adolescents

Antidepressant drugs are not licensed for the treatment of depression in children. Few randomised clinical trials have been conducted to assess safety, and the efficacy of tricyclic antidepressants (TCA) in this patient population has been questioned. In the September 2003 version of the British National Formulary, none of the antidepressants were licensed for use in children and adolescents less than 16 years of age for depressive disorders. Amitriptyline and nortriptyline may be used in those aged 16 years or more. Sertraline was licensed for obsessive-compulsive disorder in children aged 6 years and older, and three of the tricyclics were authorised for use in the treatment of nocturnal enuresis for those aged 7 years upwards.

In the same year, the Committee on Safety of Medicines (CSM) of the Medicines and Healthcare products Regulatory Agency (MHRA) issued recommendations to withdraw the use of venlafaxine and all SSRIs with the exception of fluoxetine in children and adolescents with major depressive disorders following concerns raised about their association with increased risk of suicide ideation. Since then, there has been debate about the efficacy and safety of SSRIs. Recent studies have reported the increased prescribing of psychotropic drugs in children and adolescents. Little is known about ATD prescribing in general practice for this population, and the extent of SSRI use is of particular interest following the international recommendations and expressions of concern regarding safety.

This presentation will address utilisation studies of psychotropic medications in children and adolescents, most of which reported increases in the use of antidepressants. Furthermore, international data regarding suicide risk compared between different antidepressants from spontaneous reporting as well as from epidemiological studies will be discussed.