GPs giving antidepressants to children against guidelines

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GPs are breaching medical guidelines by prescribing antidepressants for children as young as 11 who cannot get other help for their mental health problems, NHS-funded research reveals.

Official guidance says that under-18s should only be given the drugs in conjunction with talking therapies and after being assessed by a psychiatrist.

But family doctors in England are “often” writing prescriptions for antidepressants for that age group even though such youngsters have not yet seen a psychiatrist, according to a report by the National Institute for Health and Care Research (NIHR), the NHS research body.

The report linked the prescriptions to the long wait many young people, some self-harming or suicidal, face before starting treatment with NHS child and adolescent mental health services (CAMHS). Under-18s are prescribed the drugs for anxiety, depression, pain and bedwetting.

The guidance on antidepressants has been issued by the National Institute for Health and Care Excellence (NICE), which advises the NHS on which treatments are effective.

Referencing NICE’s recommendation of a two-step approval process, the NIHR study said “this often” did not happen. “No antidepressants are licensed in the UK for anxiety in children and teenagers under 18 years, except for obsessive compulsive disorder. Yet both specialists [psychiatrists] and GPs prescribe them. Thousands of children and teenagers in the UK are taking antidepressants for depression and anxiety. The numbers continue to rise and many have not seen a specialist.”

The number of 12- to 17-year-olds in England prescribed antidepressants has risen sharply since 2005, the report also discloses. It more than doubled between 2005 and 2017 and then soared again when Covid-19 struck in spring 2020, hitting an all-time high of 27,757 in March that year. About two-thirds of patients using them were girls.

Some family doctors do issue the drugs to young people, the Royal College of GPs confirmed. The RCGP council chair, Prof Martin Marshall, said: “In the vast majority of cases antidepressant medication for children will be initiated in specialist care, not in general practice. But GPs are highly trained prescribers and there may be instances where a GP believes it is appropriate and in the best interests of a young patient to prescribe medication for a mental health condition, particularly if they are having difficulties accessing specialist services.”

He defended their use, adding: “In many cases medication will be an appropriate and effective intervention for children and young people with mental health conditions.”

Olly Parker, of the charity Young Minds, said the NIHR figures were “yet another alarming sign of the crisis in young people’s mental health” adding: “Record numbers are trying to access support but finding the options are limited. Medication can play an important role in helping a young person manage their mental health but should never be a substitute for other treatments like talking therapies or CAMHS. Long-waiting times and high thresholds for treatment mean that GPs are in a difficult position because they want to help young people but there is a lack of easily accessible treatment options.”

Felicity Jane Allman, a medical student in Newcastle, who has experienced mental ill-health, declined the chance to use antidepressants as a teenager but now finds them useful. “When I first started experiencing depression as a teenager I felt very ashamed of my dark thoughts, and my family didn’t feel able to support me. I didn’t see a doctor for my mental health until I’d already tried to end my life. I was offered medication, but I didn’t understand it and so I said I wasn’t interested.

“As an adult I have taken antidepressants for years, and find them helpful, so perhaps they would have been helpful when I was younger as well. The developing mind is a difficult thing to manage.”

But the NIHR’s study, which was led by Dr Jemma Kwint, a senior research fellow, also found that the drug Fluoxetine, better known as Prozac, was effective at treating depression in under-18s. However, Kwint said, that age group should not take Venlaxafine, also known as Efexor, because it was associated with an increased risk of suicidal thoughts or attempts.

The growing use of antidepressants in under-18s means more research into which are effective and safe for them is needed to help urgently plug “gaps in our knowledge”, she added.

Both NHS England and the Royal College of Psychiatrists said the drugs were often “effective”, either when used alongside cognitive behavioural therapy or used when that has not worked.