Family doctors routinely break the rules by giving children as young as 11 antidepressants, claims a government-funded study.
GPs can only prescribe the powerful drugs to young people under 18 if they’ve been first assessed by a psychiatrist, say watchdogs at the National Institute for Health and Care Excellence (Nice).
But a report by the NHS research body the National Institute for Health and Care Research (NIHR) found that doctors ‘often’ hand out prescriptions earlier.
Only one in four teens who first received antidepressants from their primary care physician between 2006 and 2017 had seen a psychiatrist.
Overall, the number of 12- to 17-year-olds prescribing the drugs in England more than doubled between 2005 and 2017.
It surged during the onset of the Covid pandemic, peaking at a record high of 27,757 in March – two-thirds of which were girls.
Children get them for anxiety, pain and bedwetting, but also for depression.
Nice recommends the two-step approval, where children see a psychiatrist and then a GP, to ensure that young people need the drugs.
GPs did not deny prescribing the medication without a psychiatrist’s approval, saying children may have difficulty seeing “specialized services.”
NHS GPs ‘often’ break medical guidelines by prescribing antidepressants to children as young as 11, claims health service-funded study
What are Nice’s recommendations on prescribing antidepressants to children?
- Do not offer antidepressants to a child or young person with moderate to severe depression, except in combination with concomitant psychological therapy
- If an antidepressant has to be prescribed, this should only be done after assessment and diagnosis by a child and adolescent psychiatrist
- When an antidepressant is prescribed to a child or young person with moderate to severe depression, it should be fluoxetine, as it is the only antidepressant for which clinical trials show the benefits outweigh the risks
- If a child or young person is started on antidepressants, they (and their parents or carers, if applicable) should be informed about the reason for the drug treatment, the delay in onset of effect, the time course of the treatment, the possible side effects, and the need to take the medication as prescribed
- A child or adolescent prescribed an antidepressant should be closely monitored for the appearance of suicidal behavior, self-harm or hostility, especially at the beginning of treatment, by the prescribing physician and the health care professional administering the psychological therapy.
- When prescribing fluoxetine to a child or adolescent with depression, the starting dose should be 10 mg per day
In the report, the NIHR said: ‘There is no license in the UK for antidepressants for anxiety in children and teenagers under the age of 18, 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 survey found that just over half of the prescriptions were for depression, with the next most common reason being anxiety (16 percent).
Despite the fact that drugs are not licensed for any condition other than OCD in young people under the age of 18, Nice recommends that children can be given them for depression, but only if they are ‘moderate to severe’.
Children should be given fluoxetine, sold as Prozac, because it’s the only drug with clinical evidence that the benefits outweigh the risks, Nice says.
The drug should start with a daily dose of 10 mg, although this can be increased to 20 mg after a week if doctors deem it necessary.
They should be taken off the drug if they have persistent side effects, including nervousness, anxiety, rash, joint pain, shortness of breath, and seizures.
Children taking fluoxetine have a slightly higher risk of becoming suicidal than children not taking any medications, but experts aren’t sure how much more likely it is.
GPs have defended prescribing the drugs to children, although they said most of the drugs are given in specialized mental health departments.
Professor Martin Marshall, President of the Royal College of GPs, said: ‘GPs are at the forefront of providing care for younger patients with mental illness and it is something we and our teams take extremely seriously.
‘In the vast majority of cases, antidepressants for children are started 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 interest of a young patient to prescribe them medicine for mental illness, especially if they are having difficulty accessing specialized services.’
He added: ‘In many cases, medication will be an appropriate and effective intervention for children and young people with mental illness.
“However, it remains vital that all treatment options, especially talk therapies, be explored and that access to alternative therapies, which may be beneficial for young people with mental illness, but are patchy available across the country, be improved.
“In addition, when GPs refer patients to specialist services, it is essential that these referrals are taken seriously and not rejected without good reason.”