Increase in non-evidence based use of antidepressants in children is cause for concern

Editor—The use of antidepressants in children is increasing, although the evidence for the effectiveness and safety of pharmacological treatment of depressive disorder in children and adolescents is scant¹ and widely debated²—particularly for selective serotonin reuptake inhibitors (SSRIs).³,⁴

We used the ARNO database (http://sanita.cineca.it/public/arno/arnoeng.htm) to analyse drug prescriptions written during 2002 to 568 770 Italian patients under 18. A total of 1600 young people (2.8 per 1000) received at least one antidepressant, 1200 of them an SSRI and 297 a tricyclic antidepressant. Two thirds of prescriptions (8284/11 369) were for adolescents (age 14-17), mostly girls (4583/5872; rate 10.6 per 1000 v 5.9 per 1000 for boys).

These prescribing rates are lower than those reported for the United States (1-2%) and the Netherlands (4.4 per 1000), but nevertheless about 28 000 youths are exposed to treatment with antidepressants, 21 000 of them receiving SSRIs. We found a 4.5-fold increase in the rate of prescriptions for SSRIs (from 0.47 per 1000 to 2.11 per 1000) between the 2000 and 2002 datasets, which is worrying, even though it agrees with data from other reports.⁵

All the SSRIs prescribed (most commonly paroxetine) are unlicensed paediatric drugs, with the exception of sertraline for obsessive compulsive disorder in children under 6 years. The occurrence of depressive syndrome and obsessive compulsive disorder in children must be determined, along with their therapeutic needs. Appropriate, independently funded studies should be planned to guarantee effective and safe evidence based therapeutic approaches for children, adolescents, and their families.