William Birnbauer
The
Age
Monday, January 8, 2007
A STAGGERING 337,553 prescriptions for antidepressants were
written for children and adolescents in the past year, raising
fears about whether "happy pills" are being used as
a quick-fix for despondent youngsters.
Australia's drug regulator, the Therapeutic Goods Administration,
has not approved any antidepressant medicines for children or
adolescents younger than 18 but can not prevent doctors from prescribing
them.
Medical regulators and drug companies warn against the use of
antidepressants in young people and there is concern that the
drugs, including the newer breed known as serotonin reuptake inhibitors
(SSRIs), have been associated with suicidal behaviour in the young.
Yet more than 75,500 prescriptions for antidepressants were written
for children under 15 in 2005-06, according to figures prepared
exclusively by Medicare Australia for The Sunday Age.
A further 262,000 antidepressant prescriptions were filled for
youths aged between 15 and 20 in 2005-06. In Victoria there were
12,351 antidepressant scripts for children aged 14 and younger
in 2005-06. In the 15-to-20 age group, 64,663 medicines were prescribed.
There is concern particularly that Prozac (fluoxetine), the only
SSRI that appears to be more effective than a placebo in children,
will become the new Ritalin, the drug of choice for a spate of
attention deficit hyperactivity disorder diagnoses in the 1990s.
Melbourne psychiatrist George Halasz sees the increasing use
of antidepressants as further evidence of what he calls "diagnostic
creep". Not that long ago, he says, sadness was simply sadness
and shyness was shyness. Today, along with myriad conditions once
regarded as normal, sadness and shyness can be diagnosed respectively
as depression and social phobia and treated with a pill.
"There is a problem in our culture where we're finding it
a lot more difficult to cope with … events which have always
been part of life — births, deaths, accidents, illnesses,"
Dr Halasz says. "As we have less time to attend to these
natural transitions and natural stresses, there is very strong
demand on the medical profession to alleviate suffering."
But psychologist Michael Carr-Gregg says SSRIs can be an essential
adjunct to cognitive behaviour therapy. "There are kids on
this planet today who I've treated who simply wouldn't be here
if it wasn't for antidepressants," he says.
There is recent evidence that doctors are responding to concern
about antidepressants for young people — Medicare Australia's
figures reveal a decline in the past three financial years. In
2005-2006 there were 27,300 fewer scripts written for those younger
than 15 than two years earlier. The number of prescriptions for
those aged 15 to 20 in 2003-04 was 315,227; in 2005-06 the figure
had fallen to 261,999.
Prescriptions for those younger than 18 are written off-label:
that is, the decision is made by an individual clinician despite
the lack of clinical testing and accurate dosage information.
Dr Daryl Efron, a consultant pediatrician at the Royal Children's
Hospital, believes the prescription of SSRIs for children is declining
with the realisation that they are not as effective as counselling
and because of concerns about side-effects such as suicidal thoughts
and behaviours.
Despite this, 337,553 scripts were filled out in the past year
for children and adolescents, raising questions about whether
antidepressants are being used as a quick fix.
SSRIs have revolutionised the treatment of depression. The drugs
inhibit the absorption of the neurotransmitter serotonin in the
brain. They are less toxic, safer and have fewer side effects
than tricyclic antidepressants.
The European Medicines Agency recently approved the use of Prozac
for children from the age of eight, and the US Food and Drug Administration
has approved it for children with major depressive disorder.
In Australia youth depression is often not recognised or acted
on. A national survey found that of depressed adolescents, only
11 per cent had sought help from a GP and 17 per cent used mental
health services.
It was not possible from the Medicare date to say how many children
and adolescents are on antidepressants.
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