Children who are prescribed a common antidepressant could be at a higher risk of suicide and aggressive behaviour, it has been claimed.
Researchers say children and adolescents have a doubled risk of aggression and suicide when taking selective serotonin and serotonin-norepinephrine reuptake inhibitor drugs to combat depression.
They recommend "minimal use of antidepressants in children, adolescents, and young adults", though they stress there is not enough patient data available from clinical trials to assess the true risk of all associated serious harms.
Their study, published in the BMJ, examined clinical study reports of 70 trials with 18,526 patients.
The researchers, from Denmark, found no significant link between antidepressants and suicide and aggression among adults, but in children and adolescents the risk doubled.
"We suggest minimal use of antidepressants in children, adolescents, and young adults as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant," the authors wrote.
"Alternative treatments such as exercise or psychotherapy may have some benefit and could be considered."
The research led one expert to call for stricter prescribing rules.
Shirley Reynolds, professor of evidence-based psychological therapies at the University of Reading, said only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.
"Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication," she said.
"But do the results mean that children and young people should never be prescribed antidepressant medication? No. There are alternative treatments and all young people should be offered an evidence-based psychological treatment immediately.
"However, antidepressants should be available when a young person does not respond to psychological treatment or does not want psychological treatment.
"Combining antidepressant treatment and psychological treatment is associated with improved outcomes and can lead to a more rapid reduction in symptoms.
"But only a specialist child and adolescent psychiatrist should prescribe antidepressant medication to children and young people and all children and young people who are prescribed antidepressants must be carefully and regularly monitored. "
However, Dr Mara Parellada, specialist in child and adolescent psychiatry at the Centre for Biomedical Research in Mental Health Network at Complutense University of Madrid, said of the research: "The results from this study do not allow us to state that 'antidepressants double the risk of aggression and suicide in children'.
"There was no single death by suicide in children and adolescents in the 70 trials reviewed for the article."
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