• New research suggests antidepressants may double the risk of aggression and suicidal thoughts in children. (AAP)Source: AAP
Experts warn that children and adolescents who take two commonly prescribed antidepressants face double the risk of aggression and suicide, with this figure expected to be an ‘underestimation’ of the harmful effects the drugs have on people aged under 18.
By
Yasmin Noone

1 Feb 2016 - 2:07 PM  UPDATED 1 Feb 2016 - 2:08 PM

Children and adolescents who take any two of the most commonly prescribed antidepressants face an increased risk of aggression and suicide, according to new findings of a study published in BMJ last week.

The findings come from a team of researchers from Denmark who re-examined 70 past clinical trails involving 18,526 patients to determine if the risks of antidepressant use in people under-18 are currently being underestimated.

The researchers, led by Dr Tarang Sharma, saw that the cases of deaths, suicidal thoughts and attempts, and aggression were around twice as high as what was originally interpreted for children and teens taking selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Experts say the harms associated with antidepressants were underestimated because clinical trials assessing the drugs were poorly designed and misreported findings.

Harms associated with antidepressants are often not included in published trial reports, while other reports misclassify deaths and suicidal events in people taking antidepressants, explain the authors.

“This study has shown limitations in trials, not only in design, but also in reporting of clinical study reports, which may have lead to ‘serious under-estimation of the harms’," the co-authors write.

Study authors believe these findings are just the tip of the iceberg with the ‘true risk’ for all associated serious harms from antidepressants still unknown for children and adolescents.

Harms associated with antidepressants are often not included in published trial reports, while other reports misclassify deaths and suicidal events in people taking antidepressants, explain the authors.

For example, they found that more than half of the suicide attempts and suicidal ideation were coded as "emotional lability" or "worsening of depression" in past clinical trials.

"The true risk for serious harms is still unknown [because] the low incidence of these rare events, and the poor design and reporting of the trials, makes it difficult to get accurate effect estimates.”

The authors recommend "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."

Clinical director of Black Dog Institute, Associate Professor Josephine Anderson, says the evidence-based risks associated with antidepressants and children and teens have been known for some time.

However, she adds, research in this area is limited so scientists do not know why teens and children are more suspetible to negative reactions from certain antidepressants than adults.

“But we think it possibly has to do with the fact that the adolesecent brain is developing,” says A/Prof Anderson.

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HOW TO TREAT A CHILD OR TEEN

Antidepressants are usually only prescribed for people under age 18 in Australia as a last resort, under the supervision of a specialist psychiatrist.

“The first line of treatment for depression in children and adolesecents should be pshychological therapy and that indeed is evidence-based cognitive behavioural therapy and interpersonal therapy,” she says.

This is because depression in people under 18 could be caused by factors common in the development of adolescents.

“For example, family disharmony, metal illness in parents and issues happening at school might be issues that need to be addressed.

“So you do all of that as a general rule before you even think about prescribing antidepressant medication.

“But if there is an inadequate response to that treatment regime or if the young peson is unable to access psychological therapy or they don’t want to be treated with it, then it is reasonable to initiate a trial of antidepressant medication.”

2014 study released by University of Sydney shows that the number of children aged between 10 and 14 given antidepressants increased by over a third from 2009 to 2012.

Adolescents who are currently being treated for a mild depressive disorder MDD with an SSRI should not have their medication ceased abruptly.

The study found that clinicians adhere to guidelines but concluded that rapid increases in SNRI antidepressant prescribing for teens and children by medical professionals are alarming.

“Concerns exist regarding…likely overmedication of persons with mild psychological distress, and the increasing use of powerful psychotropic medications in younger populations despite uncertain risk–benefit profiles.”

But, A/Prof Anderson stresses, parents should never overreact to research findings and take their child off prescribed antidepressants as this could cause more harm than good.

Instead, she advocates that parents exercise due caution and care and consult a medical professional for further advice.

“Adolescents who are currently being treated for a mild depressive disorder MDD with an SSRI should not have their medication ceased abruptly.

“I’d always encourage parents who are concerned to talk to a GP and find out information for themselves from reputable websites.”

According to headspace, the national youth mental health foundation, about 25 per cent of people who develop a depressive disorder will do so before age 20.

Depression is the most frequently managed mental health problem for young people aged 12-24 years, with over 13 per cent of GP encounters for mental health reasons in Australia related to this disorder.

The condition is also the leading contributor to the burden of disease and injury in females aged 10-24 years, and the second leading contributor (after road traffic accidents) for males of the same age. 

 

If you are in need of support or want to talk to someone, please call Lifeline on 13 11 14 or beyondblue on 1300 22 4636.

 

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