Why are more children on antidepressants than ever before?

BBC investigation has revealed that the number of children on antidepressants in the UK has risen steadily over the past 3 years. Figures show that there has been a 15% rise in England, a 10% rise in Scotland and a 6% rise in Northern Ireland. It has been suggested that this rise could be linked to the increase in waiting times for children to access specialist support services.

BBC’s investigation has shown that the steepest increase in prescriptions was seen in the youngest patients, those 12 and under, where the average number of prescriptions rose by 24%. This is a concerning trend. The mental health charity Young Minds has revealed that waiting times for CAMHS (Children and Adult Mental Health Services) psychological therapy services are on average 12 weeks. They add that this is a long time for a young person and their family to be in distress. It is likely that families are struggling during this time and may therefore be more likely to accept a medication prescription than they might have been if therapeutic treatment were available more rapidly.

Prescriptions are also something tangible that a doctor can offer. It can be hard for a GP to turn a family away empty-handed, and simply offering a place on a 12 week waiting list can feel insufficient. Marc Bush, chief policy advisor at Young Minds, has said “that is why front-line professionals are turning to prescription pads, because they’re thinking “I’m seeing someone in front of me in crisis with a level of distress I don’t want to leave them with - how to I offer some kind of alleviation from that?” (BBC, July 2018)

Against Policy?

In fact, this state of affairs contradicts government policy. GPs should take guidance from NICE (the National Institute for Health and Care Excellence), who set out clear guidelines on the prescription of antidepressants to adolescents and children. There are several aspects of this issue that contradict NICE guidance. According to NICE:

  • Antidepressants should only be considered when symptoms are not relieved by psychological treatment in the first instance. Therapy should always be offered first and only in severe and urgent cases should antidepressants be considered at the same time as the first access of psychological therapy. What this means is that children should never be given antidepressants without psychological therapy in conjunction, and ideally at least one type of psychological therapy should be tried before antidepressants are considered. It should not be possible for a child to be prescribed antidepressants unless they have been seen by a CAMHS specialist psychological therapist.
  • NICE guidance states that only a CAMHS specialist psychiatrist can prescribe antidepressants to children and adolescents. GPs should not be allowed to prescribe this kind of medication to children.
  • Young people should be monitored carefully to check how the antidepressant drugs are affecting them. It is well known that these drugs affect young people in a very different way to adults and there is a known self-harm and suicide risk with antidepressant use in young people.

The Drugs Don’t Work

The BBC investigation has found that these guidelines have not been followed in all cases. This news is following reports earlier this year that in 29 paediatric trials of antidepressants, “every single one failed to produce an obvious benefit” ( Prof Healy reports to BBC News). Professor Healy claimed “We have a situation where if you are following the evidence, no-one should be using these drugs. At the same time, in teenagers, these drugs have become the most commonly used drugs”.

A shortfall in funding leads to increased antidepressant prescriptions

It would appear that services are relying on prescriptions of antidepressants to meet a shortfall in therapeutic services, despite the fact that this contradicts NICE guidance and also contradicts the evidence for the use of this kind of medication amongst young people. This is a worrying situation and if the evidence is right that the medications are not producing a clear positive benefit, and yet at the same time increases the risk of self-harm and suicide, then it is clear that intervention is needed quickly. It has been reported that the department of Health in England will provide an addition £1.7 billion to transform CAMHS services. This would allow an improvement in access to therapies. In Scotland, £5 million has been pledged to create a task force to tackle this issue.

What can be done in the meantime?

Whilst there is no substitute for access to psychological support, families may prefer to take matter into their own hands whilst waiting for support by accessing private therapy. Your GP may have information on how to access specialist support for children and adolescents, or otherwise you may wish to use counselling directories online, or use the British Psychological Society directory to find a chartered psychologist who specialises in working with young people. There are also charities which offer low cost counselling. For more information, see the Young Minds website for information on how to access support.