To the Editor: We thank Page and colleagues for their important article considering the sociodemographic correlates of antidepressant utilisation in Australia.1

We note that fewer than 15% of the young people in the study were prescribed fluoxetine, and almost 40% were prescribed sertraline. These rates of antidepressant use contrast with the available evidence on treating young people diagnosed with depression.

A recent review examining the effectiveness of selective serotonin reuptake inhibitors (SSRIs) for depression among children and adolescents demonstrated that fluoxetine is the only SSRI with at least some evidence for effectiveness.2 Current clinical guidelines recommend that a young person diagnosed with a major depressive disorder who is to be prescribed an antidepressant should be given fluoxetine in the first instance.3,4

Reasons for the apparent lack of concordance with the guidelines might include treatment of disorders other than depression, or prescriptions for those who have already had an unsuccessful trial of fluoxetine. It would thus be of great interest to learn what proportion of young people are prescribed an antidepressant other than fluoxetine, and what proportion of young people prescribed an antidepressant are concurrently undergoing guideline-concordant psychological treatments, such as cognitive behaviour therapy.

The data presented by Page et al draw attention to challenges faced by doctors providing treatment for young people experiencing depression, which include a lack of good evidence about the effectiveness of newer antidepressants for this age group.

However, there is an opportunity to support better use of evidence in decisions made about treatment options for young people. The provision of high-quality, evidence-based information for patients and their carers to enable informed decisions is essential, and shared decision making offers a way to enable this.5 By improving the knowledge transfer between doctor and patient, antidepressant prescription can be more judicious.