Volume 183 - Issue 5
Depressed youth, suicidality and antidepressants
Author: Duncan Topliss
Med J Aust 2005; 183 (5): 275-276. || doi: 10.5694/j.1326-5377.2005.tb07041.x
Published online: 5 September 2005
Published online: 5 September 2005
Duncan Topliss
Chairman, Adverse Drug Reactions Advisory Committee, Therapeutic Goods Administration, Department of Health and Ageing, Canberra, ACT 2601. adracAThealth.gov.au
Comment: Three essentially independent reviews of the use of selective serotonin reuptake inhibitor (SSRI) antidepressants in children and adolescents have been undertaken in Australia in the past 9 months.1-3 The review by the Adverse Drug Reactions Advisory Committee1 had input from representatives of the Royal Australian and New Zealand College of Psychiatrists and the Division of Paediatric and Child Health, Royal Australasian College of Physicians (RACP).
All three reviews noted the paucity of information to support the efficacy of these and other antidepressants in children and adolescents, and the frequent observation of increased suicidal thoughts and self-harm in clinical trials.
The colleges’ review2 and the National Prescribing Service Rational Assessment of Drugs And Research (RADAR) review3 support the ADRAC advice that:
Any use of SSRIs in children and adolescents with MDD [major depressive disorder] and other psychiatric conditions should be undertaken only within the context of comprehensive management of the patient. Management should include careful monitoring for the emergence of suicidal ideation and behaviour which may particularly develop early in therapy, or if therapy is interrupted or irregular because of poor compliance. Cognitive behaviour therapy, if it is available, may enhance the outcome in MDD.
An SSRI should be chosen for a child or adolescent with MDD or other psychiatric condition only after taking into account the recent evaluations of clinical trial data and the Australian product information. Prescribers should be aware that the marketers of fluvoxamine and sertraline (indicated for obsessive compulsive disorder) advise against their use in children and adolescents with MDD, and the marketers of citalopram, escitalopram, paroxetine, venlafaxine and fluoxetine warn or caution against their use in patients aged less than 18 years for any indication.
It is important to note that children and adolescents who are being treated for MDD with an SSRI should not have their medication ceased abruptly.
References
- Adverse Drug Reactions Advisory Committee. Use of SSRI antidepressants in children and adolescents. Aust Adverse Drug Reactions Bull 2004; 23: 22. Available at: http://www.tga.gov.au/adr/aadrb/aadr0412.pdf (accessed Jul 2005).
- Royal Australian and New Zealand College of Psychiatrists, Royal Australian College of General Practitioners and Royal Australasian College of Physicians. Clinical guidance on the use of antidepressant medications in children and adolescents. Available at: http://www.ranzcp.org/publicarea/pracguid.asp (accessed Jul 2005).
- National Prescribing Service RADAR. Selective serotonin re-uptake inhibitors in child and adolescent depression. April 2005. Available at: http://www.npsradar.org.au/npsradar/content/SSRIs.pdf (accessed Jul 2005).