Tag Archives: children

Anti-depressants doubles a child’s risk of suicidal behaviour.

Suicidal thoughts, attempts and self-harm increase in young people prescribed antidepressants, concludes study

Anti-depressants should be a doctor’s last resort when trying to treat children and adolescents with depression, according to the results of a new two year-long study.

The meta-analysis involved researchers conducting a systematic review of all available and relevant test data. Researchers examined 70 trials comparing antidepressants with placebos in order to find out how the use of antidepressants related to increases in suicide, suicidal behaviour and aggressive behaviour in young people.

In 11 of those trials, researchers found out that antidepressants doubled the risk of aggressive behaviour and suicidal behaviour in young people. Suicidal behaviour includes suicide thoughts and attempts, actual suicides and self-harming behaviour such as deliberately cutting oneself.

“There are still psychiatrists who deny that antidepressants can cause suicide in children, which is absolutely incredible,” Peter Gøtszche, the head of the Nordic Cochrane Centre at Rigshospitalet who is the co-author of the new study, told Videnskab.

“I think it is irresponsible to use antidepressants in treating children and adolescents.”

Results no surprise
Anne Katrine Pagsberg – a clinical associate professor, senior researcher and medicine chief physician at the Child and Adolescent Centre, Capital Region Psychiatry at the University of Copenhagen Hospital – was not surprised by the results.

“We are very aware of this risk,” she said. “Especially for children and young people there has long been an awareness that there may be an increase in suicidal behaviour. All our patients are closely monitored and their families informed about the risks.”

Pagsberg said that the national guidelines for the treatment of children and adolescents suffering from depression recommend that antidepressants should never be ‘front-line therapy’ and should never be used as a stand-alone treatment.

“They must always be coupled with psychosocial interventions, and patients should always be closely monitored for side-effects.”

Self-harm may not equate to suicide
Pagsberg said that self destructive behaviour may not always be a sign of suicidal intent.

“Self-harm is a serious symptom, but a young person who cuts their arm is not necessarily suicidal,” she said.

No children or young people in the 70 trials actually committed suicide, but 3 percent of the children and young people taking anti-depressants exhibited suicidal behaviour, compared to 1 percent in the placebo group.

“The front-line treatment for children and adolescents with depression will always be psychotherapy,” said Pagsberg. “In cases of severe depression, we may need to try treatments using anti-depressants, but even then the psychotropics should never stand alone.”


ADHD treatment may be needed by hundreds of thousands more children, experts suggest

| The Independent:

Hundreds of thousands more schoolchildren should be treated for attention deficit hyperactivity disorder (ADHD), say leading experts.

A major study led by University of Oxford academics suggests ADHD is seriously underdiagnosed and says more children should be given medication such as Ritalin, which it found is highly effective.

Concerns have been raised about the number of youngsters overmedicated for the disorder – but the evidence suggests just 10 per cent of those with ADHD are on any form of medication.

“We have strong evidence that in the UK, and many countries outside the US, ADHD is under recognised and under diagnosed,” said Professor David Coghill, a child and adolescent psychiatry expert from the University of Melbourne and a co-author of the study.

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BBC File on Four program on Antidepressants in Children

A recent BBC File on Four program on Antidepressants in Children, presented by Paul Connolly, has drawn disparaging comments on posts here. Here is some background detail. I was interviewed for the program. My messages were as follows:

  1. That the trials of Prozac in children were identical to the trials of other SSRIs and other antidepressant drugs in this age group – negative. There are more negative Prozac trials for depression in this age group than for any other antidepressant.
  2. Part of our problem s that MHRA and NICE don’t want to be seen to go back on judgements they made 14 years ago when they licensed Prozac. Better children die than regulators lose face.
  3. That all of the literature in this area is ghost or company written.
  4. That there is no access to data from clinical trials – MHRA don’t have access, NICE don’t have access – no-one does.

It was clear to me that Paul Connolly, although expressing shock just like Chris van Tulleken some months before at what I laid out, was not going to include this material. Chris was somewhat the braver of the two. He rather subtly skewered NICE – but probably too subtle for most people. A week before the programme ran, there was an email from File on Four saying that owing to space constraints I was one of several people being omitted.

What File on Four ended up was a combination of the irritatingly anodyne and bizarre. What is the definitive answer about whether antidepressants work, Paul Connolly asked – no one knows he said. There are definitive answers the public deserve to be told about but FoF bottled it. Doctors are all at the mercy of clinical trials, he said, before turning to Ian Goodyer, someone who has pushed antidepressants for children for years who said on the basis of the biggest trials with 475 children he could tell us that fluoxetine (Prozac) worked in 67% of cases rising to 80+ %. I’d fail a medical student who offered me this answer if presented with the results of the TADS trial – the one Goodyer was talking about. There is no good evidence fluoxetine worked in this trial. Goodyer omitted to tell us that there were 34 suicidal events on fluoxetine compared to 3 on placebo. Goodyer made something of the fact this was the biggest trial of Prozac which sounds good but isn’t the biggest – not by a longshot. Even if it were the biggest, Goodyer fails to appreciate that the bigger the trial the greater the chance you can show snake oil works. If drugs are worth it, small trials are all that is needed. Prozac, fluoxetine, is in fact the drug with more negative trials than any other. These points are irritating. The bizarre one was that FoF made Andrea Cipriani out to be the radical outlying voice. AC’s work is totally controlled by industry – he knows he has no access to the data and his work is based on ghostwritten or company written reports . He’s a very nice man but the idea that he is a voice for caution as regards the use of antidepressants is bizarre.

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