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.”