UK docs told to hold antidepressants for teens
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Antidepressants should not be used as first-line treatment in patients younger than 18 years old—even for moderate-to-severe or psychotic Depression—Britain’s health economics watchdog, the National Institute for Clinical Excellence, said on Wednesday.
In children (5-11 years old) and young people (12-18) with Depression, psychological therapy such as group cognitive behaviour therapy should be the first-line treatment, backed up by advice on exercise, diet, controlling anxiety and methods of improving sleep.
For moderate-to-severe Depression, psychological therapies should be prescribed for at least 3 months, but if no improvement is observed after four to six sessions, doctors may consider the addition of fluoxetine ( Prozac ) to the treatment. In the case of children, the option should be “cautiously” considered, NICE added in guidance to the health service.
If, after a further six sessions, the patient is not responding to either the fluoxetine or psychological therapy an alternative psychological therapy should be considered. If this fails to bring improvements, clinicians can consider sertraline ( Zoloft ) or citalopram ( Celexa ). Neither drug is licensed for children and therefore will have to be used off-label, NICE added.
In the case of continued psychotic depression, an atypical antipsychotic can be considered in addition to existing therapy.
The guidance confirms earlier regulatory advice that paroxetine ( Paxil ) and venlafaxine (Effexor/Efexor) are not recommended in children.
It adds that patients taking the herbal remedy St. John’s wort should be advised to stop.
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