Treatment of major depressive disorder in children and adolescents

Most selective serotonin reuptake inhibitors are no longer recommended

On 10 December 2003 Professor Gordon Duff, chairman of the Committee on Safety of Medicines in the United Kingdom, advised that most of the antidepressant drugs in the selective serotonin reuptake inhibitor group should not be used to treat major depressive disorder in children and adolescents under the age of 18 years.1 This is the main category of medication used in the treatment of depression in children and adolescents, and the announcement will have taken many young people who take these drugs, their parents, and doctors by surprise. Although the advice only applies to the United Kingdom, it mirrors concerns that are also being considered by the US Food and Drug Administration.2

The new advice follows the review of data from clinical trials by an expert working group, convened initially because of concerns that selective serotonin reuptake inhibitors may increase the risk of suicidal thoughts and self harm in young people. The group concluded that the balance of risks and benefits was unfavourable for three of the selective serotonin reuptake inhibitors (sertraline, citalopram, and escitalopram) and that there was insufficient evidence to support the use of a fourth, fluvoxamine. The committee had …