The news that an increasing number of children aged 12 or under are being prescribed antidepressants may provoke an almost knee-jerk reaction in some, but it needs to be looked at in a rational manner.
I admit it’s tempting to rush in with my size nines and start spouting about the need for kids to play football in the street, steal apples, play tap-door-run and swim outdoors – while eating a piece and jam they got from someone’s mother.
However, while the concept of ‘exercise medicine’ is a worthy tool to have in the healthbox and may well prove to be as close to a panacea as we’ll ever get, there’s a serious issue in play here.
For it looks, to all intents and purposes, like antidepressants known as selective serotonin re-uptake inhibitors (SSRIs) are being prescribed as ‘holding drugs’ in some cases, while children wait to see a mental health specialist.
Dr Bernadka Dubicka, who chairs the child and adolescent faculty at the Royal College of Psychiatrists, said that currently only “one in four” children and young people with a mental health problem are actually being treated.
This is worrying as in the most acute cases where children appear suicidal, time is definitely of the essence and waiting for the Prozac to kick-in seems a bit of a gamble without immediate access to psychological therapies such as counselling.
A three-month period of psychological therapy is supposed to be the first option before antidepressants are prescribed, but this is not often the case because of a lack of trained staff.
With this in mind, it’s easy to see why GPs are reaching for the prescription pads – as doing nothing at all may be the worst option. Certainly, these drugs can form part of a ‘safe’ overall treatment for young people suffering from anxiety and depression but my understanding is that they should not be prescribed in isolation.
There are cases of antidepressants leading to suicidal thoughts and side effects like self-harming have been reported with issues also existing around immediate withdrawal from such drugs.
There clearly is a need for alternative psychological treatments to be made available and the Scottish Government is committed to funding 800 additional mental health workers as part of its 10-year mental health strategy. Although, where they’re going to come from is anyone’s guess. The Scottish Government and most medical professionals believe that an increased awareness of mental health problems could explain the rise in antidepressant use.
This seems a bit convenient and deflects from the lack of mental health workers in the country, which seems to be the underlying problem here.
But it seems unclear at what point a GP decides to give a child these drugs – mild depression, not wanting to go to school? Isn’t that all part of growing up?
Surely, the first line of defence is the parents and no doubt the numbers of children on antidepressants will be higher in the most deprived areas of the country.
So there’s room for a debate to be had around the issue. Over-prescription, which appears to be the elephant in the room, needs to be seriously examined.
I understand the need for caution, given that it’s children’s mental health we are dealing with here, but the fact that more than 5,000 under-18s in Scotland were on antidepressants in 2017/18 doesn’t seem quite right.