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GP writing a prescription
Some experts fear antidepressants are being overprescribed because of long waits for psychotherapy. Photograph: Anthony Devlin/PA
Some experts fear antidepressants are being overprescribed because of long waits for psychotherapy. Photograph: Anthony Devlin/PA

Tens of thousands of under-18s on antidepressants in England

This article is more than 6 years old

Data shows that between April 2015 and March 2016, 64,765 children were given medication, including 315 aged six or under

Almost 65,000 young people in England, including children as young as six, are being prescribed antidepressants by their doctors. The figures have prompted concern that medics may be overprescribing strong medication because of stretched and underfunded mental health services.

Data released by NHS England under the Freedom of Information Act, showed that 64,765 under-18s, including 3,876 children aged seven to 12 and 315 aged six or younger, were given medication typically used to treat depression and anxiety between April 2015 and March 2016.

Dr Marc Bush, a senior policy adviser at the charity Young Minds, said the statistics were “substantial” and underlined the fact that large numbers of young people are experiencing mental health problems. “It is important that they can access the treatment and care they need. Antidepressants have a role to play, but are not the whole solution,” he said.

Bush said he was extremely worried at the prospect of children under six being prescribed antidepressants. “It feels quite difficult to comprehend, given what we know about the impact of pharmacology on people’s development,” he said.

Experts fear that some children and young people are given the drugs because they face such long waits for psychotherapy on the NHS.

Dr Antonis Kousoulis, a clinician and assistant director at the Mental Health Foundation, said the figures show “we are failing to provide a choice of age-appropriate psychological treatments at the point of the need”.

“GPs overprescribe antidepressants often because of the long waiting lists for specialist services,” he went on. “But the evidence that these medicines are effective in children is not as comprehensive as is it for‎ drugs for other conditions.”

Guidance from the National Institute for Health and Care Excellence (Nice) says antidepressants should be given only to teenagers and children with moderate or severe depression, when psychotherapy has failed. It also advises that such medication should be taken in concert with other support, such as counselling.

Fluoxetine, which is sold under the trade name Prozac, is the only drug recommended for younger people, but other medication can be used as second-line treatment if fluoxetine does not work.

According to Nice, fluoxetine should be “cautiously considered” for those aged five to 11, but notes that the evidence for its effectiveness in the age group is not established.

David Taylor, the Royal Pharmaceutical Society’s spokesman on mental health medicines and director of pharmacy and pathology at the Maudsley hospital, said: “Antidepressants are only used in children in circumstances where there is clear support from robust clinical trials. Adolescents with anxiety, obsessive compulsive disorder and post-traumatic stress disorder may be prescribed antidepressants, and fluoxetine is used in depression.”

A spokesperson for NHS England said: “Depression and anxiety can be debilitating, and while there are excellent psychological treatments for children and young people, in some cases it is medically appropriate to offer medication, usually in addition to any psychological therapy they are already having.”

Kousoulis said depression in childhood may be caused by a combination of genetic predisposition and personal circumstances. He cited family breakdown as one potential trigger.

Dr Jon Goldin, vice-chair of the child and adolescent faculty at the Royal College of Psychiatrists, said: “It’s not easy to be a child and teen in today’s society. There are lots of pressures. It’s partly the education system and the emphasis on testing and exams … Social media is also a problem in that children compare themselves unfavourably to images they see online.”

Experts noted that the figures for under-12s could include children given antidepressants for other problems. Tricyclic antidepressants are sometimes used to treat chronic pain and bedwetting in children, and may be prescribed to manage epileptic fits.

A major study published in the Lancet last year concluded that the majority of antidepressants do not work on children and teenagers, and that prescribing them could do more harm than good.

The new data is released as concerns grow about a lack of funding for mental health services. Norman Lamb, the Liberal Democrats’ health spokesman, said: “There is no doubt a significant link between the growing use of antidepressants and the immense pressure children’s mental health services are under.

“Children’s mental health services are in desperate need of more resources. The Conservative government has failed to invest properly and has failed to make good on the funding promises we made in the coalition. Money isn’t getting through to the frontline, and now we are seeing the consequences of this neglect.”

Goldin echoed calls for more resources. “There is also more awareness and people are more willing to talk about things. There is less stigma, but what we don’t want is people turning to adults for help and the help not being available,” he said.

This article was amended on 7 September 2017 to correct the prescriptions data, which was initially misinterpreted.

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