Evidence
Alert

Teenagers' use of antidepressants is rising with variations across regions and ethnic groups

The number of 12-to-17 year olds prescribed antidepressants in England more than doubled between 2005 and 2017. This is one of the striking changes seen in a new study into the use of antidepressants by children and young people. It also found that antidepressant prescriptions for 5-to-11 year olds decreased between 1999 and 2017.

Antidepressants are not usually recommended as the first treatment for those under 18 years because of a lack of evidence on whether they are safe and effective in young people. But prescriptions have risen in the UK and elsewhere.

This study also found that children and young people living in deprived areas were more likely to be prescribed antidepressants than those from affluent areas. Teenagers from Black, Asian and other ethnic minority (BAME) groups were less likely than White teenagers to be prescribed antidepressants.

Further research is needed to explore the reasons behind these findings. The rise in antidepressant use in 12-to-17 year olds could be due to increasing rates of depression in young people. They may be more aware of mental health and more likely to seek help.  Or it may suggest that young people are unable to access other treatments such as cognitive behavioural therapy and other talking therapies.

The regional and ethnic variation in antidepressant prescriptions might be due to differences in the number of young people experiencing depression. Or it might suggest people from certain areas or groups have difficulty accessing mental health services.

What’s the issue?

Compared with adults, children with depression can be underdiagnosed and undertreated. They can experience problems at school and might be at risk of attempting suicide.

Talking therapy with a counsellor or psychologist is considered the main treatment for depression in children but almost a quarter of young people wait more than six months to see a mental health specialist in England. Antidepressants are often prescribed by their GPs instead.

However, it is not known how safe or effective these medicines are for children. The UK NICE guideline for depression in children and young people recommends only selected antidepressants for young people with moderate or severe depression. They should be given alongside talking therapies, following assessment by a mental health specialist.

Antidepressant use among young people was increasing until a drop in 2002, linked to concerns about safety and possible increases in suicidal behaviour. Use began to increase again from 2005. Prior to this study, it was unclear whether the rise in antidepressant prescribing was still continuing.

Previous research has shown that children living in deprived areas are more likely to be prescribed antidepressants. However, it was not known if young people from particular regions or ethnic groups are more likely to be prescribed antidepressants.

What’s new?

Researchers analysed the health records of more than 4 million 5-to-17 year olds in England from 1998 to 2017. This anonymised information came from the primary care database QResearch. They considered four types of prescription: selective serotonin reuptake inhibitors (SSRIs), tricyclic and related antidepressants (TCAs), serotonin and norepinephrine reuptake inhibitors (SNRIs) and other antidepressants.

They found that:

  • antidepressant prescriptions for 5-to-11 year olds fell between 1999 and 2017 due to a decrease in TCA prescriptions, although there was a slight increase in SSRI prescriptions
  • antidepressant use in 12-to-17 year olds more than doubled between 2005 and 2017
  • prescriptions for the SSRIs fluoxetine and sertraline increased most over the study period
  • children and young people in London were least likely to be prescribed antidepressants; those in South East England were most likely
  • children and young people living in more deprived areas were more likely to be prescribed antidepressants
  • fewer BAME teenagers were prescribed antidepressants, compared to White teenagers.

Why is this important?

Antidepressant use in teenagers is increasing. However, it is not clear whether this is due to growing rates of mental health problems, greater awareness of mental health issues or a lack of access to talking therapies.

The variation in antidepressant prescribing in different regions and ethnic groups suggests there could be health inequalities in access to appropriate care for certain children and young people with mental health problems.

What’s next?

Further research is needed to understand why these patterns in antidepressant prescribing among children and young people exist.

Researchers could look at whether certain groups are more likely to experience depression, or if some young people experience more difficulty accessing mental health diagnosis and support than others.

The recent increase in sertraline prescriptions was surprising. Sertraline is licensed for treating obsessive-compulsive disorder (OCD) and only recommended as a second-line treatment for depression. OCD is rare in England so does not explain the high use of sertraline.

Although there are currently no UK guidelines on treating children and young people with anxiety, research has found SSRIs, including sertraline, can help. GPs may be following the adult guidance for anxiety, which suggests prescribing sertraline. Clinical guidelines for helping children with the full range of anxiety disorders are needed.

You may be interested to read

The full paper: Jack RH, and others. Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study. PLOS Medicine. 2020;17:e1003215

A study looking at how many children prescribed antidepressants visit a mental health specialist: Jack RH, and others. Secondary care specialist visits made by children and young people prescribed antidepressants in primary care: a descriptive study using the QResearch database. BMC Medicine. 2020;18:93

A study looking at mental health problems in children in different parts of England: Grigoroglou C, and others. Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England. Psychol Med. 2020;50:293–302

Research into how guidelines for treating children with depression have influenced antidepressant prescribing: Tiffin PA, and others. What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study. BMJ Open. 2019;9:e028201

Funding

This research was funded by the NIHR Nottingham Biomedical Research Centre.

Commentaries

Study author

This work provides a really useful picture of how antidepressants are being prescribed in primary care to children and young people in England and shows a continuing increase in antidepressant prescribing to adolescents.

We don’t yet know why prescription rates are increasing or why there are differences in prescribing rates between deprivation categories, regions and ethnic groups, but we need to make sure that there are no barriers preventing children and young people getting the appropriate support and treatment they need.

Ruth Jack, Senior Research Fellow, University of Nottingham

Patient

It’s important to understand the realities of antidepressant medication, especially SSRIs, which may be more or less effective, and have different side effect profiles, in people of different ages. But information shared with the public ought to be balanced and not demonise antidepressant medication. I would not want people who are feeling low to avoid seeing the GP because of a fear of being prescribed antidepressants.

It might be interesting to offer training or information to GPs, who are the ones prescribing. Maybe they could forge closer connections with link workers to increase social prescribing. CAMHS (Child and Adolescent Mental Health Service) staff, who are often the next step in a young person’s mental health treatment, also need to be aware of this study.

Felicity Allman, Newcastle upon Tyne

Conflicts of Interest

Two of the authors have received fees and funding from pharmaceutical and software companies.