BMJ  2005;330:1151 (14 May), doi:10.1136/bmj.330.7500.1151

Letter

Do selective serotonin reuptake inhibitors cause suicide?

Antidepressant prescribing to children and adolescents by GPs has fallen since CSM advice

EDITOR—The decline in routine prescribing of antidepressants in children and adolescents expected by Cipriani et al has already started.¹ We analysed antidepressant prescribing by general practitioners between 1 January 2000 and 31 December 2004 using the IMS Disease Analyzer-Mediplus database to examine the effects of the UK Committee on Safety of Medicines' advice on antidepressant prevalence.^{2 3}

Antidepressant use increased between 2000 and 2002 (5.4 per 1000 to 6.6/1000); the prescription of selective serotonin reuptake inhibitors (SSRIs) and venlafaxine rose. Between 2002 and 2004 antidepressant prevalence decreased (6.6/1000 to 5.7/1000). The use of the withdrawn antidepressants (citalopram, escitalopram, fluvoxamine, paroxetine, sertraline, and venlafaxine) dropped by a third (3.1/1000 v 2.0/1000), but there was no change in fluoxetine prevalence (2.1/1000 v 2.3/1000). The use of tricyclic antidepressants declined (2.0/1000 v 1.7/1000; P = 0.03).

Since 2003 fewer children and adolescents have been prescribed antidepressants in primary care, particularly the withdrawn drugs. However, the use of fluoxetine and non-selective SSRIs has not risen, implying that they are not used as alternative treatments.

Fewer prescriptions may be issued for mild depression, or patients and their parents are more aware, and therefore more cautious, about antidepressant treatment. Also, clinicians may choose psychotherapies, such as cognitive behaviour therapy, over antidepressants.

New referrals to child and adolescent mental health services need to be measured for health service planning. Further research into the integrated management of depression in childhood and adolescence is urgently required so that adequate infrastructure and resources can be provided.

macey.murray{at}ulsop.ac.uk
Centre for Paediatric Pharmacy Research, the School of Pharmacy, University of London, WC1N 1AX, and the Institute of Child Health, University College London, WC1N 1EH

Centre for Paediatric Pharmacy Research, the School of Pharmacy, University of London, WC1N 1AX, and the Institute of Child Health, University College London, WC1N 1EH

Disease Analyzer Centre of Excellence, IMS Health, Pinner HA5 5HQ

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Competing interests: ICKW has received research and educational grants from different pharmaceutical companies including GlaxoSmithKline, Eli Lilly, and Pfizer (manufacturers of different SSRIs) but none was related to antidepressants or this study.

References

1. Cipriani A, Barbui C, Geddes JR. Suicide, depression, and antidepressants. BMJ 2005;330: 373-4. (19 February.)[Free Full Text]
2. IMS Health. IMS disease analyzer. www.ims-global.com/disease_analyzer/ (accessed 15 Feb 2005).
3. Committee on Safety of Medicines. Selective serotonin reuptake inhibitors (SSRIs): overview of regulatory status and CSM advice relating to major depressive disorder (MDD) in children and adolescents including a summary of available safety and efficacy data. http://medicines.mhra.gov.uk/ourwork/monitorsafequalmed/safetymessages/ssrioverview_101203.htm (accessed 15 Feb 2005).

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Relevant Article

Suicide, depression, and antidepressants

Andrea Cipriani, Corrado Barbui, and John R Geddes
BMJ 2005 330: 373-374. [Extract] [Full Text] [PDF]