Intended for healthcare professionals


Treating major depression in children and adolescents

BMJ 2004; 328 doi: (Published 26 February 2004) Cite this as: BMJ 2004;328:524

Research is needed into safer and more effective drugs

  1. Macey L Murray, research fellow (macey.murray{at},
  2. Ian C K Wong, director,
  3. Corinne S de Vries, senior lecturer
  1. Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London, London WC1N 1AX
  2. Department of Pharmacoepidemiology, Postgraduate Medical School, University of Surrey, Guildford GU2 7DJ

    EDITOR—We report our preliminary findings on prescribing of antidepressants in general practice, in response to the recommendation by the regulatory agency for medicines and healthcare products to withdraw selective serotonin reuptake inhibitors from use in paediatric depression.1 2

    We used the general practice research database to analyse use between 1 January 1992 and 31 December 2001 (88 522 prescriptions issued to 23 999 children and adolescents).3 Fifty nine per cent of antidepressant prescriptions were for tricyclics; 39% were for selective serotonin reuptake inhibitors. The most commonly prescribed antidepressants were imipramine (25% of prescriptions), fluoxetine (19%), and amitriptyline (18%). Paroxetine, sertraline, citalopram, venlafaxine, and fluvoxamine accounted for 21% of prescriptions. Sixty three per cent, 35%, and 2% of patients were given tricyclics, selective serotonin reuptake inhibitors, and other antidepressants, respectively, as the first antidepressant prescribed.

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    In patients aged 10 years or younger the most commonly recorded indication for tricyclic use was enuresis (78%); in those aged 15 years or older it was depression (53%). In this older group, use of antidepressants was three times more common in girls than boys. In 1992 tricyclics were prescribed to nine times more patients than selective serotonin reuptake inhibitors; by 2001 twice as many patients received selective serotonin reuptake inhibitors than tricyclics.

    Selective serotonin reuptake inhibitors gained popularity for the treatment of depression compared with tricyclics, but tricyclics were used commonly in nocturnal enuresis. These trends may change after the recommendation. However, tricyclics are ineffective in prepubertal depression, and there is marginal evidence to support their use in adolescents,4 leaving an urgent need to research safer and more effective medicines for children and adolescents with depression.5


    • ICKW's post is funded by a public health career scientist award from the Department of Health

    • Competing interests ICKW has received funding from various pharmaceutical companies including companies that produce selective serotonin reuptake inhibitors but none was related to this study