Depression and SSRI antidepressants in children and
Members of the NZ Branch of the
Faculty of Child and Adolescent Psychiatry developed a position statement*
reflecting their professional concerns and clinical practice.
*This is not a College
[RANZCP] position statement
The issue of medication for depression in children and youth
cannot be divorced from that of depression.
is a common, serious and significant illness of youth.
most important cause of suicide is untreated depression
varies in severity from mild to very severe
degrees of depression probably require different treatments
are a range of treatments for depression in young people, only one of which is
medication. Several studies show Cognitive-Behavioural Therapy [CBT] is
beneficial, and research is needed to evaluate other
There are significant service issues
that need addressing if we are to comprehensively address depression in children
diagnosis and effective treatment requires skilled medical and non-medical
professionals and well resourced Child and Adolescent Mental Health Services
Zealand currently has less than half the workforce and other resources needed to
maintain even a minimum CAMHS
and improved resourcing are a priority issue for DHBs and others to
shows that SSRIs are helpful for other problems in young people, not only
depression. Specifically they are very useful for Obsessive-Compulsive Disorder,
and sometimes for other anxiety disorders.
is no evidence that prescribing SSRIs to young people increases suicide.
the number of prescriptions of SSRIs to youth in NZ has increased the rate of
youth suicide in NZ has fallen.
increase in suicidal thinking described as a risk occurs in less than 2% of
those taking the medication ~ that is a small problem.
show that SSRIs, particularly Fluoxetine help depression in adolescents. There
is a degree of conflicting evidence, but the balance is significantly in favour
of SSRIs being effective. There is a need for more well designed studies to
in children is infrequent and studies of medication too few and mostly too
poorly designed to reach any firm conclusions.
depression carries a greater risk of suicide than appropriate prescribing of
do not accept that using SSRIs in adolescence constitutes a risk which is
remotely as great as severe depression itself and it would be unfortunate if the
position taken by Medsafe were to result in the withholding of appropriate SSRI
need for patients and caregivers to have proper information was and remains good
practice, but reiteration of this is valuable.
need for specialist opinion before antidepressant medication is commenced is
supported, but it would be unfortunate if the current shortage of a skilled
workforce in NZ CAMHS were to cause a family doctor to withhold treatment for
Faculty of Child and Adolescent
Psychiatry (New Zealand