Doctors do not always follow the guidelines when prescribing antidepressants to young people

Many doctors in the Netherlands fail to follow the guidelines when prescribing antidepressants to children and teenagers with depression. Fewer than one in five children are prescribed the correct drug at the start of treatment and the initial dose is often higher than recommended. More than half of the teenagers in the study were started on an adult dose, for example. These are the results of research carried out in the department of Psychiatry of the University Medical Center Groningen and the department of Pharmacy of the University of Groningen. An article based on the research has been published in the scientific journal European Child & Adolescent Psychiatry.

In the Netherlands, approximately 10,000 young people below the age of 18 take antidepressants. Dutch guidelines recommend that medication should only be prescribed to young people suffering from severe depression. Fluoxetine is recommended as the first course of treatment, since this antidepressant has the strongest evidence of efficacy in children and adolescents and may be associated with a lower risk of suicidality than other antidepressants.. A low dose is recommended at the start of treatment.

The Groningen-based prescription database research project (IADB.nl) has revealed that fewer than twenty percent of young people are prescribed fluoxetine at the start of the treatment, despite the guidelines that appeared in 2009. The drug most commonly prescribed in the 1990s was paroxetine (22 percent). This percentage dropped sharply after 2003, when the link with a high risk of suicidality in young people became known. However, prescriptions for paroxetine were not replaced by prescriptions for fluoxetine (as urged in the guidelines), but by citalopram. This was the drug most commonly prescribed to young people between 6 and 17 years old between 2010-2014 (40 percent), despite the lack of evidence regarding its effectiveness in treating depression in children and adolescents.

Although most of the children (58 percent) were started on the recommended low dose, ten percent were initially prescribed an adult dose, which is two to four times higher than is recommended for children. Sixty percent of the teenagers were prescribed an adult dose at the start of their treatment.

The researchers also reported some positive findings: although the majority of prescriptions for antidepressants between 1994-2003 were written by GPs, as time went by, more and more prescriptions were written by medical specialists, as recommended in the guidelines. The maintenance doses prescribed were nearly always in line with the guidelines, and the initial doses of some antidepressants, citalopram in particular, became lower in recent years.

Based on the results, the researchers conclude that doctors should be made more aware of the importance of following the guidelines when prescribing antidepressants, and should be particularly vigilant about prescribing the correct dose to young people. A better understanding of doctors’ reasons for prescribing citalopram may help to improve prescription habits and ensure that doctors follow the guidelines more closely.

Read the article in European Child & Adolescent Psychiatry here: http://link.springer.com/article/10.1007/s00787-016-0836-3