GPs Support Responsible Use Of SSRIs In Children And Adolescents - Royal Australian College Of General Practitioners

Main Category: Depression
Also Included In: Pediatrics / Children's Health;  Psychology / Psychiatry;  Primary Care / General Practice
Article Date: 31 Jul 2008 - 1:00 PDT

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Recent media coverage has questioned the prescription and safety of a class of antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) in children and adolescents.

"General practitioners are a critical part of the mental health care system in Australia and are often the first point of contact in the health system for people with mental health concerns. GPs are ideally placed to conduct assessments, provide information and coordinate care for people, including children and adolescents, with depression," said Dr Caroline Johnson, member of the RACGP National Standing Committee - Quality Care and a Melbourne-based GP.

"General practitioners are aware of a potential increase in suicidal thinking and behaviour for adolescents on SSRIs, and consequently the RACGP and other medical colleges, have developed advice for members on use.

"Good general practice involves assessing the needs of each individual. The patient and GP need to consider a range of factors including severity of symptoms, past history, current medications and lifestyle when determining an appropriate treatment pathway.

"As a first step, GPs and patients should discuss treatment options, which may include talking therapies such as cognitive behavioural therapy that focuses on changing negative thinking and behaviour that can contribute to depression, support groups, medication or a combination of treatments. For children and adolescents suffering from depression, there are many treatment options that are not medication based.

"Studies have shown that cognitive behavioural therapy is often effective in depression.

"However, antidepressants, such as SSRIs, form a valuable part of care provided to some patients within the context of a comprehensive management plan and only where cognitive behavioural therapy has failed, the depression is so severe that it interferes with the young person's capacity to engage in counselling, or the depression is life threatening. The college's policy suggests a cautious approach with careful monitoring and specialist consultation as required.

"We believe it is important that children and adolescents continue to have access to these medications. As with any prescribing decision, the potential risks need to be balanced against the potential benefits, and should take into account evidence from research, as well as the particular clinical circumstances of the individual patient," said Dr Johnson.

When children and adolescents are commenced on an SSRI, the college recommends:

- Starting with a low dose and building up gradually

- Warning parents and patients about potential activation symptoms, including the possible emergence of suicidal thoughts early in treatment

- Careful monitoring in the early weeks for the emergence of behavioural activation/ changes, with the prescriber/ doctor being available for contact

- Consultation, wherever possible, with a child and adolescent psychiatrist or developmental paediatrician in the case of non-response or significant deterioration. This may be done by telephone or teleconferencing (where available) if review in person is impractical

- Following recovery, the antidepressant should be continued for a period of six to twelve months to prevent relapse or recurrence.

"Undiagnosed depression can be very serious - medical research shows that the longer a depressed person goes untreated, the longer their condition can last and the lower their chances for a full recovery.

"It is very important to find the treatment or combination of treatments that will work best to increase an individual's chances of becoming well; patients need access to care as early as possible after they identify that they have mental health concerns. While GPs play a significant role in assisting patients who experience depression, the RACGP continues to be concerned about ongoing issues with access to and affordability of specialist mental health services for these patients.

"If anyone currently taking antidepressants has concerns about their medication based on media reports, we encourage them to talk to their regular doctor before making any alterations to their treatment plan," said Dr Caroline Johnson.

For more details on the RACGP's clinical guidance on the use of Selective Serotonin Reuptake Inhibitors (SSRIs) when treating children and adolescents, please visit here.

The Royal Australian College of General Practitioners (RACGP) is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP has the largest general practitioner membership of any medical organisation in Australia and represents the majority of Australia's general practitioners.

Royal Australian College of General Practitioners