UK to ban use of most SSRIs in under 18s

[reprise]

Drugs for depressed children banned (http://www.guardian.co.uk/uk_news/story/0,3604,1103563,00.html)

I have mixed feelings about this particular strategy for dealing with the inappropriate prescription of SSRIs, and wonder what others think.

My personal preference is that we return to the days when these medications must be initially prescribed by a specialist practitioner. Most of the problems I have seen in adults and children taking SSRIs have been due to inadequate monitoring of the effect of the medication on their condition, and I'm inclined to believe that improved prescribing and monitoring protocols are a better option than simply removing a particular class of drugs from therapeutic use in a particular demographic group.

What do others think about this move?

[epepke]

Originally posted by reprise
Drugs for depressed children banned (http://www.guardian.co.uk/uk_news/story/0,3604,1103563,00.html)

I have mixed feelings about this particular strategy for dealing with the inappropriate prescription of SSRIs, and wonder what others think.

My personal preference is that we return to the days when these medications must be initially prescribed by a specialist practitioner. Most of the problems I have seen in adults and children taking SSRIs have been due to inadequate monitoring of the effect of the medication on their condition, and I'm inclined to believe that improved prescribing and monitoring protocols are a better option than simply removing a particular class of drugs from therapeutic use in a particular demographic group.

What do others think about this move?

It seems fairly insane to me, a bit like trying to kill a mouse with a thermonuclear device.

The biggest danger in SSRI's is that they can trigger manic episodes in bipolars when unopposed. This is a big problem in the US because we're so paranoid about benzodiazepines over here, but I wouldn't expect it to be such a major problem in the UK.

Another problem is the possibility of anorgasmia, which I imagine might be fairly significant for an adolescent.

However, most of the other side-effects, like tintinnitus and serotonin sickness, while unpleasant, are not likely to cause suicidal ideation or violence. The condition that it treats (when it works, which isn't always) is known to cause suicidal ideation. In the absence of real evidence, I suspect a [i]post hoc ergo propter hoc[i/] fallacy, here. Perhaps there were some high-profile cases of kids on SSRIs who killed themselves in the notoriously sensationalistic English press that gave the impression that, if only they had not been taking SSRIs, they'd be perfectly happy little child-bots.

As for becoming dependent on SSRIs, well, gee whillikers, Batman! SSRIs are palliatives. Chronic depression is a chronic condition; that's why we call it "chronic." It doesn't just magically go away after you've taking the drug for a certain period of time. Well, it can, but it isn't guaranteed to, and it won't be because of the drug. Of course people are going to have problems when they stop taking the medication. Heart patients are going to have problems when they stop taking their digitalis, too.

[Boo]

Unfortunately, when drug trials are done the population is limited to adults. Effacy, side effects and long term data on medication perscribed to adolescents tends to be anecdotal based on small observed populations, usually hospital inpatients and treatment centers. Because puberty affects the way the body can metabolize medications Dr's often end up making educated guesses on dosing and efffectiveness.

Add in that even among the adult population it is not uncommon for a patient to try several medications and dosing schedules before finding one that works.

Now that depression has become the new 'treatable condition' and 'the one thing no-one should have to suffer from.' Every Primary Care or Specialist is urged to prescibe them for their patients that meet the checklist criteria. Without any other intervention meds are a bandaid for a gaping wound.

This seems to be a cyclical thing within the medical community. A few years ago it was Ritalin and ADD.

Personally, I think until the stigma has been fully removed from Psychiatric treatments and the medical community learns that medication is not the be all - end all of treating patients and their families, this cycle will continue and our children and adolescents ( and their families) will pay the price.


Boo

[Dancing David]

Two Thoughts:

1. The problems are often caused by a chaotic home environment, not an actaul biological disorder. Domestic violence can often manifest in children as ADD and of course depression.

2. I was depressed as a youth, I can't remeber a time in my youth when I wasn't anxious and depressed, I tried to commit suicide twice before I was fourteen. I think that in my case low level of SSRI could have made a huge difference by bring down the anxiety. I agree that GPs should not perscribe psychiatric meds to anyone, especialy benzos!(It is cool as a starter for a GP to perscribe but not a good continuation)

[Paul C. Anagnostopoulos]

I agree with David, although he has me beat on suicide attempts by a factor of two.

The problem then was that no one was paying any attention. The problem now is that people are perhaps paying too much attention, followed, after treatment, by paying too little.

~~ Paul