Abstract

HEALY, David; LE NOURY, Joanna  and  JUREIDINI, Jon. Antidepressants in pediatrics: the greatest failing in health care?. Rev. Asoc. Esp. Neuropsiq. [online]. 2018, vol.38, n.133, pp.195-216. ISSN 2340-2733.  https://dx.doi.org/10.4321/s0211-57352018000100011.

Children's mental health services are said to be the biggest failure in Britain's National Health Service, specially, with regard to the treatment of depression and suicidal behaviour in children and adolescents. The use of antidepressants in children and adolescents shows the largest gap existing in health services between clinical practice and scientific evidence, among open label studies that claim its benefits and a big number of randomized controlled trials (RCTs) that indicate the opposite, and among RCTs as they are published and advertised and what their data actually prove. However, antidepressants are commonly used and they probably are the most prescribed drugs in adolescents. The context of antidepressant use during childhood, the evidence analysis, the harms and risks, the increase of suicidal events, and other issues related to clinical practice are addressed. The place of SSRIs in clinical practice might be related to their potential serenic effect, different from the anxiolytic effect of benzodiazepines and antipsychotics. If “this therapeutic principle” were considered as primary outcome, it would allow a better understanding of RCT data and a clinical practice based on a more balanced risk-benefit ratio. Its application would require a collaborative work with patients and a significant degree of autonomy with regards to what is included in the clinical guidelines. The paper examines general troubles of healthcare services, their sustainability, health promotion, and drug use, comparing the diagnosis and treatment of child and youth depression with those of osteoporosis and other diseases, like asthma and high blood pressure. Finally, a free access campaign to clinical trial data is advocated.

Keywords : depression; suicidal behaviour; children and adolescents; antidepressants; SSRIs.

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