This article will no doubt be viewed as controversial. I write, as always, not to make statements but to make people think about issues we need to question.
The recent media attention given to children and antidepressants has caused me to revisit a question I have been asking for some time. Given we know adverse effects of antidepressants include mental disturbance, suicide and violence and available studies suggest they add little long-term benefit; could prescribing psychoactive psychotropic medication to Under 18s be deemed child abuse?
According to NHS choices “The use of antidepressants isn't usually recommended in children and young people under the age of 18. This is because there's evidence that, in rare cases, they can trigger thoughts about suicide and acts of self-harm in this age group. Concerns have also been raised that their use could affect the development of the brain in children and young people.
An exception can usually only be made if the following points are met:
the person being treated has failed to respond to talking therapies such as cognitive behavioural therapy, and
the person being treated will continue to receive talking therapies in combination with antidepressants, and
the treatment is supervised by a psychiatrist (a doctor who specialises in treating mental health conditions)
If an antidepressant is recommended, then fluoxetine is usually the first choice.”
If the NHS guidance is being followed, why are tens of thousands of children in the UK being prescribed antidepressants? Why is the figure growing at an alarming rate and why are children waiting up to 10 months for the recommended talking therapies? Despite the Medicines and Healthcare Products Regulatory Agency (MHRA) deciding to disapprove of the use of SSRI drugs, (except fluoxetine, (Prozac)), in children and adolescents, it is still legal for doctors to prescribe them off label. There are currently seven SSRIs (Selective Serotonin Reuptake Inhibitors) prescribed in the UK: citalopram (Cipramil), dapoxetine (Priligy), escitalopram (Cipralex), fluoxetine (Prozac ),fluvoxamine (Faverin), paroxetine (Seroxat), and sertraline (Lustral).
Data concerning the safety and efficacy of antidepressant use for children is far from reassuring. There have been disturbing reports of SSRI trials and young people alleging drug companies hid unfavourable data, exaggerated the benefits and hid the adverse effects, in particular the risk of suicidality. In 2004, the US Food and Drug Administration issued a ‘Black Box Warning’ for all SSRI drugs prescribed to under 18s, signifying medical studies indicate the drugs carry 'a significant risk of serious or life-threatening adverse effects'. The medicalizing of child behaviour, however, continues to be booming business for Big Pharma.
Peter Breggin, a leading psychiatrist and medical expert who has examined dozens of cases of individuals who have committed suicide or violent crimes while under the influence of SSRIs says certain behaviors are “known to be associated with these drugs,” including “anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania.” Any of these adverse effects, including emotional blunting, can cause both suicide and violence. As far back as 1994, he suggested that a label warning for SSRI antidepressants should include specific behavioural reactions including violence, depression and suicide.
The website SSRI Stories, (www.ssristories.org), is a collection of over 6,000 “stories” that have appeared in the media (newspapers, TV, scientific journals) in which prescription drugs were mentioned and in which the drugs may be linked to a variety of adverse outcomes including suicide and violence. There are over 1300 harrowing deaths reported in detail in the suicide section, all of which were linked to prescription medication, in particular SSRI antidepressants.
In my years working with children in primary and secondary schools I have very rarely seen a child I believed to be genuinely mentally ill. More often they were subjected to social causes of anxiety or sadness. General feelings of helplessness because of poverty, family and peer relationships, loneliness,pressure from school and social media are the norm in today’s society. So why are we continuing to treat children as if they have psychiatric disorders?
Some things just don’t make sense. In an age where we obsess over additives in food, protecting our children on-line, keeping them safe from bullies and plastering them from head to toe in sunscreen, why do we pay so little attention to the growing trend to prescribe mind altering antidepressants to children?
Today it can be a cruel world, but nothing is more so than allowing children to believe the notion that they are mentally ill and their problems can be solved by popping a pill. Parents need to accept and teach their children to deal with suffering as part of growing up. Whilst Psychiatry says ordinary distress and sadness is mental illness, we must teach children that however painful their distress may be, it is, more often than not their normal reactions to the difficulties of everyday life.
Prescribing Antidepressants to children is incompatible with “Building Resilient Kids”, a mantra heard throughout education and social care. Things go wrong when children don’t live up to the expectations of today’s society. Why is it sometimes easier for some parents to buy into the false dangerous narrative that, just like adults, children have a chemical imbalance leading to depression? Why do many assume the pills which ‘create’ a chemical imbalance will do no harm?
We are, without doubt, creating the next generation of prescribed drug dependent adults. Children are being parked on antidepressants and the rise in longtime use is a growing problem in the UK. Many adults who try to quit say they cannot because of withdrawal symptoms they were never warned about. Yet, the medical profession has no good answer for people struggling to stop taking the drugs — no scientifically backed guidelines, no means to determine who’s at highest risk, there are no appropriate strategies available to these individuals. Withdrawal from antidepressants can be disabling and can cause a range of severe physical and psychological effects which often last for months and sometimes years; in some cases, withdrawal charities report, it may lead to suicide.
The United Nations Convention on the Rights of the Child (UNCRC) sets out the fundamental rights of all children and young people. “Nearly 25 years ago, the world made a promise to children: that we would do everything in our power to protect and promote their rights to survive and thrive, to learn and grow, to make their voices heard and to reach their full potential. The Convention changed the way children are viewed and treated – i.e., as human beings with a distinct set of rights instead of as passive objects of care and charity.”
Ironically, Article 33 of the UNCRC states, “You have the right to be protected from dangerous drugs. It specifically names narcotics and psychotropic substances.”
By encouraging children to believe they are broken and are to blame for their distress and by medicating them with powerful drugs we know change brain chemistry, are we taking away their right to survive, and even ability to thrive, be protected and reach their full potential? At what point in their life might a child question their medication? When they do, what damage might already have been done? Parents have a responsibility to learn the truth about antidepressants and their unknown effects on a developing brain. Does any parent have the right to control the development of their child with drugs?
The reality is children parked on antidepressants at a young age become adults. At some point they will make up their own mind about their medication, might find themselves battling prescribed drug dependence or they simply might not like the way they turned out. When this happens, just who will they blame?
Never stop taking or reduce antidepressants without the support and guidance of a medical professional.