Lack of talking therapies highlights dilemma over children’s Prozac use

Doctors are now licensed to prescribe Prozac for children but, despite instructions that the drug must be used with talking therapies, Amy Taylor finds concern over its use

Prozac became the first drug to be licensed to treat depression in children in the UK earlier this month, sparking fears that GPs may over-prescribe the drug to young people (Warning over using Prozac for children, 15 June).

Drugs regulator the European Medicines Agency has approved the use of the drug for children aged eight and above who suffer from moderate to severe depression and fail to respond to psychological therapy. It says the drug should be used only with talking therapies and use should be reconsidered if no clinical benefit is seen within nine weeks of treatment.

David Cottrell, professor of child and adolescent psychiatry at the University of Leeds and a trustee of children’s mental health charity YoungMinds, does not believe that the decision will lead to more children being prescribed Prozac. Doctors have been prescribing the drug to under-18s without a licence for years and the ruling regulates this practice, he says.

Figures show that the lack of a licence for children has not stopped the drug being used. In early 2004 it was estimated that about 40,000 under-18s in the UK were on selective serotonin reuptake inhibitors, a class of antidepressants that includes Prozac, which is taken by about half of this group.

Paul Farmer, chief executive of mental health charity Mind, says professionals must listen to children’s experiences of using Prozac. He cites the long time it took for adverse reactions to the antidepressant drug Seroxat to be heard.

Farmer says: “On awarding the licence there needs to be a message about clinicians being careful about giving the treatment and monitoring the side-effects. People don’t listen enough to people’s experiences and that’s even more important when you are talking about children.”

Suspected side-effects can be reported through the yellow card system. This involves medical professionals or patients sending information to drug regulatory bodies if they experience bad reactions. Farmer says the fact that the drug is now licensed for children means that this system can be used, which he says is essential.

It is believed to be the first time a regulator has required psychological therapy to be given before and alongside drug use as a condition of its licence. The requirements are also in line with guidance on prescribing antidepressants to children produced by the National Institute for Health and Clinical Excellence last September.

Farmer says this is to be welcomed but that talking therapies are scarce in some parts of the country. “There are problems with accessing talking therapy treatment,” he says. “Having to hold your tongue for nine months is a big underlying issue.”

Paul Corry, director of public affairs at mental health charity Rethink, says drugs are over-prescribed to children for depression and agrees that more talking therapy services are desperately needed. “Most areas don’t even have waiting lists because they say there’s no point waiting for things that they can’t deliver.” He adds that some doctors put 14-year-olds on lists for adults’ services because the wait is so long they will be 18 when their turn comes round.

The government launched a 3.7m talking therapy pilot project last month, saying it wanted to “end the Prozac nation”. So far this has resulted in two limited demonstration sites in Newham, east London, and Doncaster where adults with common mental health problems will receive psychological therapies.

Part of the reason behind this is to take people off long-term incapacity benefit but Corry says it is equally cost-effective to provide the therapy to children as it will prevent them from requiring more expensive interventions later.

Last week Richard Layard, the Labour peer behind the government’s talking therapies policy, said the Department of Health would not fund the roll-out of talking therapies without a “clamour” for them from the mental health sector. The clamour is now there but, unless ministers listen to concerns about the drug and fund the roll-out of talking therapies, there is the danger of creating a younger Prozac nation.