Published: February 2009

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Selective serotonin re-uptake inhibitors (SSRI) in children and adolescents

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Prescriber Update 30(1): 1
February 2009

Prescribers are reminded of the risks and benefits associated with SSRI antidepressants when used to treat major depressive disorder (MDD) in children and adolescents.

Medsafe and the Medicines Adverse Reaction Committee have recently conducted a review on the use of SSRI antidepressants in children and adolescents. Following this review, Medsafe advises the following:

1. The most common reason for suicidality and completed suicide is an untreated or worsening mood disorder.
2. The only antidepressant with overall data indicating efficacy better than placebo in children and adolescents is fluoxetine. This may indicate a positive risk benefit balance for fluoxetine.
3. All SSRIs have consistently been associated with an increase in suicidality in meta-analyses of clinical trials of the use of SSRIs to treat MDD in children and adolescents. The term suicidality includes suicidal thinking and suicide attempts, but has not been proven to correlate with or lead to completed suicide.
4. No antidepressant has ministerial consent for the indication of treating MDD in children and adolescents. This means informed consent must be obtained from the patient or parent prior to initiating an SSRI for MDD in children or adolescents.
5. Any patient diagnosed with MDD should be monitored closely for suicidality. If the treatment of a specific patient warrants antidepressant use, this should be considered in consultation with a Child and Adolescent Psychiatrist, an adult Psychiatrist, or a Paediatrician. Particular care should be taken in the period shortly after initiating antidepressant treatment, after a change in dosage, and after discontinuing treatment.

This advice should be read in conjunction with current clinical treatment guidelines for depression published by: The Royal Australian and New Zealand College of Psychiatrists; The New Zealand Guidelines Group; The Werry Centre for Child and Adolescent Mental Health Workforce Development; and Best Practice Advocacy Centre (BPAC)^NZ.