The use of Selective Serotonin Re-uptake Inhibitors (SSRIs) in the treatment of depressive disorders in children and adolescents.

There is a controversy about the use of SSRIs in the treatment of depressive disorders'in children and adolescents. Media concern that SSRIs might precipitate suicidal acts in teenagers was highlighted in a BBC Panorama programme (BBC News, 2003). Shortly afterwards, the pharmaceutical companies GlaxoSmithKline and Wyeth issued warnings about their products Paroxetine and Venlafaxine. In December 2003, the Committee on Safety of Medicines (CSM) reviewed the evidence of published and unpublished trials of SSRIs for the treatment of depression in children and adolescents and other antidepressants — Venlafaxine, and Mirtazapine (Committee on Safety of Medicines, 2003). The CSM raised two areas of concern: (1) efficacy apart from fluoxetine SSRIs appeared to be no more effective than placebo; and (2) safety -an apparent increase in self-harm and suicidal thoughts in those treated with SSRIs. On this basis the CSM no longer recommended the use of SSRIs in the treatment of depressed children with the exception of Fluoxetine, and then only under specialist supervision. In the United Kingdom the use of all the SSRIs including Fluoxetine is off licence for the treatment of depression in this age group. In Sept 2004 the US Food and Drug Administration (FDA) issued warnings about the increased risk of suicidal thoughts and actions with all