Antidepressant prescription by British child psychiatrists: practice and safety issues

To evaluate the pattern of prescribing antidepressant (AD) drugs by British child psychiatrists with particular emphasis on the impact of newer-type (heterocyclic and selective serotonin reuptake inhibitor) agents on this practice and to assess the safety of AD use for children in terms of clinicians' reports of adverse effects.

A short postal survey asking specific questions about these aspects of their clinical practice was sent to 350 British child psychiatrists.

The response rate was 71%. A clear majority of the 238 respondents (85%) who provided analyzable reports had prescribed ADs, the most popular of these being amitriptyline and imipramine, although nearly one third of prescribers also used newer agents occasionally and the selective serotonin reuptake inhibitors specifically, very rarely indeed. British child psychiatrists issued only one or two new prescriptions for AD medication per year. ADs were being used for a wide range of child and adolescent psychiatric disorders beyond the product data sheet-recommended indications of "depression" and "nocturnal enuresis." High rates of mostly mild adverse effects were reported in children treated with older-type ADs; however, the use of newer ADs did not appear to have influenced this picture when the reports of prescribers of only older ADs were compared with reports of those who also prescribed newer agents.

Despite a willingness to use this form of treatment, British child psychiatrists tend to use it very sparingly compared to practices revealed in American studies. The preferential and infrequent use of older AD agents may account for the high rates of adverse effects reported. These practices do not allow clinicians to become familiar with, and thus more comfortable about, using newer agents.