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Youth suicide rates 'not lowered by restricting antidepressants'

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Antidepressants Suicide rates have not been affected by a restriction on antidepressant use among young people, a study has shown.

Research from Bristol University, which analysed suicide rates among 15 to 19-year-olds in 22 countries from 1990 to 2006, found no change despite the more stringent regulations, the BBC reports.

In October 2003, the Department of Health issued a warning that a number of commonly prescribed antidepressants should not be given to people under 18. The advice followed a review by an Expert Working Group set up to look at the safety of SSRIs (selective serotonin reuptake inhibitors) after concerns were raised that they made some patients suicidal.

The BBC reports that antidepressant use in young people in the UK fell by 50 per cent after the warnings.

Lead researcher of the Bristol university team, Dr Ben Wheeler, told Pulse magazine that there was little evidence to suggest the reduction in prescriptions had been effective in lowering the number of suicides among young people, despite such concerns from some medical practitioners when the restrictions came into place.

"We found no clear evidence of a beneficial effect on population suicide rates," he said in the interview. "However, and equally importantly, we did not find evidence of an adverse effect on suicide rates either."

"This is important, because many mental health workers and researchers have been concerned that reduced antidepressant prescribing to children might inadvertently lead to an increase in suicides," Dr Wheeler commented.

Limited access to treatment

Mental health provision for young people has recently come under scrutiny by an influential government minister, who has succeeded in bringing the important issue once again into the public domain. Lord Layard, emeritus professor of economics at the London School of Economics, revealed that ten per cent of children suffer from some form of mental illness, but only a quarter of them have received specialist treatment in the past year.

In 'Health: Cognitive Therapy, Question for Short Debate', published on the UK Parliament website in March, Lord Layard warned that such a situation "is just not good enough". He advised embarking on a five-year strategy which would train 200 extra child therapists every year and be adequately funded to pay local services for providing the on-the-job training within the NICE guidelines.

"Child mental illness is even more tragic than for adults. It is also the source of so many of our social problems," Lord Layard commented, urging government to continue the funding of mental health services.

Understanding modern childhood

Lord Layard's comments draw on The Good Childhood Inquiry, commissioned by The Children's Society as the UK's first independent, national inquiry into childhood. Published in February of this year, its findings show that one in ten five to 16-year-olds now has clinically significant mental health difficulties - ranging from anxiety, depression, over activity, inattentiveness (ADHD) and anorexia, through to conduct disorders such as uncontrollable or destructive behaviour.

The report finds that mental health difficulties have increased because the quality of children’s experience has deteriorated. Key factors that directly affect mental health include living apart from your father (which increased difficulties by over 40 per cent), family conflict, poor mental health of a parent, living in rented housing and "more than two adverse life events", according to the report.

A "spotlight" on young people's mental health

Responding to Lord Layard's comments, Sarah Brennan, chief executive of mental health charity YoungMinds, said: "We welcome the spotlight on increasing our knowledge of what is currently provided and what is effective in helping children and young people’s mental health problems."

A YoungMinds poll of young people with mental health problems, published in March 2009, found that three-quarters were offered no support when waiting for treatment. Those surveyed reported that doctors often failed to explain to young people the side effects of the treatments offered, and three quarters of the respondents did not know or were unsure what to do if they were unhappy with their treatment.

"Developing understanding is central to achieving a transformation within services that Lord Layard and the CAMHS [child and adolescent mental health services] review want to achieve," Ms Brennan commented.

Rise in prescription of antidepressants

While the prescribing of antidepressants to those under 18 has been curbed in recent years, overall antidepressant prescription rates in England have nearly doubled in the last ten years, the Mental Health Foundation says. Figures from the NHS show that antidepressant prescriptions in English Primary Care Trusts (PCTs) increased on average by two per cent in the first two quarters of the last financial year (2008-09). According to the statistics, only nine of 152 PCTs saw a reduction in the number of prescriptions.

Simon Lawton-Smith, head of policy for the Mental Health Foundation, said: "This data shows how over-reliant we've become on antidepressants, with a near doubling in the number of prescriptions in a decade. Medication can be helpful for some people, but it is not the only or always the best answer."

He recommends more choice for doctors and their patients "including psychological therapies, exercise schemes and social prescribing," instead of medication.

"It may be that more people are coming forward for treatment than previously," he said, referring to the NHS figures on antidepressant prescriptions, "although the evidence suggests that mental health problems remain chronically under-treated".

The Mental Health Foundation supports the government's scheme to provide more psychological therapy in England "as an important first step towards achieving a more balanced approach to treating mental health problems."

In October 2007, the government announced funding that will rise to £170 million a year by 2010-11 for its Improving Access to Psychological Therapies programme. The scheme aims to cut waiting times and improve access to treatment for mental health issues.

If you are experiencing suicidal thoughts or emotional distress, you can contact Samaritans for support 24 hours a day by phone on 08457 90 90 90 (UK) and 1850 60 90 90 (ROI), or email at jo@samaritans.org, or face to face – visit www.samaritans.org for details of your nearest branch.

Youth suicide rates 'not lowered by restricting antidepressants'

Limited access to treatment

Understanding modern childhood

A "spotlight" on young people's mental health

Rise in prescription of antidepressants

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