Why are we giving our primary school aged children anti-depressants?
When Ben Williams was seven, he began exhibiting the signs of depression, says his mother Jane. “Then one day, I can recall sitting at the top of the stairs with him crying, and he said: ‘Mummy, I am not destined to have a happy life. I’d be better off dead.’ I had no idea where the words came from. I couldn’t believe it.”
Jane, 42, who runs her own coaching and secretarial business in Colne, Lancashire, went to her local GP but was told her son was going through a phase.
“I said, are you kidding me?”, she recalls. “I had to battle to get him some help seeing different GPs until finally I got a referral to Child and Adolescents Mental Health Services (CAMHS). Even this didn’t help because Ben didn’t find it easy to talk to strangers.”
The turning point came when aged 10, in 2010, Ben tried to kill himself. Afterwards he was prescribed a low dose of antidepressants, becoming one of the growing number of children who take these drugs.
New statistics this week showed that doctors handed out 198,906 prescriptions for drugs to treat depression and anxiety to children younger than 18 between April 2015 and September 2016.
And 12,756 of these prescriptions were given to children aged seven to 12, with 617 assigned to those aged younger than six.
The news has caused surprise and concern. Dr Helen Webberley of www.mywebdoctor.co.uk is on the front line when it comes to dealing with children with mental health conditions. “As a GP and Gender Specialist,” she says, “I work with children with a variety of problems, but this statistic really does shock me.
“Depression can occur in two broad ways - it can happen out of the blue for no reason (extraordinarily rare in children) or it can happen because stress, anxiety and difficulties have been going on for so long that the brain’s “coping chemicals” - serotonin and noradrenaline - can get depleted and they need a top-up with medicines (anti-depressants).
“For children to be suffering for so long that their coping chemicals get used up, they must be going through some tough times, and this clearly needs exploring.”
Dr Marc Bush, Chief Policy Advisor at mental health charity Young Minds is concerned about the potential for over medicalisation: “It is worrying that so many primary care professionals are reaching for the prescribing pad and that antidepressants are the first port of call.
“Children taking adult medication will see brain and physical development affected. They should only be offered when appropriate and alongside other support such as family or individual therapy.”
Antidepressants, however, do have a place in treatment explains Olivia Fiertag, Consultant Child and Adolescent Psychiatrist at Nightingale Hospital: “Each child is different, and often antidepressants are not the first-choice treatment for young children with depression or anxiety (with therapy often being the first choice) but in some circumstances yes, a doctor may recommend antidepressants and any prescribing should be done under the supervision of a child psychiatrist.”
She points out: “Most children with depression respond very well to treatment and make a good recovery.”
Jane Williams was relieved Ben had been given tangible help: “With a physical illness, you’d take paracetamol, so why not take something for a mental health problem?”
Perhaps the greatest concern then is not that so many children are being prescribed anti-depressants but that there is a clear lack of additional support.
“Child mental health services are over-stretched,” says Dr Webberley, “and the waiting lists are long.” Despite NHS England’s plans to expand CAMHS so that an additional 70,000 patients can access help each year by 2020/21, NHS England national clinical director for mental health Professor Tim Kendall warned in April they will struggle to recruit the 1,700 extra therapists to CAMHS needed as the service is already short-staffed.
“The NHS says one in three will be seen,” says Dr Bush, “but what about the other two in three – we can’t just leave them to pharmaceutical intervention. We can’t leave them in crisis in communities getting less well and ending up in A and E.”
I would like to think that prescribing anti-depressants for children was an absolute last resort, and that there would have been support for that child and their family at a much earlier stage
Dr Webberley would like to see more early intervention. “Prevention is better than cure, and if we can identify children in need before they need medication, then surely that is better. I would like to think that prescribing anti-depressants for children was an absolute last resort, and that there would have been support for that child and their family at a much earlier stage.”
Dr Bush agrees: “At Young Minds, we can’t even answer all the calls we get from parents and guardians who call us to say they are at an absolute loss.”
That’s a feeling Jane Williams knows. Ben is now 17 and no longer prescribed antidepressants as he has made several suicide threats so can only take them under medical supervision. But as he won’t talk to a crisis team, they cannot access any help.
“I babysit him. We live in limbo. There needs to be more funding for mental health, but parents need guidance too. You never think it will happen to your child until it does.”
