September 28, 2005

UK docs told to hold antidepressants for teens

LONDON (Agence de Presse Medicale) - Antidepressants should
not be used as first-line treatment in patients younger than 18
years old -- even for moderate-to-severe or psychotic
depression -- Britain's health economics watchdog, the National
Institute for Clinical Excellence, said on Wednesday.

In children (5-11 years old) and young people (12-18) with
depression, psychological therapy such as group cognitive
behavior therapy should be the first-line treatment, backed up
by advice on exercise, diet, controlling anxiety and methods of
improving sleep.

For moderate-to-severe depression, psychological therapies
should be prescribed for at least 3 months, but if no
improvement is observed after four to six sessions, doctors may
consider the addition of fluoxetine (Prozac) to the treatment.
In the case of children, the option should be "cautiously"
considered, NICE added in guidance to the health service.

If, after a further six sessions, the patient is not
responding to either the fluoxetine or psychological therapy an
alternative psychological therapy should be considered. If this
fails to bring improvements, clinicians can consider sertraline
(Zoloft) or citalopram (Celexa). Neither drug is licensed for
children and therefore will have to be used off-label, NICE

In the case of continued psychotic depression, an atypical
antipsychotic can be considered in addition to existing

The guidance confirms earlier regulatory advice that
paroxetine (Paxil) and venlafaxine (Effexor/Efexor) are not
recommended in children.

It adds that patients taking the herbal remedy St. John's
wort should be advised to stop.