Clinical characteristics associated with the prescribing of SSRI medication in adolescents with major unipolar depression

Lesley Cousins; Kirstie J Whitaker; Barry Widmer; Nick Midgley; Sarah Byford; Bernadka Dubicka; Raphael Kelvin; Shirley Reynolds; Christopher Roberts; Fiona Holland; Barbara Barrett; Robert Senior; Paul Wilkinson; Mary Target; Peter Fonagy; Ian M Goodyer

doi:10.1007/s00787-016-0849-y

Clinical characteristics associated with the prescribing of SSRI medication in adolescents with major unipolar depression

Eur Child Adolesc Psychiatry. 2016 Dec;25(12):1287-1295. doi: 10.1007/s00787-016-0849-y. Epub 2016 Apr 28.

Authors

Lesley Cousins^{1

2}, Kirstie J Whitaker¹, Barry Widmer¹, Nick Midgley^{3

4}, Sarah Byford⁵, Bernadka Dubicka^{6

7}, Raphael Kelvin^{1

2}, Shirley Reynolds⁸, Christopher Roberts⁹, Fiona Holland⁹, Barbara Barrett⁵, Robert Senior¹⁰, Paul Wilkinson^{1

2}, Mary Target^{3

4}, Peter Fonagy^{3

4}, Ian M Goodyer^{11

12}

Affiliations

¹ Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK.
² Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
³ Anna Freud Centre, University College London, London, UK.
⁴ Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
⁵ Centre for the Economics of Mental and Physical Health, Kings College London, London, UK.
⁶ Institute of Brain and Behaviour and Mental Health, University of Manchester, Manchester, UK.
⁷ Lancashire Care Foundation Trust, Preston, UK.
⁸ School of Medicine, University of East Anglia, Norwich, UK.
⁹ Biostatistics Group, Institute of Population Health, University of Manchester, Manchester, UK.
¹⁰ The Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, UK.
¹¹ Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK. [email protected].
¹² Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. [email protected].

Abstract

Unipolar major depressions (MD) emerge markedly during adolescence. National Institute for Health and Care Excellence (NICE) UK recommends psychological therapies, with accompanying selective serotonin reuptake inhibitors (SSRIs) prescribed in severe cases only. Here, we seek to determine the extent and rationale of SSRI prescribing in adolescent MD before entering a randomised clinical trial. SSRI prescribing, together with their clinical characteristics was determined in 465 adolescent patients with MD prior to receiving a standardised psychological therapy as part of the Improving mood with psychoanalytic and cognitive therapies (IMPACT) clinical trial. Overall, 88 (19 %) had been prescribed antidepressants prior to psychological treatment. The clinical correlates varied by gender: respectively, depression severity in boys and self-harming behaviours in girls. Prescribing also differed between clinical research centres. Medical practitioners consider severity of depression in boys as an indicator for antidepressant prescribing. Self-injury in girls appears to be utilised as a prescribing aid which is inconsistent with past and current revised UK NICE guidelines.

Keywords: Adolescents; Antidepressants; Depression; Risk; SSRIs; Self-harm.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Adolescent
Antidepressive Agents / therapeutic use*
Depressive Disorder, Major / diagnosis*
Depressive Disorder, Major / drug therapy*
Depressive Disorder, Major / psychology
Drug Prescriptions*
Female
Humans
Male
Selective Serotonin Reuptake Inhibitors / therapeutic use*
Self-Injurious Behavior / diagnosis
Self-Injurious Behavior / drug therapy
Self-Injurious Behavior / psychology
Severity of Illness Index*
Sex Characteristics
Surveys and Questionnaires

Substances

Antidepressive Agents
Serotonin Uptake Inhibitors

Abstract

Publication types

MeSH terms

Substances

Grants and funding