We share the concern of the National Institute for Health and Care Excellence (Nice) at using these drugs for children under 18 years of age in this country, which is occurring more apparently (Fears for children under 10 on strong antidepressants, 22 November). The US Food and Drug Administration has warned about the increased suicide risk associated with the use of selective serotonin reuptake inhibitors (SSRIs) and issued a “black-box warning”, highlighting the increased risk of suicidal thinking in their use with adolescents.
I have been advised by colleagues in psychiatry that these drugs can raise young people’s energy level before they act to raise their mood, especially in the early months of use. This could lead to increasing the mindset and energy to carry out their “dark thoughts”, either harming themselves or others.
We wholeheartedly support the Nice guidelines recommendations that prescribing these drugs should be a last resort for children under 18 and not be used for those under the age of 10.
Dave Traxson Chair of Calm (Child-friendly Alternatives to Labelling & Psychiatric Medications)
Professor Peter Kinderman Professor of clinical psychology at Liverpool University, past president of the British Psychological Society (2016-17) and Vice-chair of Calm
• Your report is shocking. The two drugs most widely prescribed as first choice are paroxetine and venlafaxine, both SSRIs. These are powerful drugs, and the effect on developing brains is little researched. What little research there is suggests an increased risk of suicidal thoughts. But not only that, they are the two SSRIs with the most devastating withdrawal symptoms.
Antidepressant withdrawal (“antidepressant discontinuation syndrome”) is seldom referred to when antidepressants are prescribed, for obvious reasons. The symptoms can be very serious, very frightening, and sometimes worse than the initial presenting symptoms. Withdrawal needs to be closely supervised and extremely gradual to minimise these symptoms. And drug companies make it more difficult to achieve by not producing low enough dosages to facilitate gradual tapering.
What are we doing subjecting our children and young people to such damaging and dangerous drugs? Why aren’t we helping them throughout their education to develop the life skills necessary to manage their emotions? The resilience to the stresses of 21st-century life is a far better long-term solution than toxic drugs that might commit a child to years trapped in a cycle of dependence.
Chris Youle
Winchester, Hampshire
• The results of the NHS digital survey into the mental health of children and young people (More than a fifth of girls aged 17-19 attempt self-harm or suicide, 23 November) are certainly alarming but it is doubtful they can be accurately presented as the “latest evidence of the growing epidemic of mental ill health in young people”. In five- to 15-year-olds (the only age group covered in all three surveys) there was a slight increase over time in the prevalence of mental disorders, from 9.7% in 1999 to 10.1% in 2004 to 11.2% in 2017; hardly a dramatic rise. The figures relating to emotional disorder and self-harm in 17- to 19-year-olds cannot be said to represent a rise as this age group was not investigated in previous surveys.
Not mentioned in your report is the fact that the study shows other disorder types, especially antisocial behaviour and hyperactivity, have been largely stable since 1999. In addition, the rate of autism spectrum disorder was stable between 2004 and 2017, providing no support for the commonly held view that rates of this disorder are rising. The figures presented in this authoritative study are sufficiently worrying to amply justify calls for more specialist services, but talk of an epidemic is exaggerated.
Professor Philip Graham
London
• It is shocking that people, including children, caught up in terror attacks who have been injured, lost a close relative, or witnessed horrific scenes, should be left with little or no support from mental health services (Terror victims call for improved counselling, 21 November). Because the psychological effects are invisible, they do not attract nearly the same attention as physical injuries, although the wounds can be just as deep and the scars just as long lasting.
We know from people who contact our helpline that many are struggling due to the long waits between seeing their GP or consultant and receiving any form or counselling.
If we cannot deal with people who have been seriously affected by such extreme events, how can the government hope to fulfil its promise that everyone in need should have access to early intervention and psychotherapy?
Marjorie Wallace
Chief executive, Sane
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