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Depression in children:
drugs should not be a first-line treatment

Treatment of children and adolescents considered to be depressive should rely first and foremost on non-drug treatments. Currently there is no antidepressant that has a favourable risk-benefit balance in children.

It is hard to form a diagnosis of depression in children and adolescents. Their treatment should be based mainly on non-drug measures.

Fluoxetine was approved in France for treatment of depression in children and adolescents. However clinical trials carried out on hundreds of children have failed to demonstrate that fluoxetine has any effect on depressive disorders, especially in the long term. Furthermore, fluoxetine presents potentially severe adverse effects: risk of suicide, growth retardation, psychological disorders. Worrying toxic data from animal testing is a cause for concern over the drug’s long-term effects on humans. There is no justification for prescribing fluoxetine for these patients other than within a possible research framework for the severest cases.

Evaluation studies have been carried out on other antidepressants for the treatment of children and adolescents thought to be suffering from depression. For all the antidepressants evaluated, the risk-benefit balance appears to be unfavourable. The treatment of children and adolescents suffering from depression calls for a multidisciplinary approach with the emphasis on psychotherapy techniques.

©Prescrire June 2008

Source: "Fluoxétine (Prozac° ou autre). Dépression et enfants : que d'incertitudes" Rev Prescrire 2008 ; 28 (296): 410-411.

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