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The Herald Scotland
In less than a decade, the number of ten to 14-year-olds taking anti-anxiety and insomnia drugs such as diazepam, zopiclone and benzodiazepines – better known as sedatives or tranquilisers – has soared eight-fold, from 703 in 2009/10 to 5,533by 2018/19.
Official guidelines stress that tranquilisers should be restricted to cases of anxiety which are “severe, disabling or causing unacceptable distress”, or for the treatment of sleeping problems “only after the underlying causes have been established and treated”.
But as of last year, one in 50 children aged 10 to 14 in Scotland was prescribed a sedative.
Over the same nine-year period in this age group, the number of children taking antidepressants has almost tripled, from from 483 to 1,354, with the use of antipsychotics to relieve hallucinations, delusional beliefs, and disordered thoughts also up 27%, from 327 to 416.
The increases are particularly stark because they far outstrip the population average.
Since 2009, the total number of Scots taking antidepressants has increased 48%, with 3.3% and 2.5% rises respectively in the number of people on sedatives and antipsychotics.
There are also signs that the use of psychoactive drugs in children is gaining momentum.
Although the use of both tranquilisers and antidepressants in 10 to 14-year-olds has been climbing steadily since 2009, the year-on-year increases have been going up – particularly since 2013 – and the spike in patient numbers between 2017/18 and 2018/19 was the largest yet recorded.
One in 200 10 to 14-year-olds was on an antidepressant last year.
Exactly what is behind the pattern – and whether it should be happening at all – remains contentious.
It must be said that antidepressants are not always prescribed for depression: amitriptyline is also prescribed for pain, fluoxetine in patients with bulimia, and sertraline for obsessive-compulsive disorder (OCD). Some older types of antidepressants are even used for bed wetting, while the common sedative diazepam (Valium) eases muscle spasms. They are also prescribed for ME and migraine.
It is also impossible from the statistics, collated by ISD Scotland, to determine how many children were given a one-off prescription and how many are on long-term treatment.
However, it is also true that diagnoses of major depressive and anxiety disorders in young people have being growing rapidly, not only in Scotland but across the UK and in the United States.
John Read, a professor of clinical psychology at the University of East London who was among the expert panel for Public Health England’s recent review into prescribed drug dependence, said he was “alarmed but not surprised” by the Scottish figures.
He described it as an “extremely worrying medicalisation of distress”.
He added: “These children have got things going on in their lives that they need help with, but they don’t have medical disorders that need medicating. We don’t have any evidence that there’s an increase in mental health problems in our youth.
“What there is is a very effective marketing campaign by the drug companies. It’s a known strategy they’ve used for 50 years: once they’ve saturated the adult market, for which there is research and regulation, they push beyond that in two directions.
“They push them into old people’s homes, and they push down into the under-18 and under-16 bracket for which there is practically no research – certainly no long-term research – on the effects of these drugs on children’s brains.
“We just have no idea what effect these chemicals have on the developing brains of our children.
“It’s utterly unethical and certainly unscientific to be using these drugs on kids this young.”
Most sedatives are not licensed for use in under-15s but can be prescribed ‘off-label’ by a specialist doctor for strictly limited periods – typically no more than four weeks – due to the risk of addiction.
In June this year, NICE guidelines were also updated in support of using the antidepressant fluoxetine (Prozac) in five to 11-year-olds with moderate to severe depression, combined with psychological therapy. It was already indicated for use in the 12 to 17 age group.
Dr Aileen Blower, vice-chair of the child and adolescent faculty in Scotland for the Royal College of Psychiatrists, said that as long as they are prescribed cautiously, at low and gradually increased doses with careful monitoring, there was no evidence to suggest antidepressants were any more dangerous in young people than any other prescribed medications.
Blower said: “The rationale for giving antidepressants is that they speed up recovery because they help a young person re-engage with other things that promote recovery, like social networks and school, or psychological therapy.
“The overall illness course is shorter. Young people are at such a crucial time in development so any time in recovery is extremely valuable.
“They don’t work for everybody but, in my experience, they work for a majority and they can really help young people engage with psychological therapies, get back to school, look after themselves, and definitely reduce suicide risk.”
There are no official figures on suicides among under-15s in Scotland as they are termed “events of undetermined intent” – in other words, it is considered impossible to tell whether children at that age actually wanted to end their lives.
The same applies in those aged 85 and over.
Between 2011 and 2018 there were 101 such “undetermined” deaths among the very young and very old.
Among 15 to 24-year-olds the suicide rate in 2018 was the highest in more than a decade, at 15.1 per 100,000, but not the highest on record. It peaked in 1993 at 19 per 100,000.
However, a major study published in the British Medical Journal in 2016 did find that under-18s taking antidepressants were three times more likely to think about and attempt suicide than those on a placebo. The same increase was not found in adults.
That said, the authors stressed that while the increased risk was real, it was also small: only three in every 100 children taking antidepressants developed suicidal thoughts (compared to one in 100 on the placebo), and none actually committed suicide.
Their main criticism was that a shortage of antidepressant studies in young people and poor data reporting means that “a true risk for serious harms is still uncertain”. They concluded by advising “minimal use” of antidepressants in children and teenagers.
Although research has found evidence that unhappiness – or ‘low mood’ – is becoming more prevalent among teenage girls, Blower says that should not be conflated with a rise in clinical depression.
She believes mental health awareness drives – in schools, by charities and in public health initiatives or popular culture – mean youngsters who would not previously have sought help now do.
But she says that does not mean young people’s mental health is actually worse now than in decades past.
She said: “There’s been a steady increase in referral rates to Child and Adolescent Mental Health Services and an increase in the numbers of young people being seen. That’s a good thing.
“All the time I’ve practised young people have suffered adversity, these aren’t new problems. Difficulties in schooling and peer relationships, poverty, loss, bereavement, physical illness – these all increase the risk of depression.
“The only difference now is social media. But whether that’s having the impact that people fear, I don’t know.”
Beverley Thorpe, an Inverness-shire based researcher for the Council for Evidence-based Psychiatry, which lobbies on the potentially harmful effects of psychiatric drugs, believes “bombarding” young people with the awareness message has been counterproductive.
She said: “Many of the things children are experiencing are probably normal childhood experiences; the problem is that nowadays we’re told we need help for it.
“Doctors often have no alternative when children face waiting 10-11 months or more for psychological therapy. Sometimes antidepressants are the only help that’s there. But the guidelines state that children should be reviewed weekly in the first four weeks. Yet that’s often impossible.
“Available studies show there is very little long-term benefit, there are very few trials for children in that age group, and studies on trials that have been done show they hid a lot of unfavourable data and exaggerated a lot of the benefits.
“We really need to re-evaluate the way we help children with the situations that they find themselves in.”