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What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study
  1. Paul A Tiffin1,2,
  2. Jose L Mediavilla3,
  3. Helen Close4,
  4. Adetayo S Kasim5,
  5. Patrick Welsh4,
  6. Lewis W Paton1,
  7. James M Mason6
  1. 1Department of Health Sciences, University of York, York, UK
  2. 2Health Professions Education Unit, Hull York Medical School, York, UK
  3. 3Darlington Community Team for Children and Young People, Tees Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
  4. 4The Research Design Service North East and Cumbria, Institute of Health and Society, University of Newcastle, Newcastle, UK
  5. 5Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, UK
  6. 6Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Paul A Tiffin; paul.tiffin{at}


Objectives To assess the impact of both the Committee on Safety of Medicines (CSM) warning (December 2003) and the National Institute for Health and Care Excellence (NICE) guidance (September 2005) on antidepressant prescription rates in children and adolescents within the UK primary care service.

Setting Population based study of primary care antidepressant prescribing using the Clinical Practice Research Datalink (CPRD).

Participants Under-18s presenting to primary care with a depressive disorder or related diagnostic code recorded in the CPRD.

Primary outcome measure Antidepressant prescription rates per month per 100 000 depressed 4–17 year olds.

Results Following the CSM warning, the prior trend towards increased prescribing rates for selective serotonin reuptake inhibitors (SSRIs) in children was significantly reversed (β for change in trend −12.34 (95% CI −18.67 to −6.00, p<0.001)). However, after the publication of the NICE guidelines the prior trend towards increased prescribing resumed for those SSRIs mentioned as potential treatments in the guidance (fluoxetine, citalopram and sertraline) (β for change in trend 11.52 (95% CI 5.32 to 17.73, p<0.001)). Prescribing of other SSRIs and tricyclics remained low.

Conclusions Despite a strong emphasis on psychosocial interventions for child and adolescent depression, it may be that the NICE guidelines inadvertently encouraged further antidepressant prescribing, at least for those SSRIs cited. Although the guidelines gave cautions and caveats for the use of antidepressants, practitioners may have interpreted these recommendations as endorsing their use in young people with depression and related conditions. However, more accurate prevalence trend estimates for depression in this age group, and information on the use of psychosocial interventions would be needed to rule out other reasons underlying this increase in prescribing.

  • primary care
  • epidemiology

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  • Contributors PAT led on project conception, design and statistical analyses. JLM led on data cleaning and linking. HC contributed to project design and data preparation. ASK contributed to data analysis and the supervision of statistical analyses. PW contributed to data preparation and cleaning. LWP contributed to statistical analyses. JMM contributed to the study design and additional supervision of statistical analyses. All authors contributed to the drafting and critical appraisal of the manuscript. All authors have approved the final version of the manuscript submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available from the Clinical Practice Research Datalink via an application.

  • Patient consent for publication Not required.

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