title: Clinical characteristics associated with the prescribing of SSRI medication in adolescents with major unipolar depression.
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.
authors.affiliation: Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK.|Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Cousins
authors.affiliation: Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK.
authors.forename: Kirstie J
authors.initials: KJ
authors.lastname: Whitaker
authors.affiliation: Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Widmer
authors.affiliation: Anna Freud Centre, University College London, London, UK.|Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Midgley
authors.affiliation: Centre for the Economics of Mental and Physical Health, Kings College London, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Byford
authors.affiliation: Institute of Brain and Behaviour and Mental Health, University of Manchester, Manchester, UK.|Lancashire Care Foundation Trust, Preston, UK.
authors.forename: Bernadka
authors.initials: B
authors.lastname: Dubicka
authors.affiliation: Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK.|Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: Raphael
authors.initials: R
authors.lastname: Kelvin
authors.affiliation: School of Medicine, University of East Anglia, Norwich, UK.
authors.forename: Shirley
authors.initials: S
authors.lastname: Reynolds
authors.affiliation: Biostatistics Group, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Roberts
authors.affiliation: Biostatistics Group, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Holland
authors.affiliation: Centre for the Economics of Mental and Physical Health, Kings College London, London, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
authors.affiliation: The Tavistock and Portman NHS Foundation Trust, Tavistock Centre, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Senior
authors.affiliation: Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK.|Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Wilkinson
authors.affiliation: Anna Freud Centre, University College London, London, UK.|Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Target
authors.affiliation: Anna Freud Centre, University College London, London, UK.|Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Fonagy
authors.affiliation: Developmental Psychiatry Section, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, UK. ig104@cam.ac.uk.|Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. ig104@cam.ac.uk.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Goodyer
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D012727:Sex Characteristics; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Adolescents; Antidepressants; Depression; Risk; SSRIs; Self-harm