CMAJ • June 8, 2004; 170 (12). doi:10.1503/cmaj.1040647.
© 2004 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

SSRI treatment for under-18s

Andrew Herxheimer* and Barbara Mintzes{dagger}

*Emeritus Fellow, UK Cochrane Centre, London, UK; {dagger}Postdoctoral Fellow, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC

Yes, we think that Mark Voysey has indeed got it straight, although we believe that it is not appropriate to prescribe SSRIs for children or adolescents even as a last resort. As outlined in our commentary,1 there is just no convincing evidence that they work. Jureidini and associates2 have pointed out that even among the minority of trials that have been published, authors consistently exaggerated benefits and downplayed serious risks. Overall, these authors concluded that trial results failed to support a benefit of sufficient magnitude to outweigh the risks.2

Voysey tries never to complain without offering some constructive suggestion. In a similar spirit, we suggest that the changes needed are systemic. Canada's parliamentary health committee has just released an excellent report,3 calling for 3 key changes to drug regulation: better monitoring and public access to information on clinical trials, conditional drug approvals coupled with improved post-market surveillance and enforcement of Canada's law prohibiting direct-to-consumer advertising of prescription drugs. These changes are badly needed and would go a long way toward preventing similar future harm. Canada is of course not the only country in which drug regulation needs a radical overhaul: regulatory agencies in Europe and the United States also fail to adequately consider the public interest.4

Andrew Herxheimer Emeritus Fellow UK Cochrane Centre London, UK Barbara Mintzes Postdoctoral Fellow Centre for Health Services and Policy Research University of British Columbia Vancouver, BC

Footnotes

Competing interests: None declared.


References

  1. Herxheimer A, Mintzes B. Antidepressants and adverse effects in young patients: uncovering the evidence [editorial]. CMAJ 2004;170 (4):487-9.[Free Full Text]
  2. Jureidini JN, Doecke CJ, Mansfield PR, Haby MM, Menkes DB, Tonkin AL. Efficacy and safety of antidepressants for children and adolescents. BMJ 2004;328:879-83.[Free Full Text]
  3. Brown B, chair. Opening the medicine cabinet. First report on health aspects of prescription drugs. Report of the Standing Committee on Health. Ottawa: House of Commons; 2004 Apr. Available: www.parl.gc.ca/InfocomDoc/Documents/37/3/parlbus/commbus/house/reports/healrp01/healrp01-e.pdf (accessed 2004 Apr 13).
  4. Medawar C, Hardon A. Medicines out of control? Antidepressants and the conspiracy of goodwill. Amsterdam: Aksant Academic Publishers; 2004.




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