SSRI treatment for under-18s

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