BackgroundConcerns relating to increased use of psychotropic medication contrast with those of
under-treatment and under-recognition of common mental disorders in children and young
people (CYP) across developed countries. Little is known about the indications recorded
for antidepressant prescribing in primary care in CYP.MethodThis was an electronic cohort study of routinely collected primary-care data from a
population of 1.9 million, Wales, UK. Poisson regression was undertaken to model
adjusted counts of recorded depression symptoms, diagnoses and antidepressant
prescriptions. Associated indications were explored.Results3 58 383 registered patients aged 6–18 years between 1 January 2003 and 31 December
2013 provided a total of 19 20 338 person-years of follow-up. The adjusted incidence of
antidepressant prescribing increased significantly [incidence rate ratio (IRR) for 2013
= 1.28], mainly in older adolescents. The majority of new antidepressant prescriptions
were for citalopram. Recorded depression diagnoses showed a steady decline (IRR = 0.72)
while depression symptoms (IRR = 2.41) increased. Just over half of new antidepressant
prescriptions were associated with depression (diagnosis or symptoms). Other
antidepressant prescribing, largely unlicensed, was associated with diagnoses such as
anxiety and pain.ConclusionAntidepressant prescribing is increasing in CYP while recorded depression diagnoses
decline. Unlicensed citalopram prescribing occurs outside current guidelines, despite
its known toxicity in overdose. Unlicensed antidepressant prescribing is associated with
a wide range of diagnoses, and while accepted practice, is often not supported by safety
and efficacy studies. New strategies to implement current guidance for the management of
depression in CYP are required.