Happy pills a symptom of deep malaise

Children throughout the world are increasingly being prescribed antidepressants and other psychiatric drugs, according to research just published in Archives of Disease in Childhood, the official journal of the Royal College of Paediatrics and Child Health. And the figure is rising fastest in the UK: between 2000 and 2002, the rate of increase here was five times that of comparable European neighbours.

Researchers at the Institute of Child Health and London University's school of pharmacy analysed recent prescribing trends for antidepressants, stimulants, tranquillisers and antipsychotics on children up to the age of 17 in the UK, France, Germany, Spain, Canada, the United States, Argentina, Brazil, and Mexico. All showed big rises, except Canada and Germany; the latter had the lowest increase, 13 per cent. The biggest increase, 68 per cent, was in the UK.

The authors acknowledge that the increase might be due to improvements in the diagnosis of mental illness among young people. But even if that is true, why are drugs the primary treatment, and why are British children more depressed than others?

Another study in the same journal, also from London's school of pharmacy, produced figures for a sample of general practices which, if extrapolated, suggest that more than 600,000 children and adolescents in the UK have been prescribed antidepressants over the past decade. The largest increase is among 11 to 14-year-old girls: 20 times as many were prescribed such drugs in 2001 than in 1992.

In 2003, the Committee on Safety of Medicines recommended the withdrawal of several antidepressants following concerns that they might be exacerbating suicidal tendencies among children and adolescents. It will be interesting to see if suicide rates fall, as GPs are being given no alternative options - such as family therapy - to medication. Anyway, it is highly unlikely that a pill can directly tackle the underlying causes of our children's emotional distress.

Even more worrying, the level of recognised mental illness among children is likely to be an underestimate. Specialists have long known that depression in children is easily missed by parents, teachers and GPs.

Depressed children rarely show the same symptoms as adults; instead they tend to display bad behaviour, aggression, withdrawal, and opposition to and defiance of authority. They may also turn to drugs or alcohol.

Truanting and hanging out with "the wrong kind" is strongly linked to a "masked" depression.

But if the reality is worse than the figures suggest, why is the mental and emotional health of our children in such a parlous state, and why is it deteriorating so rapidly? Depressed children usually have highly stressed parents who have become withdrawn or preoccupied with their own problems.

It often seems as if the child's depression has distressed the parents, but more frequently it's the other way round.

A well parent who provides support for the rest of the family can compensate for a depressed parent. But things begin to fall apart when both parents are upset or at loggerheads. Perhaps, therefore, the soaring level of relationship breakdown and spiralling divorce rates are to blame.

The danger is that these spectacular figures will be misunderstood for what they really are: an indication of the emotional health of the British family. The evidence is that the problem has reached crisis point and needs urgent attention.

Professor Raj Persaud is a consultant psychiatrist at the Bethlem Royal and Maudsley hospitals in London. His latest book is The Motivated Mind (Bantam Press, pound;12.99). Email: rajpersaud@tes.co.uk

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