This week Mad in America explores four recently published articles related to antidepressant use in children and adolescents. The first reports that although clinical trials have found little efficacy for the use of fluoxetine (Prozac) as a treatment for depression in children, clinical guidelines still recommend it. The second finds that persistent antidepressant use is common and rising in Australian children. The third links persistent antidepressant use to increased risk of sudden cardiac death in Danish residents. The fourth examines the overmedicalization of childhood that often results in exposure to potentially harmful treatments. Taken together, these articles reveal a system that overmedicalizes childhood and clinical guidelines that expose children to drugs despite little to no efficacy and significant negative effects.

Prozac Ineffective for Kids, but Still Recommended

A new commentary published in the Journal of Clinical Epidemiology reports that the antidepressant fluoxetine, commonly sold as Prozac, has been shown to work no better than placebo at treating depression in pediatric populations. The current work, led by Martin Plöderl from the Paracelsus Medical University in Austria, finds that treatment guidelines have mostly ignored these clinical trial findings, with some still recommending this drug as a first line treatment.

Clinical guidelines for the use of fluoxetine in pediatric populations rely mainly on two clinical trials. A 2016 trial found that antidepressants were largely not effective for treating depression in children, with fluoxetine being the only drug to show even minimal clinical significance.

A more recent trial in 2020 showed similar results for fluoxetine. Both trials rated the confidence in their efficacy findings for fluoxetine as “very low,” citing issues with imprecision and inconsistency. Despite these trials showing minimal improvements and “very low” confidence in fluoxetine’s efficacy, recent clinical guidelines rely on both to support recommending this drug to treat depression in children.

A 2021 trial published as a Cochrane review found that fluoxetine showed no clinical significance for the treatment of depression in children. Although the lead author clearly stated that the difference between a placebo and fluoxetine was “small and unimportant,” clinical guidelines published by the American Academy of Child & Adolescent Psychiatry in 2023 cited this trial to support the use of this drug to treat depression in children. The authors of the current work note that other clinical guidelines published after the Cochrane review trial have similarly ignored unfavorable findings for fluoxetine.

This kind of reframing of evidence and ignoring negative clinical trial results increases children’s exposure to drugs with little to no clinical benefit.

Persistent Antidepressant Use in Children is Common and Increasing

A new study published in the Australian & New Zealand Journal of Psychiatry finds that persistent antidepressant use is fairly common in children and adolescents. This research, led by Gizat M. Kassie from the South Australian Health and Medical Research Institute, reports that prolonged antidepressant use is more common in girls and participants using other psychotropic drugs.

The authors used data from Australia’s Pharmaceutical Benefits Scheme to investigate rates of antidepressant use by children and adolescents for more than one year, and more than two years. Persistent use was defined as a continuous supply of antidepressants with no more than 90 days between dispensing. In total, the authors examined data from 44,366 children and adolescents between the ages of 5 – 18 that were prescribed antidepressants.

One quarter of participants (23.1%) filled an antidepressant prescription just once. Thirty-three percent were persistent users after one year, and 19.8% were persistent after 2 years. Girls were 13% more likely to be persistent users after one year compared to boys. Participants that were taking antipsychotics (37% more likely) and stimulants (60%) were also more likely to be persistent users after one year. These numbers were similar for persistent use rates after 2 years. Those prescribed SSRIs were more likely to be consistent users compared to those prescribed SNRIs and mirtazapine.

According to the current work, persistent antidepressant use by children and adolescents in Australia has risen nearly every year between 2014 – 2022. Persistent use after one year was 31% more likely in 2022 compared to 2014. Persistent use after two years was 39% more likely in 2022 compared to 2014.

There were two major limitations with this work. The authors measured dispensed rather than consumed antidepressants. The participants were Australian, significantly limiting generalizability to other populations.

Research has linked persistent antidepressant use to negative outcomes.

One-third of Sudden Cardiac Deaths Involve Antidepressants

A new article published in Heart Rhythm finds that long-term exposure to antidepressants is linked to increased risk of sudden cardiac death. This study, led by Jasmin Mujkanovic from Copenhagen University Hospital in Denmark, reports that while this elevated risk is highest in current antidepressant users, recent and remote users are also affected.

The authors examined data from 4.3 million Danish residents that were between 18-90 years old at the start of the study in 2010. They used the Danish National Prescription registry to gather data on antidepressant dispensing. Persistent antidepressant use was defined as filling two or more prescriptions each year.

During the duration of the study, the authors recorded 6,002 sudden cardiac deaths. Thirty-two percent (1,907) of these deaths occurred in antidepressant users. Persistent use from 1 – 5 years was linked to a 41% increased risk of sudden cardiac death. More than six years of persistent antidepressant use was associated with a 74% increased risk of sudden cardiac death. Current antidepressant users saw the largest increased risk of sudden cardiac death (71%), followed by recent (24%) and remote (11%) users.

This research had several limitations. As the design was observational, this data cannot definitively say that antidepressants are causing sudden cardiac death. The authors measured antidepressant dispensing, not consumption. The authors also did not have access to data that may have affected the results, such as symptom severity and the possibility of undiagnosed cardiovascular disease in some participants. The authors examined Danish residents, significantly limiting generalizability to other populations.

Overmedicalization of Childhood

A new viewpoint article published in BMJ Paediatrics Open explores the overmedicalization of childhood. The authors, led by Lester Liao from the McGill University Health Centre in Canada, examines why childhood is overmedicalized, the harm that results from this practice, and ways this trend can be countered.

The current work outlines three main drivers of the overmedicalization of childhood. First, the authors point to an interventionist trend in health in which developmental models prescribe norms and any deviation is framed as pathological. Second, medical and educational institutions expose children to various screenings that frame differences in development as medical problems. Third, psychiatric publications like the DSM reframe normal experiences, such as grief, as pathological. These types of publications also tend to widen what counts as “illness.” For example, the reconception of autism as a “spectrum” allows for the framing of more behaviors as “autistic.”

With the biomedical framing of psychological distress as “illness,” relatively normal behavior, such as lining up toys, having an aversion to sticky hands, or getting in a fight at school, routinely results in children seeing psychiatrists and other medical professionals. This leads to increased diagnosis of mental health disorders, exposing children to the stigma attached to diagnosis. Children are also increasingly exposed to psychotropic medications that can have significant negative effects.

The authors offer seven strategies for medical professionals to counter the overmedicalization of childhood.

• Try to understand children’s experience without relying on diagnostic labels
• Seriously consider the harms of making a diagnosis
• Decrease drug prescriptions for children
• Allow children space to grow and develop uniquely rather than according to specific developmental models
• Seek out training around overmedicalization
• Increase social prescriptions such as relational practices
• Re-empower families by acknowledging that they know their children best and that their bond with their children is primary

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Kassie, G. M., Ilomaki, J., Wood, S. J., Gould, J., Raven, M., Jureidini, J. N., & Grzeskowiak, L. E. (2026). Persistence of antidepressant treatment in children and adolescents: A population-based Cohort Study. Australian & New Zealand Journal of Psychiatry. (Link)

Liao, L., Teoh, Y., Ghosh, S., Jain, M., Marder, L., Turner, S., & Raman, S. (2026). Overmedicalisation of childhood: What Paediatricians and child health professionals can do. BMJ Paediatrics Open, 10(1). (Link)

Mujkanovic, J., Warming, P. E., Kessing, L. V., KøberMD, L. V., Winkel, B. G., Lynge, T. H., & Tfelt-Hansen, J. (2026). Antidepressant treatment duration and risk of sudden cardiac death: A nationwide cohort Study1. Heart Rhythm. (Link)

Plöderl, M., Lyus, R. J., Horowitz, M., & Moncrieff, J. (2025). The Loss of Efficacy of Fluoxetine in Pediatric Depression: Explanations, Lack of Acknowledgment, and Implications for Other Treatments. (Link)

The post Questioning the Prescription: Antidepressants and the Medicalization of Childhood appeared first on Mad In America.

 

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