J Med Ethics 34:710-714 doi:10.1136/jme.2007.023119
  • Clinical ethics

The ethics of paediatric anti-depressant use: erring on the side of caution

  1. M C Shearer1,2,
  2. S L Bermingham1
  1. 1
    School of Biology, University of St Andrews, St Andrews, Fife, UK
  2. 2
    The Ethox Centre, Department of Public Health and Primary Health Care, University of Oxford, Oxford, UK
  1. Dr M C Shearer, School of Biology, Bute Building, University of St Andrews, St Andrews, Fife KY16 9TS, UK; morven.shearer{at}
  • Received 14 September 2007
  • Revised 26 January 2008
  • Accepted 31 January 2008


This paper aims to outline the ethical concerns regarding the use of antidepressant medication in children and adolescents. Recent debates surrounding this issue have focused on the link between selective serotonin reuptake inhibitor use and an increased risk of suicidal thinking/behaviour, and weighed that against the benefit of the alleviation of depressive symptoms. It is argued here that such an approach is simplistic. There are several serious risks surrounding antidepressant use in the young that ought to be included in the equation, along with a consideration of the neuroethical concerns surrounding pharmacotherapy for affective disorders. Using the precautionary principle as a framework for analysis it is concluded that the risks are sufficiently serious and plausible that the prescribing of antidepressant medication to the young ought to be severely restricted; further it is imperative that the child and their parents are made fully aware of the risks, short-term and long-term, involved.


  • Competing interests: None.

  • i The argument for the use of antidepressants in the paediatric population is that they have been effective in the treatment for adult-onset depression. However the two disorders may in fact have different underlying aetiologies.

  • ii Informed consent normally involves briefing the relevant parties as to the different treatment options available (including the option not to treat) mentioning the benefits, likelihood of success and possible risks.

  • iii Throughout this paper children and adolescents have been grouped together as most studies have used age ranges that fall into both categories. This is potentially misleading as depression in older adolescents may more closely resemble adult onset depression.

  • iv We have focused on fluoxetine as it is the only SSRI currently licensed for use in depression for children over 8-years-old. However other SSRIs and antidepressants are used off-label for depression and other conditions. The concerns about neurodevelopment remain the same and need to be addressed re: informed consent.