Pediatricians don’t prescribe many antidepressants

Pediatricians are reluctant to prescribe antidepressants to teenagers regardless of the severity of their depression, according to the results of a recent cross-sectional survey.

Lead researcher Ana Radovic, MD, Children’s Hospital of Pittsburgh, and colleagues surveyed 58 pediatric primary care physicians (PCPs) within a large pediatric network. They presented the participants with 2 vignettes: one about a 15-year-old girl with moderate depression and one about a 15-year-old girl with severe depression. They then asked the respondents to make an initial treatment recommendation for each patient.

The investigators found that only one-fourth of the PCPs surveyed recommended antidepressants for the patient with moderate depression, and not quite one-third (32%) recommended an antidepressant for the patient with severe depression. Yet current guidelines recommend antidepressants and/or cognitive therapy for adolescents with moderate and severe depression.

Most of the respondents reported that they would refer the patients to a psychiatrist. About 60% reported that they would do so with the moderately depressed patient and about 90% reported that they would do so with the severely depressed patient.

Pediatricians with greater knowledge about depression and those with an on-site mental health care provider are more likely to prescribe antidepressants for depressed teenagers. Those who feel a higher sense of personal burden are less likely to do so.

The researchers conclude that without the participation of pediatric PCPs in the treatment of teenaged depression, the child psychiatry workforce will be overloaded. They recommend more experiential training for pediatricians when it comes to depression and antidepressants and also co-management with mental health providers.

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