SSRIs

There is very poor evidence for effectiveness of anti-depressants in children and increasing concerns about their safety.

The best data available suggests a doubling to 4% of the risk of self destructive thoughts or actions. 

It is likely the risk is greatest immediately after starting the medication and when stopping it, so, if you already have patients on SSRIs who have been on them for some time then safety issues are less of a concern. 

However, when you stop anti-depressants (or if you think your patients are considering stopping them without your involvement) it is important to be very cautious. 

We suggest reducing dosage very gradually, and staying on each reduced dose for a week

ie. somebody starting on 2 tablets/day would reduce to 2 tablets the first day and 1½ tablets the second day, alternating for a week before further reducing to 1½ tablets a day. 

We recommend against initiating prescriptions for SSRIs.  If you are tempted to do so, why not use the Hotline to discuss this case further.