On the front line in the face of the distress of young people, more and more doctors are prescribing drugs that have not been tested for their age group. With, in mind, the hope of relieving their patients, many of whom have been having dark thoughts since the outbreak of the health crisis in 2020. What does it matter if studies do not show any use for their own remedies, composed by guesswork and experience.
A massive phenomenon, so voluminous that it is now rare to find a prescription that respects the official recommendations, issued by the High Authority of Health and in force since 2014. Cobbled-together prescriptions outside the box have become the norm. And this, despite the risks that these methods pose to adolescents, whose brains have not quite finished growing.
In 2023, 288,000 young people received an antidepressant that was not recommended by health authorities because it was considered too dangerous at this stage of brain and mental maturity for the low positive effects observed. In other words, and for this family of drugs alone, 3 out of 4 prescriptions that year were found to be non-compliant with good practices for 12-25 year-olds.
288,000 young people received an inadvisable molecule
These data, taken from the annual report of the Health Insurance, analyzed by L’Express before it was submitted to the government, are intriguing. Because if misused, these drugs are likely to cause serious health problems. Worse, in addition to being toxic, certain pharmaceutical substances can facilitate the transition to suicidal action, instead of defusing it.
This is the case of paroxetine, identified as harmful to young people for about ten years, but still prescribed by poorly informed or reckless practitioners. It does not matter if the company that manufactures it, GlaxoSmithKline, was convicted by US authorities in 2012 for hiding its harmful effects. It was then ordered to pay $3 billion, a record fine at the time.
Paroxetine suddenly made headlines again at the beginning of the year. The press, especially Radio France, had echoed the suicide of two teenagers, Romain and Florian. The first threw himself under a train, the second put a rope around his neck, three years ago. Both had been given paroxetine before their actions. They were 16 and 20 years old. Currently being investigated by the Vienna court, the case demonstrates the parsimony that should be observed in the use of these drugs.
The risk of facilitating suicide, instead of countering it
Overall, data from the Health Insurance show that out of 384,000 adolescents with depressive disorders treated in 2023, only 96,000 received the antidepressant deemed effective at this age, called fluoxetine – or Prozac, by its trade name. However, it is the only molecule to have an effect superior to the placebo for suitable risks, according to a study published in 2016 in the scientific journal The Lancet.
In addition to presenting a health risk, these out-of-box prescriptions are also very costly for the taxpayer. Expressed in financial terms, reimbursements related to antidepressants considered ineffective amounted to approximately 7.2 million euros in 2023. So much public money wasted for nothing or almost nothing, if we are to believe the conclusions of scientific studies.
This upside-down assessment continues to make people tense. From the management of the National Health Insurance Fund to the psychiatric practices aware of these dysfunctions, the figures are shocking: “It’s nonsense! The practitioners behind these prescriptions are tinkering with pseudo-treatments with half-pills. There are children at the end of the chain,” denounces Xavier Pommereau, coordinating psychiatrist at the Clinique Béthanie in Talence (Gironde).
Massive gaps, everywhere
According to the expert, the phenomenon is much more worrying than the general increase in prescriptions, which has been singled out. In 2023, a report published by the High Council for the Family had caused a lot of ink to flow by going in this direction, before being qualified by many experts. In many respects, the continual increase in the number of children on psychotropic drugs may appear normal, due to more frequent suffering and a delay in certain diagnoses.
But this time, the experts who are able to justify so many deviations from the norm would be wise. Especially since they are not limited to the choice of substance alone. Treatment durations are also rarely respected. In 2023, only 21% of patients received a prescription for antidepressants for more than six months. However, this is the minimum time needed to hope to see results. In fact, half of the prescriptions are finished within two months.
Of course, many patients abandon their treatment because of side effects or simply due to lack of follow-up. “People gain weight, or have a loss of libido, which can have significant repercussions on mental health,” recalls Bruno Falissard, research director at Inserm. But these elements are not enough to explain such large gaps with institutional constraints.
The thorny question of sedatives
Because anomalies are almost everywhere. Legion, too, in the case of anxiolytics, for example. Doctors use these powerful sedatives in the event of a serious panic attack. They help calm down or help you get some sleep at the peak of suffering. But some can be addictive, which makes them particularly dangerous: adolescence is an age at risk.
In 37% of cases, practitioners double antidepressants with anxiolytics. In this type of indication, treatment should not exceed fifteen days, to reduce the risk of addiction. Except that, here again, the gaps are numerous: 40% of treatments exceed thirty days. On this subject, psychiatrists are not left out. They are the worst prescribers.
Another alarming curve: antipsychotics. Their use has climbed by 38% in 2023. Products that are nevertheless reserved for specific conditions, very little sensitive to the gloom of the times, such as schizophrenia. “These substances are diverted for their non-addictive calming effect. But the problem is that they are aggressive for the brain and multiply the risks of Parkinson’s syndrome”, deplores psychiatrist Xavier Pommereau.
General practitioners on the front line
As a countermeasure, the Health Insurance plans to strengthen the training of general practitioners. They are often the only contact available to families, while in some places it takes two years to get an appointment with a specialist. However, they are also the least competent on these issues. “General practitioners are only trained in the most prominent mental illnesses and have difficulty establishing the degree of severity of suffering,” summarizes Bruno Falissard.
Far from the Health Insurance the idea of accusing one profession or another of being at the origin of the dynamic. Institutional diplomacy and freedom to practice oblige. Especially since, as each time that we touch on children and the psyche, the situation is complex and cannot be summed up in simple figures. But it still provides some telling correlations: on average, a child who has received an antidepressant from a private psychiatrist follows 5.5 months of treatment, against 3.6 if it is prescribed by a general practitioner.
A “consensus conference” could also see the light of day. A common practice in medicine. When there is a medical controversy, scientists from the relevant fields sometimes sit around a table to draft an agreement on what is established and what remains to be proven. Health Insurance is pushing: it sees it as a way of encouraging prescribers to commit to the recommendations.
Prescribe or die
The initiative was met with very cold reception by those concerned. “Ask the doctor who has in front of him a child who is trying to commit suicide, a devastated family and the fate of so many lives in his hands, not to prescribe when he has nothing else to do, and you will see how he will react”, warns Bruno Falissard, also president of the president of the French Society of Child Psychiatry.
The specialist warns against simplistic temptations. Better informing health personnel, “making them responsible”, could help to bring these figures down to more acceptable levels. However, applying the theory to the letter is not possible, nor even desirable. Many families, and sometimes patients themselves, refuse to undergo psychotherapy, for example. However, it is the most appropriate response at this age. And when everything planned by officials has been tried, and lives are still in danger, why deprive ourselves of prescribing?
All these statistics highlight how dysfunctional the child psychiatry system is. To deal with the distress of young people, building a bond of trust is essential. To convince people to agree to follow the right therapies, and therefore reduce the number of hasty prescriptions, it takes time, availability, resources, and quick and easy access to specialists. The entire profession agrees. After the Pediatrics Conference, LThe government had pledged to take action on this issue. It has since been dissolved.
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