Mood drugs are prescribed by family physicians and paeditricians as there are only few child psychiatrists/psychologists available in Sri Lanka. Though there are no official figures for prescribing these mood drugs are available for Sri Lanka, in western countries these figures show that the number of times these drugs were recommended has been almost, doubled during the last five years (in Canada there were 322,000 prescriptions in 1998 to 543,000 prescriptions, in 2004 - IMS Canada) Health Authorities in western countries caution that no one should abruptly stop taking these medications as they must be cut back gradually to avoid potential serious withdrawal effects.

The Federal Drugs Authority in US has alerted doctors and patients to watch for signs of serious self-harm behaviours (Suicide) and conduct disorders during the first few weeks’ these drugs are prescribed and when ever their dose is changed. This move came out in 2004 when scores of parents reported how their children became suicidal or violent after taking these mood drugs.

Because suicidal thoughts are common among depressed patients, many doctors say it is impossible to tell if the drugs or the disease is the cause. The Mood and Anxieties Disorders Clinic in British Columbia’s Children’s Hospital says that there is definitely a subgroup of children who experience obsessive suicidal thoughts after going on the medication. Some doctors believe that these mood drugs stimulate certain mechanisms in the brain that may reduce or increase suicidal tendencies in specific group of patients. It has been documented that even some normal people who are not depressed will become obsessed by thoughts of suicide and self-harm when put on these mood drugs. Psychologists and Child Psychiatrists say that the doctors can use these drugs, but only if the patient is at severe risk due to their psychological condition and after other measures - such as cognitive behavioural therapy, improved diet, exercise and sleep fail to achieve results. Many child psychiatrists and child psychologists in US were upset, when they found out that drug companies did not report studies that showed these mood drugs were causing self-harm behaviours and conduct disorders in children. Since these drugs were already approved for adults they were not obliged to report the negative data from studies of children. Not documenting these negative reports, puts the doctors in difficult situation as they needed that information to make an educated choice about prescribing these mood drugs. But the pharmaceutical companies say that they report on these adverse reactions in the small print. Some doctors say though there is a great deal of alarm, the dangers are probably exaggerated. They say that 40-60% of patients 18 and under who are severely depressed will be actively suicidal at some point and that it is important to conduct more research on the use of these mood drugs in children. Most doctors believe that these drugs are useful in children if it is used more carefully. Mood drugs are believed to alter the chemistry of ‘messengers’ in the brain (neuro transmitters - serotonin, norepinephrine and dopamine). And because studies have shown about 70-80% of paediatric patients prescribed drugs for depression get better even with a placebo (eg. vitamins), it is hard to tell how effective they are. Another concern among child psychiatrists/psychologists is the number of children on these mood drugs are taking more than one psycho-active medications, a study by the American Psychological Association in 2004 found that 42% of children are given two or more medications affecting their central nervous system and 10% were prescribed two or more antidepressant medications.

Health authorities in Sri Lanka should emphasise that when ever a mood drug is prescribed to a child, the parents or the guardians of these children should be informed about all possible side effects especially about the conduct disorders and the possibility of self- harm (Suicidal effects) behaviours.