Antidepressant Prescribing in Turkish Children and Adolescents Is Often Off-Label, Study Finds

A retrospective review of 650 children and adolescents prescribed antidepressants at a public mental health hospital in Türkiye found that nearly three quarters of the prescriptions were off-label, yet most patients showed clinical improvement on their clinicians’ ratings.

The patients, aged 4 to 17 years with a mean age of 13.23 years, were predominantly female at 58.9 percent, and 43.8 percent were in the oldest age band of 15 to 17 years. Anxiety disorders were the most frequent diagnosis at 41.8 percent, followed by major depressive disorder at 37.8 percent and attention-deficit/hyperactivity disorder at 28.8 percent. Selective serotonin reuptake inhibitors dominated prescribing: 92.5 percent of patients received at least one SSRI, most commonly fluoxetine at 48.2 percent and sertraline at 34.2 percent.

Off-label status was judged against US Food and Drug Administration paediatric labelling, and 74.8 percent of prescriptions fell outside it. Nearly 44 percent of the cohort received concomitant psychotropic treatment alongside the antidepressant. Adverse effects, mainly sedation and weight gain, occurred in 21.4 percent of patients overall, but the split was stark: 11.8 percent on monotherapy versus 33.7 percent among those taking multiple psychotropics.

Clinical improvement was measured with the Clinical Global Impression scale, where a positive response was defined as a CGI-Improvement score of 1 or 2 at the last recorded follow-up. By that criterion, 84.6 percent of patients were classified as responders. The authors are explicit that without a control group this figure cannot be taken as evidence of efficacy; it reflects how clinicians rated their patients in routine care, not the outcome of a controlled trial.

The exploratory multivariable logistic regression analyses adjusted for several factors simultaneously and pointed to age as the strongest correlate of improvement. Relative to children aged 4 to 10 years, those aged 11 to 14 had lower odds of a positive response (adjusted odds ratio 0.37, 95 percent confidence interval 0.17 to 0.83), as did those aged 15 to 17 (aOR 0.28, 95 percent CI 0.13 to 0.61). A prior antidepressant trial was also associated with lower odds of response (aOR 0.46, 95 percent CI 0.27 to 0.78).

Diagnostic category shaped how likely prescribing was to be off-label. Generalised anxiety disorder was associated with higher odds of off-label use (aOR 2.41, 95 percent CI 1.35 to 4.30), whereas major depressive disorder was associated with lower odds (aOR 0.31, 95 percent CI 0.21 to 0.47).

Adverse effects were statistically associated with two factors: concomitant psychotropic treatment (aOR 3.32, 95 percent CI 2.14 to 5.16) and an ADHD diagnosis (aOR 1.77, 95 percent CI 1.17 to 2.69). The authors stress that these are associations from observational records, not causal effects, and that unmeasured clinical differences between patients could account for part of the patterns observed.

The study’s design imposes clear limits on interpretation. It was retrospective and single-centre, drawing on records from one public hospital, so the findings may not generalise to other settings or countries. Outcome assessment relied on CGI ratings recorded in routine clinical practice rather than a standardised prospective protocol, and the response definition used the last recorded follow-up, which may vary in duration across patients. The authors describe their results as exploratory and non-causal and call for prospective, multicentre studies with standardised outcome assessment to inform prescribing guidelines.

For clinicians, the practical signals are that combination treatment in this sample carried roughly three times the rate of adverse effects compared with monotherapy, and that younger children showed the highest rated improvement. Whether those patterns hold under controlled, prospective measurement remains the question the authors say future research must answer.

Subject of Research: Antidepressant prescribing patterns, off-label use and clinical outcomes in children and adolescents at a Turkish mental health hospital

Article Title: Patterns and clinical outcomes of antidepressant prescribing in children and adolescents: real-world evidence from a mental health hospital in Türkiye

Article References: Arıcı Gürbüz, A., & Altun, H. (2026). Patterns and clinical outcomes of antidepressant prescribing in children and adolescents: real-world evidence from a mental health hospital in Türkiye. Frontiers in Psychiatry, 17, Article 1947706. https://doi.org/10.3389/fpsyt.2026.1947706

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1947706

Keywords: antidepressants, children, adolescents, off-label use, SSRI, fluoxetine, sertraline, Türkiye, psychopharmacology, adverse effects, retrospective study, CGI