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

Background Antidepressant use in child and adolescent psychiatry has increased diagnoses, antidepressant data from Türkiye remain scarce. This study aimed to describe antidepressant prescribing patterns and to explore clinical and demographic factors associated with clinical improvement, off-label use and adverse effects in a child and adolescent psychiatry outpatient population. Methods This single-centre retrospective study reviewed the records of 650 patients aged 4–17 years prescribed antidepressants at a public mental health hospital between August 2020 and December 2021.Demographic characteristics, psychiatric diagnoses, antidepressant agents and doses, off-label status (FDA paediatric labelling),concomitant psychotropic treatment, adverse effects and Clinical Global Impression (CGI) ratings were extracted. A positive response was defined as a CGI-Improvement (CGI-I) score of 1–2 at the last recorded follow-up. Multivariable logistic regression was used to explore factors associated with CGI-I response, off-label prescribing and adverse effects. Results Most patients were female (58.9%), and 43.8% were aged 15–17 years; the mean age was 13.23 ± 3.18 years. At least one selective serotonin reuptake inhibitor (SSRI) was prescribed to 92.5% of patients, mainly fluoxetine (48.2%) and sertraline (34.2%).Anxiety disorders (41.8%),major depressive disorder (MDD; 37.8%) and attention-deficit/hyperactivity disorder (ADHD;28.8%) were the most frequent diagnoses. Prescribing was off-label in 74.8%, and 43.8% received concomitant psychotropic treatment. Adverse effects, mainly sedation and weight gain, occurred in 21.4% (monotherapy 11.8% vs. concomitant treatment 33.7%).A positive CGI-I response was recorded in 84.6%;without a control group, this does not indicate efficacy. Relative to age 4–10 years, age 11–14 years (aOR 0.37,95%CI 0.17–0.83) and 15–17 years (aOR 0.28,95% CI 0.13–0.61), and a prior antidepressant trial (aOR 0.46,95%CI 0.27–0.78),were associated with lower odds of a positive response. Off-label prescribing was more likely in generalised anxiety disorder (aOR 2.41,95%CI 1.35–4.30) and less likely in MDD (aOR 0.31,95% CI 0.21–0.47).Adverse effects were associated with concomitant treatment (aOR 3.32,95% CI 2.14–5.16) and ADHD (aOR 1.77,95%CI 1.17–2.69). Conclusions In this single-centre sample, antidepressant prescribing was most common among female patients and older adolescents, dominated by SSRIs, frequently off-label and often combined with other psychotropics. Younger age was associated with greater clinical improvement, and concomitant treatment with adverse effects. These exploratory, non-causal findings highlight the need for prospective, multicentre studies with standardised outcome assessment to inform prescribing guidelines.