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Background We read with interest the report by Jack et al. in this issue of BMC Medicine [1] regarding adherence to the NICE antidepressant prescribing guidelines for children and young people with depression [2]. Using an extensive database, the authors determined how often children and adolescents were prescribed antidepressants without a recent assessment by a child and adolescent psychiatrist or pediatrician. The results indicate only 25% of children prescribed selective serotonin reuptake inhibitors (SSRIs) had seen a child and adolescent psychiatrist. The paper’s premise is that adherence to the NICE guidelines is important and that the adherence gap is problematic. The authors discuss a number of factors that contribute to the gap, e.g., long waits for specialist care, and some potential solutions including better training for general practitioners who are likely to prescribe. While we support high-quality prescribing [3], we are concerned with the growing number of studies like Jack et al. [1], which suggest the need for more restrictive antidepressant use. Our concern is that such studies, while focused on quality prescribing, may inhibit access to evidence-based care for the large numbers of children affected with anxiety and depression. Problems with the current literature regarding antidepressant prescribing In the USA, like in the UK, an increasing number of reports appear to support restricting antidepressant use in children and young people. Such papers come in a number of forms and have obvious limitations:

High-quality antidepressant prescribing: please consider whether “perfection is the enemy of progress”