Paediatric psychiatrists have reacted with dismay after European guidance suggested they should not be prescribing the most popular group of anti-depressant drugs to children with depression.

The European Medicines Agency (EMA) said selective serotonin reuptake inhibitors (SSRIs) "should generally not be used in this age group" as trials had shown an "increased risk of suicidal behaviour". Its recommendations will be considered by the European Commission for further investigation.

The only antidepressant drug currently considered safe for use with children by the UK's Medicines and Healthcare products Regulatory Agency (MHRA) is the SSRI drug fluoxetine, known commercially as Prozac. But the EMA guidance suggests this should not be used either.

Dr Andrew McCulloch, chief executive of the Mental Health Foundation, told Children Now the situation was "a total mess". He claimed clinicians were being put in an "impossible situation", and said the guidance also left parents with "a lot of fears" if their child was being prescribed Prozac.

Dr Quentin Spender, consultant child psychiatrist at Chichester Child and Adolescent Mental Health Services, said: "A lot of medicines we use are unlicenced for use with children and that can leave us open to criticism.

"The evidence suggests that antidepressants and psychological treatments in combination work best, but we don't have the resources. The choice is often nothing, or antidepressants."

A Department of Health spokeswoman said: "The MHRA has acted faster and gone further than any other regulator in the world to take action on emerging safety issues relating to SSRIs.

"After a thorough review of the data, the UK advised that the treatment of childhood depression with any SSRI except Prozac should not continue."

Professor Sue Bailey, chair of the faculty of Child and Adolescent Psychiatry at the Royal College of Psychiatrists, agreed that the MHRA's guidance was consistent with advice from Europe.

But she added: "It's not an impossible position, but it is difficult.

The pressure comes when the psychological treatments are not available."

The guidance from the EMA came after new research revealed a huge rise in the last decade in the number of children taking SSRI drugs.

- See Analysis, p11.