Monday, December 18, 2017

Rise in Antidepressant Prescriptions for Youth Raises Questions About Why

The number of prescriptions of antidepressants for children and adolescents fell after the Food and Drug Administration in 2004 directed pharmaceutical companies to issue a black-box warning about the potential link between antidepressant use and the risk of increased suicidal ideation among youth. A study published in Psychiatric Services now shows that following that initial decline, the rate of antidepressant prescribing to children returned to pre-2004 levels within a few years. 

Nilay Kafali, Ph.D., of RTI International and colleagues found that 2.26% of children aged 5 to 17 were prescribed antidepressants in 2009, similar to the 2003 level of 2.29%. Between 2004 and 2008, that rate had dropped to below 2%.

The authors calculated these rates using data from the Medical Expenditure Panel Survey (a set of nationally representative surveys of individuals, medical providers, and employers that detail the usage and costs of health care services and health insurance coverage). They included available data on children aged 5 to 17 between 2000 and 2011. To estimate how the impact of the black-box warning on antidepressant use among children changed over time, the authors divided the entire sample period into four periods: early prewarning (2000–2001), prewarning (2002–2003), early postwarning (2004–2007), and late postwarning (2008–2011). 

They found that there was a 0.5% statistically significant decline in antidepressant use during the early postwarning years compared with prewarning years, with a particularly strong decrease among children rated as having non-severe psychological impairment (which the authors defined as a Columbia impairment Scale score of <16). By 2009, though, the rates had returned to pre-2004 levels.

“These findings suggest that providers and families of youths may have reacted to the black-box warning in an appropriate manner, weighing the warning with the risks and benefits of the treatment,” Kafali and colleagues wrote. “A return to the rates of antidepressant use before the black-box warning raises concern that this thoughtful accounting of the risks and benefits may have dissipated over time.”

“It is possible that over time physicians have become somewhat inured to the safety warnings,” said Mark Olfson, M.D., M.P.H., a professor of psychiatry and epidemiology at Columbia University Medical Center, who was not involved with this study. “However, it is also possible that increasing prevalence of depression or anxiety among young people during the great recession played a role,” he added.

Olfson, who was not involved with this study, noted that other community surveys including the Youth Risk Behavior Survey, the National Survey on Drug Use and Health, and the Monitoring the Future surveys have revealed a recent increase in depressed mood and major depressive episodes among children and adolescents. 

For related information, see the Psychiatric News article “U.S. Experiences Uptick in Rates of Suicide.”

(Image: iStock/gradyreese)


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