Fewer kids on SSRI antidepressants
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Within 2 years after the October 2003 FDA public health advisory about the risk of suicide in children taking a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs), significant reductions in rates of diagnosis and antidepressant treatment of childhood depression occurred, researchers report.
“Antidepressant use was expected to decline, consistent with effects on other drugs after warnings are issued,” Dr. Anne M. Libby of University of Colorado Health Science Center at Denver told Reuters Health.
However, “we were most surprised at the diagnosing rate decline, reversing a national trend as evidence of a decade of work to educate and promote depression treatment in primary care,” she added.
“Our concern is the lack of treatment for a disorder that is quite serious in childhood, as depression is a large and significant risk factor for suicide,” Libby added.
She and colleagues used a large national claims database of more than 85 managed care plans to analyze data on 65,349 children aged 5 to 18 years who were diagnosed with depression between October 1998 and September 2005.
They used time-series models to compare depression diagnoses and antidepressant prescribing trends during the 2 years after the FDA advisory and the expected trends based on data from the 5-year period preceding the advisory.
“The most important observations,” noted Libby, are that, after the October 2003 public health advisory on SSRIs in children, “national rates of new depression diagnoses are significantly lower than what the historical trend would have predicted.”
Among those who were diagnosed with depression, the proportion of cases that received antidepressants in the first 30 days were far lower than would have been expected based on the historical trend, authors report in the American Journal of Psychiatry.
Of concern, however, for those newly diagnosed pediatric patients, “there was not strong evidence of other types of treatment to make up that gap, whether psychosocial ‘talk’ therapy or other psychotropic medications,” Libby told Reuters Health.
Dr. Cynthia R. Pfeffer, from New York Presbyterian Hospital, New York, who was not involved in the study, warns that the FDA advisories “may have had the unintended effect of discouraging the prescription of antidepressants for pediatric patients and pediatric utilization of antidepressants without compensatory increases in other specific treatments.”
SOURCE: American Journal of Psychiatry, June 2007.
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