Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge, a new study found.
The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth, said Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University.
The findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.
"We found that antidepressant treatment had a protective effect on readmission," Fontanella said. "Although the findings are preliminary, our results should be reassuring to child psychiatrists who may have been concerned about prescribing antidepressants since the FDA warning."
But another key finding from the study showed that hospitalized youth who were prescribed three or more medications from different drug classes for mental health issues had a 3-fold increased risk of being readmitted within a month of discharge.
Fontanella conducted the study with Ohio State researchers Jeffrey Bridge, assistant professor of pediatrics, and John Campo, chief of child and adolescent psychiatry. Both are also associated with the Research Institute at Nationwide Children's Hospital in Columbus.
The study appears in the December issue of The Annals of Pharmacotherapy.
The researchers did a retrospective study of 318 Medicaid-covered adolescents who were admitted to three major psychiatric hospitals in Maryland because of attempted suicide or suicidal behaviors.
They examined hospital medical records for the adolescents and recorded all medication changes - including additions, discontinuations and changed dosages that occurred during the hospital stay.
The researchers then identified which patients were readmitted to any hospital in Maryland within 30 days of their discharge.
Hospital readmissions within 30 days are considered an indicator of quality of care, Fontanella said. Most readmissions or post-hospitalization suicide attempts occur during that time period.
Fontanella said that this is the first study to investigate the effects of hospital medication changes and use of multiple medications on readmission of suicidal youth.
"We know little about how medication is being used to treat youth in inpatient care," she said. "This is a first step in figuring out what is effective and what is not."
The study found that 78 percent of the inpatients had one or more changes in their medication, typically the addition of an antidepressant, mood stabilizer or antipsychotic.
About a quarter of the adolescents were prescribed three or more medications from different drug classes. That's particularly concerning since those prescribed three or more drugs were 2.6 times more likely to be readmitted within 30 days, Fontanella said.
Fontanella emphasized that the study does not address the appropriateness of the medication prescriptions given to any individual patient in the study. However, she added that psychiatrists need to be "very judicious" in prescribing multiple drugs to adolescents, given the risks.
"What we're advocating is more quality monitoring and help for clinicians in hospitals to weigh the risks and benefits to putting adolescents on multiple medications," she said.