FDA warning leads to decrease in antidepressant prescribing for young patients

An FDA warning regarding increased suicide risk in children and teens taking antidepressant drugs has led to an overall decrease in antidepressant prescribing for young patients, reports a study in the November issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

However, the decrease appears limited to patients with less-severe depression, and has been accompanied by increased use of psychotherapy, report Satish C. Valluri, Ph.D., M.P.H., and colleagues of University of Maryland, Baltimore.

Antidepressant Prescribing Decreases for Non-Major Depression…
In March, 2004, the U.S. Food and Drug Administration issued a warning about a possible increase in suicidal thoughts and behavior in children and adolescents starting treatment for antidepressant drugs. Later that year, a stronger "black box" warning was added.

To analyze the impact of the warnings, the researchers analyzed rates of antidepressant prescribing for young patients with newly diagnosed depression from before to after March, 2004. The study included more than 40,000 children and adolescents diagnosed with depression from 2003 to 2006, identified from a large insurance database.

Youth diagnosed with depression after the FDA warning were 15 percent less likely to be prescribed antidepressant drugs. However, on more detailed analysis, the reduction in antidepressant use was limited to patients with diagnoses other than major depressive disorder. For this group of children with less-severe depression, antidepressant prescribing decreased by 21 percent.

In contrast, rates of antidepressant treatment were unchanged for children and adolescents with major depression. The trends in antidepressant prescribing were about the same for children (under age 12) as adolescents (aged 12 to 17).

…While More Depressed Youth Receive Psychotherapy
As antidepressant prescribing decreased, more young patients received psychotherapy after being diagnosed with depression. The increase in psychotherapy was greater for children (31 percent), but still significant for adolescents (19 percent). The difference was most pronounced for youth receiving psychotherapy as their only treatment for depression: from 37 percent before the FDA warning to 44 percent afterward.

Before and after the warning, about 80 percent of children and teens received some type of treatment—antidepressant, psychotherapy, or both—within six months after being diagnosed with depression.

Previous studies had reported decreased use of antidepressants in young patients since the 2004 FDA warnings. The new study provides a more detailed evaluation, including comparison of children versus adolescents and patients with major depressive disorder versus less-severe depression.

The results suggest that the decrease in antidepressant prescribing has been limited to patients with less severe depression—who account for the great majority of depressed youth. Meanwhile, there has been no significant change in antidepressant treatment for children and teens with major depression.

At the same time, the use of psychotherapy alone as initial treatment for depression has increased—especially among children under 12. "Together these findings suggest more clinically nuanced pediatric antidepressant prescribing patterns than previously found," Valluri and coauthors conclude. They urge further studies to evaluate the impact of reduced antidepressant prescribing in young patients with less-severe depression.