National trends in prescribing antidepressants before and after an FDA advisory on suicidality risk in youths

Abstract

Objective: This study evaluated the national trends in prescribing pharmacologic treatments for pediatric depression before and after a 2003 U.S. Food and Drug Administration advisory linking an increased risk of suicidality with antidepressants among pediatric patients with major depressive disorder.

Methods: National estimates on outpatient visits between 1998 and 2007 with a diagnosis of depression, a prescription for an antidepressant, or both among children ages 5 to 17 and adults were obtained from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

Results: Among children, depression visits increased from 1998-1999 to 2002-2003 (3.2 and 4.3 million, respectively) but decreased to 3.2 million in 2006-2007. Antidepressant visits increased from 1998-1999 to 2002-2003 (3.4 and 7.6 million, respectively) but dropped to 6.7 million in 2006-2007. Depression visits with an antidepressant prescribed rose from 1998-1999 to 2002-2003 (1.7 and 2.8 million, respectively) but dropped in 2004-2005 and 2006-2007 (2.4 and 2.1 million, respectively). Nevertheless, the proportion of depression visits with an antidepressant prescribed, having risen from 54% in 1998-1999 to 66% in 2002-2003, remained stable in 2004-2005 (65%) and in 2006-2007 (64%), the result, seemingly, of more prescribing of antidepressants for major depressive disorder and less for other depression. Utilization patterns among adults were not interrupted.

Conclusions: Children's depression visits and visits with an antidepressant prescribed dropped after the advisory, but children with major depressive disorder appeared no less likely to be prescribed antidepressants.