PHOENIX — The proportion of clinic visits to psychiatrists involving antidepressants for youths fell compared with the proportion of visits to primary care physicians after the black box warning linking antidepressant use to suicidality in youths.
However, visits by adults for antidepressants did not change by specialty during the same time period—suggesting that the Food and Drug Administration's suicidality warning of 2004 caused the change in pediatric prescriptions.
Results of an analysis of data from the National Ambulatory Medical Care Survey seem to show that the FDA warning “had a greater impact on the prescribing of antidepressants to youth by psychiatrists than by primary care physicians,” Julie M. Zito, Ph.D., said at a poster presentation at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health.
Dr. Zito and her associates compared the national ambulatory trend data from the years 2000–2001 and 2002–2003 (before the FDA warning) with data from 2004–2005 (after the warning).
The proportion of visits by youth (aged under 18 years) to psychiatrists for antidepressants changed little between 2000 (63%) and 2003 (62%), but fell after the FDA warning to 54% in 2004 and 41% in 2005, reported Dr. Zito, professor of pharmacoepidemiology and psychotherapeutics at the University of Maryland, Baltimore.
The proportion of visits by youths to primary care physicians (pediatricians, internists, and family physicians) for antidepressants was 31% in both 2000 and 2003, but increased to 42% in 2004 and to 45% in 2005. Visits by youth to other specialties for antidepressants comprised 6% in 2000, 8% in 2003, 4% in 2004, and 14% in 2005.
The proportion of visits by adults, in comparison, changed relatively little by specialty, with visits to psychiatrists for antidepressants comprising 21% in 2003 and 20% in 2005. Primary care physicians handled 54% of adult visits for antidepressants in 2003 and 53% in 2005. Other specialties covered 22% of adult visits for antidepressants in 2003 and 27% in 2005.
In each year, the share of antidepressant visits by youth to psychiatrists was larger than the share of antidepressant visits by adults to psychiatrists. Adults were more likely to be treated by primary care physicians.
Among the visits for antidepressant prescriptions for youths during 2004–2005, 67% were for selective serotonin reuptake inhibitors, 36% were for tricyclic antidepressants, and 26% were for other medications.
Dr. Zito has no association with companies that manufacture antidepressants.
In 2003, 31% of vists by youths to PCPs were for for antidepressants, versus 42% in 2004 and 45% in 2005. DR. ZITO