New prescriptions for antidepressants in children and adolescents dropped by 33% in Tennessee after regulatory agencies issued warnings about increased risks for suicide, according to Dr. Benji T. Kurian and his associates at Vanderbilt University School of Medicine, Nashville, Tenn.
The reduction was even greater for selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine and for selective norepinephrine reuptake inhibitors (SNRIs), which dropped by 54%. However, there was no cutback in already established therapy with antidepressants or other psychotropic drugs, “which suggests that the primary effect of the warnings was to alter the decision to treat newly presenting patient[s],” the researchers said.
Dr. Kurian and his associates used prescription data from TennCare, Tennessee's expanded Medicaid program, to examine prescribing trends during the 24 months preceding the 2003 regulatory warnings about antidepressants in the pediatric population and the 21 months afterward. The mean number of subjects assessed each month was 405,000.
“Previous studies have shown that trends in the pediatric use of antipsychotics in TennCare are very similar to those in the entire United States,” they noted.
Before the regulatory warnings were issued, there was a mean of 23 new antidepressant users per 10,000 children and adolescents per month, compared with 15 new users after the warnings were publicized, a decrease of 33%. The reduction in new prescriptions was most pronounced for SSRIs other than fluoxetine and for SNRIs.
In contrast, there was a 60% increase in new prescriptions for fluoxetine, the one SSRI that initially was exempted from the warnings. There was no significant change in new prescriptions for tricyclic and related antidepressants, nor in prescribing patterns for psychostimulants, mood stabilizers, antipsychotics, or benzodiazepines during this interval, the investigators said (Arch. Ped. Adoles. Med. 2007;161:690–6).
“We could not evaluate the clinical and public health consequences” of this change “because we were unable to assess the appropriateness of antidepressant prescribing in this study population,” Dr. Kurian and his associates said.
The decrease in new prescriptions may have been beneficial had the affected patients only had “marginal indications” for the drugs. “Conversely, if this group had serious affective disorders, the failure to initiate treatment could have had adverse clinical and developmental consequences,” they noted.
“There is an urgent need for better data on the efficacy and safety of antidepressants to guide pediatric practice,” Dr. Kurian and his associates said.