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

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.