Antidepressant Use for Kids Doubled Before FDA Warnings

Despite guidelines, use of psychotherapy declined, study finds

WEDNESDAY, Nov. 15, 2005 (HealthDay News) -- Even as concerns about teen suicide and antidepressant use surfaced during the last decade, prescriptions for the mood-altering drugs increased dramatically as therapy sessions declined, new research shows.

And, while guidelines call for initially treating childhood depression with psychotherapy -- and medication plus psychotherapy only in the most serious cases -- many teens received only medication, including drugs not approved for use by children, Stanford University School of Medicine researchers said.

Although only Prozac was approved by the U.S. Food and Drug Administration for use with children, the majority of antidepressant prescriptions issued in the years covered by the study -- 1995 through 2002 -- were for newer, non-approved medications.

Up until two years before the FDA mandated black-box warnings on antidepressants warning of potential dangers to kids, the research found that:

  • Doctor visits for pediatric depression more than doubled from 1995 to 2002. In 1995, there were 1.44 million visits for depression; by 2002, that figure had risen to 3.22 million.
  • At the same time, the number of visits in which antidepressants were prescribed rose from 47 percent in 1995 to 52 percent in 2002. And psychotherapy or mental-health counseling declined from 83 percent to 68 percent.

"We were interested in tracking the use of antidepressants in the pediatric population," said lead researcher Dr. Randall S. Stafford, an associate professor of medicine at the university, "because of the recent concern about using antidepressants in this group."

In their study, Stafford and his colleagues used data from two national ambulatory-care surveys, focusing on teens who visited doctors between 1995 and 2002.

"The use of antidepressants rose dramatically over that time," Stafford said. "We found that not only had there been an increase in the use of antidepressants, but the likelihood that these children would be receiving psychotherapy or mental-health counseling had declined."

The findings appear in the November issue of the Journal of Adolescent Health.

In 1995, Prozac was the primary medication used, Stafford said. "As new drugs have entered the market, there has been diffusion of those drugs to the adolescent population. The likelihood of a child being on an antidepressant that was FDA-approved for the pediatric population has decreased," he added.

Stafford said he's concerned that these newer drugs have not been extensively tested for use with children and adolescents. "I think there is an issue in exposing this population to a set of drugs which don't have the usual data behind them that we typically associate with a drug used in adults," he said.

One expert noted that the data used for the study do not reflect recent FDA warnings about the use of antidepressants in children. In October 2004, the agency required that all manufacturers of antidepressants revise the labeling for their products to include a black-box warning that alerts health-care providers to an increased risk of suicidal thoughts or actions among children.

"The potential silver lining in this otherwise overcast tale is its vintage," said Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine.

"The more recent data analyzed are now nearing four years old. The black box warning on SSRIs was mandated by the FDA in 2004, well after the trends reported in this paper," he added.

Katz said he hoped that the trends reported in the study have not persisted in more recent years as the understanding of the potential hazards of SSRI antidepressant use in children and adolescents has increased.

"More recent data should be examined at the first opportunity to put such hope to the test," he said.

"Whatever the more recent trends in SSRI use and psychotherapy, the high and apparently rising rate of youth depression is a matter of grave societal concern," Katz added.

"An examination of what factors in the lives of our children make them vulnerable to depression should be among the nation's public health priorities," he said. "We must identify these factors, and devote any necessary resources to their minimization. Even the best and safest treatment for youth depression is not as good as preventing that depression in the first place."

More information

The National Library of Medicine can tell you more about adolescent depression.

SOURCES: Randall S. Stafford, M.D. Ph.D., assistant professor of medicine, Stanford University School of Medicine, Palo Alto, Calif.; David L. Katz, M.D., M.P.H., associate professor of public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; November 2005, Journal of Adolescent Health
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