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April 2, 2007 -- Prescriptions for antidepressants dropped dramatically among children and teens following public warnings about deadly side effects, but now suicides are up, researchers say.
The findings highlight the critical role of mass media in driving medical care, and they are especially troubling in light of reports showing an increase in actual suicides in children and teens at the same time antidepressant use was declining because of fear the drugs may cause an increase in suicidal behaviors, a study co-author tells WebMD.
In 2004, for the first time in a decade, suicide rates among children and adolescents rose instead of declining. That was also the year the FDA held highly publicized hearings that led to stronger warnings about suicide risk on selective serotonin reuptake inhibitor (SSRI) antidepressants like Prozac, Paxil, Zoloft, and Celexa.
The move followed an FDA warning of an increased risk of suicidal attempts, thoughts, and behaviors among children and teens who took SSRIs. That warning was issued in the fall of 2003, and it was also widely publicized.
“Mainstream media had a very large impact on prescription practices,” says Amir Kalali, MD, of the private research group Quintiles Transnational. “There hasn’t been much thought given to quantifying the impact of mass media [on health care practices], but we hope this paper gets the dialogue going.”
Kalali, Charles Nemeroff, MD, PhD, of Emory University in Atlanta, and colleagues analyzed prescription data and physician surveys detailing prescription practices to identify trends in antidepressant use among children and adolescents.
The data they analyzed included more than half -- 55% -- of all U.S. retail pharmacy prescriptions, including private payers, Medicaid, and cash transactions.
The physician survey involved about 3,400 office-based physicians across 29 specialties.
The examination of antidepressant prescription practices from 2000 to 2005 showed a sharp decline in prescriptions to children and teenagers beginning in February 2004.
Between April 2002 and February 2004, antidepressant prescriptions among kids and teens increased by an average of 0.79% a month. Between February 2004 and July 2004 prescriptions declined by an average of 4% a month.
Prescriptions declined by 5% during the first quarter of 2004 and 11% in the second quarter of 2004. Rates stabilized after July and have just begun to move upward, according to study co-author Elisa Cascade, MBA, vice president of Quintiles Transnational.
The researchers also confirmed a shift away from generalized care and toward more specialized care by psychiatrists and other mental health professionals for depressed patients 18 and younger.
While this sounds like a good thing, it may mean fewer depressed kids and teens are being treated because of a shortage of pediatric psychiatrists, Kalali says.
“Anytime there are safety issues associated with a medication, primary care physicians are going to be less confident about prescribing that medication,” he says.
If generalists are referring young patients to specialists but there aren’t enough specialists to go around, that could mean patients get no care at all, he says.
The study is published in the April issue of the journal Archives of General Psychiatry.
Just two months ago, the CDC reported that suicide rates among children and teens rose by more than 18% during 2004.
David Shern, PhD, president of the patient advocacy group Mental Health America, tells WebMD that the 2004 FDA hearings did not include enough discussion about the dangers of failing to prescribe antidepressants to depressed children and adolescents.
Now we see an increase in suicides following years of declines,” he says. “We are not in the position to draw causal inferences, but this gives us good reason to pause and be concerned.”